The role of empathic nursing telephone interventions with advanced cancer patients: A qualitative study.

PURPOSE: Effective symptom management and provider-patient communication are critical components of quality palliative cancer care. Studies suggest nurse-telephone-interventions are feasible, acceptable and may improve the provision and satisfaction with care. However, little is known about what specific elements of nurse-telephone-interventions are most beneficial. The study's purpose was to describe the nature and key elements of therapeutic calls made by nurses to advanced cancer patients to understand what may have previously contributed to improvement in patients who received the intervention. METHODS: As part of a larger study on methylphenidate and/or a nurse-telephone-intervention for fatigue in advanced cancer patients from a tertiary hospital, nurse calls were made to 95 patients. This qualitative descriptive study used thematic analysis of transcribed telephone calls between nurses and advanced cancer patients. RESULTS: The overarching theme of these calls was supporting patients with empathy. Empathy in these conversations included nurses' efforts to understand patients' experiences, nurses communicating their understanding back to patients and nurses taking action in response to their understanding of patients' experiences. While humor and validation were used to communicate empathy, problem solving and providing support constituted the content of empathic communication. CONCLUSIONS: This study illustrates a nurse-telephone-interventions that embraced multiple components of clinical empathy. Nurse-telephone-interventions are feasible and acceptable with diverse, advanced cancer patients. The growing evidence base underscoring the numerous benefits of medical empathy may serve as a basis for adopting simple, feasible and accessible approaches such as empathic nurse-telephone-interventions in both research and clinical practice.

The lived experience of adults with heart failure: a phenomenological study.

BACKGROUND: Although a number of studies have been conducted on patients with Heart Failure (HF), they have not given a rigorous comprehensive description of what it is like to live with HF. The objective of this study was to describe the lived experience of adults with HF. STUDY DESIGN: A hermeneutic phenomenological design was used. METHODS: Cohen's method was used to conduct the study. Thirty HF patients were enrolled between February and July 2014 from an outpatient cardiovascular clinic in Tuscany, Italy. Phenomenological interviews took place at patients' homes, and the investigators analyzed verbatim transcripts. Once data saturation was achieved, to ensure data trustworthiness, participants were asked to confirm all the extracted themes. Atals.ti vers.7 was used for data analysis. RESULTS: The patients were mostly male (67%) with a mean age of 71 (SD 9.15) and an age range of 48-86. Seven themes emerged from the phenomenological analysis: 1) important life changes; 2) social isolation caused by the illness; 3) anger and resignation associated with the disease; 4) relief from spirituality; 5) will to live; 6) uncertainty about the future and 7) the inescapability of disease and death. CONCLUSIONS: The meaning that patients attribute to their lived experience helps to create their needs, which are important to direct care. Family support and religious beliefs are an important source for HF patients to better manage their fears and cope with the future. Findings of this study provide nurses with a comprehensive description of what it is like to live with HF, which can be useful in helping to meet patients' needs more effectively and in tailoring interventions.

Validation of the M.D. Anderson Symptom Inventory Brain Tumor Module (MDASI-BT).

BACKGROUND: Symptom occurrence has been shown to predict treatment course and survival in patients with solid tumors. Primary brain tumor (PBT) patients are unique in the occurrence of neurologic symptoms. Currently, no instrument exists that measures both neurologic and cancer-related symptoms. METHODS: Patients diagnosed with PBT participated in this study. Data was collected at one point in time and included demographic and clinical factors, and the M.D. Anderson Symptom Inventory-Brain Tumor Module (MDASI-BT). The study evaluated the reliability and validity of the MDASI-BT in primary brain tumor patients. RESULTS: Two hundred and one patients participated in this study. Mean symptom severity of items as well as cluster analysis was used to reduce the number of total items to 22 (13 core, 9 brain tumor items). Regression analysis showed more than half (56%) of the variability in symptom severity was explained by brain module items. The MDASI-BT measures six underlying constructs including affective, cognitive, focal neurologic deficit, constitutional, generalized symptom, and a gastrointestinal related factor. The internal consistency (reliability) of the instrument was 0.91. The MDASI-BT was sensitive to disease severity based on performance status (P<0.001), tumor recurrence (P<0.01), and mean symptom interference (P<0.001). CONCLUSIONS: The 22 item MDASI-BT demonstrated validity and reliability in patients with PBT. This instrument can be used to identify symptom occurrence throughout the disease trajectory and to evaluate interventions designed for symptom management.

Isolation in blood and marrow transplantation.

This phenomenological study explored the perceptions of 20 patients who had undergone an autologous bone marrow transplantation (ABMT). Transcripts from interviews were analyzed for themes. Three themes emerged related to the experience of isolation during and after ABMT: physical isolation (protecting self and others), emotional isolation (protecting self and others), and physical and emotional isolation (supporting self and others). During physical isolation, participants were protected from infection and tried to protect family and friends from emotional burden. However, physical isolation often led to emotional isolation, which the physical presence of others ameliorated, particularly when an emotional presence was coexistent. Emotional presence was a main source of social support. Participants felt family and friends needed more guidance on ways to provide effective support. An important implication for health care professionals is that emotional support in the form of positive presencing should accompany providing information to both patients and family members.

Culturally competent care.

OBJECTIVES: To define key concepts and summarize available guidelines that are important resources to assist nurses to provide culturally competent care. DATA SOURCES: Medline, anthropologic and epidemiologic literature, and National Institutes of Health documents. CONCLUSIONS: Controversy remains about the most appropriate language to use to describe features of diverse populations. IMPLICATIONS FOR NURSING PRACTICE: Becoming culturally competent begins by understanding terms and concepts that are essential in developing cultural awareness, knowledge, and skills. Sensitivity to language and the history of the development of some labels are important.

Qualitative research with diverse populations.

OBJECTIVES: To describe the benefits of conducting qualitative research with members of diverse cultures. DATA SOURCES: Research studies, articles and books on philosophy of science. CONCLUSIONS: Qualitative research with diverse populations is useful when little research exists on a topic, when there are no reliable and valid instruments for the groups, and when the appropriate language to use or the appropriate concepts and questions to ask are unclear. Participating in research that includes discussing your experiences has also been found to be valuable to those participating. IMPLICATIONS FOR NURSING PRACTICE: Qualitative studies with diverse groups are needed to understand the concepts that are important to members of these groups, and to guide us in asking the correct questions using correct language.

African American women's experiences with breast cancer screening.

PURPOSE: To describe the experience and meaning of breast cancer screening for African American women. Breast cancer screening offers the greatest hope of reducing breast cancer mortality and improving breast cancer outcomes. Despite the proliferation of initiatives targeting African American women, they continue to be first diagnosed only when they have late-stage disease. DESIGN AND METHODS: Using hermeneutic phenomenological research methods, 23 low- and middle-income African American women were interviewed to gain an understanding of their experiences with breast cancer screening. FINDINGS: Participants varied in their experiences with breast cancer screening. Women spoke of a desire for a holistic approach to health that did not separate the breast from the rest of the body. This desire is indicated in the theme of minding the body, self, and spirit, along with themes of relationships and spreading the word about breast health issues. CONCLUSIONS: Interventions for African American women should include a focus on minding the body, self, and spirit to promote breast cancer screening, and should indicate the importance of relationships and spreading the word about breast cancer screening.

Bone marrow transplantation: the battle for hope in the face of fear.

PURPOSE/OBJECTIVES: To describe patients' experience of having an autologous bone marrow transplantation (BMT). DESIGN: Hermeneutic phenomenologic, descriptive, and interpretive. SETTING: Outpatient treatment area of a comprehensive cancer center in the Southwest. SAMPLE: 20 adult survivors of autologous BMT, 15 women and 5 men, with a mean age of 46 years. METHODS: Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology, which combines descriptive and interpretive phenomenology. CONCLUSIONS: These patients illustrate that fear, a predominant reality when undergoing autologous BMT, is balanced with hope for survival. The overarching fear, fear of death, often was related to the unknown, including cancer recurrence. The fear of the unknown also came from being unprepared physically and emotionally. Losses were intertwined with these fears and included loss of both control and trust in one's body. Patients discussed fear of leaving the hospital and not having someone "constantly looking at you to make sure that the cancer isn't back." These fears and losses changed patients' view of life and led to a need for help in bringing closure to the experience. IMPLICATIONS FOR NURSING PRACTICE: Specific nursing actions to help allay fear include providing information about both feelings and procedures, giving opportunities to discuss fears and losses, arranging meetings with others who have had a BMT or suggesting an appropriate support group, and including family in all interventions, as appropriate. Reducing fears with these interventions helped patients maintain hope. By understanding the relationship between hope and fear, nurses caring for people having BMT can use specific strategies to decrease fear, hence increasing hope in patients. Nursing education can emphasize the need to adequately prepare patients. Further research is indicated to explore the effectiveness of interventions to prepare patients for BMT and the interplay between hope and fear.

Multimeasure pain assessment in an ethnically diverse group of patients with cancer.

The purposes of this study were (a) to describe the relationship between pain perception and ethnic identity and socioeconomic status, (b) to evaluate the intercorrelations between pain measures in different ethnic groups, and (c) to determine whether ethnicity or socioeconomic status influences patient's pain control beliefs and satisfaction with the pain management provided. The sample consisted of 51 English-, Korean-, or Spanish-speaking participants experiencing cancer pain who were 18 years and older and were having a Karnofsky score of no less than 30. The Visual Analogue Scale (VAS), Memorial Pain Scale (MPS), and Face Scale (FS) were used to measure pain perception. In all pain analyses, Hispanics, African Americans, and Anglos did not differ significantly. The data suggest that the pain scales used in this study are appropriate for use in a multicultural population.

Autologous bone marrow transplantation: the patient's perspective of information needs.

Phenomenologic inquiry was used to explore patients' experiences with autologous bone marrow transplantation (ABMT). Interviews were conducted before and after implementation of a clinical pathway that included a teaching protocol for ABMT. Texts were analyzed individually, compared for pre- and postpathway patients to determine if different themes emerged from these two groups, and then combined. Themes common to both groups included (a) a range of needs for information, (b) everybody's different: a fine balance (the challenge of finding a balance when giving information to patients who vary in the amount of information they desire), (c) someone who has been there (the value of talking to someone who has survived an ABMT), (d) and the burden of ABMT patients teaching family. One theme that reflected different experiences of pre- and postpathway patients was that of the need to know detailed information about the ABMT and the fear of knowing too much. Whereas postpathway patients reflected more on the burden of knowing too much, prepathway patients expressed more dissatisfaction about not being told enough about procedures and symptoms to be expected. Suggestions for teaching patients about ABMT include being generally realistic while focusing on the positive, and viewing patient education as a process individualized according to each patient's needs.

Breast cancer screening and African American women: fear, fatalism, and silence.

PURPOSE/OBJECTIVES: To explore the beliefs, attitudes, and practices related to breast cancer and breast cancer screening among low- and middle-income African American women. DESIGN: Qualitative study using focus group methodology. SAMPLE/SETTING: 26 African American women, age 40-65, selected from three employment groups, recruited from a community-based center and a local teacher's union in a moderate-sized urban area. METHODS: Three 90-minute focus group discussions exploring breast cancer beliefs, attitudes, and practices were audiotaped, transcribed verbatim, and analyzed using thematic context analysis techniques. FINDINGS: When breast cancer was discussed, fear was the predominant feeling expressed in all groups. This fear was a primary reason not to engage in breast cancer screening. Unemployed women and service workers emphasized the role of violence in causing breast cancer, whereas teachers discussed injury and sex as causing breast cancer. All participants stressed that breast cancer is seldom discussed within the African American community. Teachers added that this secrecy within the African American community leads to breast cancer being viewed as a white woman's disease. CONCLUSIONS: Despite initiatives promoting breast cancer awareness. African American women still hold misconceptions regarding the etiology of breast cancer and fatalistic perspectives regarding breast cancer outcomes, perhaps because breast cancer is discussed infrequently. Because pain, fear, and fatalism were discussed in all groups, future research should address the influence of these factors to increase screening behaviors. IMPLICATIONS FOR NURSING PRACTICE: Because unemployed women, service workers, and teachers differed in their beliefs about breast cancer and breast cancer screening, nurses must be mindful of the need to tailor Interventions to address the needs of both low- and middle-income African American women.

Healthcare reform. Its effects on nurses.

Healthcare reform has been a major economic and political focus throughout the 1990s. In a national survey of registered nurses about work life and health, many narrative comments addressed changes in the healthcare system. This qualitative study an analysis of these comments, identified themes related to nurses' perceptions of changes and the effect of healthcare reform on the practice of nursing.

Beyond body image: the experience of breast cancer.

PURPOSE/OBJECTIVES: To describe the mental and emotional impact of treatment for breast cancer with a focus on the ways the body is experienced. DESIGN: Phenomenologic, descriptive, and interpretive. SETTING: An outpatient treatment area of a comprehensive cancer center in the southwestern United States. SAMPLE: 20 women, ages 20-68 (mean = 50 years), who had mastectomies (including both modified radical mastectomies and lumpectomies, with some having reconstruction) for breast cancer. METHODS: Content analysis of verbatim transcriptions of open-ended interviews using hermeneutic phenomenology and descriptive and interpretive presentation of a paradigm case. MAIN RESEARCH VARIABLES: Reaction to breast cancer and its treatment. FINDINGS: Informants' descriptions demonstrate that the body can be viewed as having three aspects: (a) the body as symbol or social expression (i.e., how bodies make a social statement and tell others who you are); (b) the body as a way of being in the world, including sensations and symptoms such as nausea, fatigue, and pain; and (c) the existential sense that one needs a body to be in the world (i.e., the body expresses existence), which led to more awareness of the possibility of death. CONCLUSIONS: Women treated for breast cancer view their bodies in ways that go beyond what is suggested by the literature on body image and breast cancer, encompassing a wide range of responses. IMPLICATIONS FOR NURSING PRACTICE: The contribution of this study is the documentation of the complexity of the meaning of "body" for women with breast cancer. Appropriate interventions differ for each aspect of the body: for the body as social symbol, programs such as Look Good ... Feel Better or image centers; for the body's sensations and symptoms, information about what to expect and about symptom prevention and management; for the existential body, active listening to fears and concerns and providing assistance as needed.

Using qualitative research in advanced practice.

Although using research in nursing has become increasingly valued, some incorrectly believe that only the findings of quantitative research can be applied. While there are distinct differences between qualitative and quantitative research, both paradigms have an important role to play in nursing. This article explores the topic of research utilization and discusses qualitative research and its evaluation and use. The discussion, and examples from qualitative research, emphasize how useful qualitative research can be to advanced practice nurses.

The meaning of cancer and oncology nursing: link to effective care.

A better understanding of the meaning of cancer and oncology nursing may yield insights that will help identify ways in which nurses can obtain the resources they need to meet their own needs and to provide effective care. This article briefly reviews literature on job stress, burnout, coping, and job satisfaction and summarizes our research on nurses' descriptions of the meaning and nature of their work with cancer patients. Nurses described having three important roles: maintaining the goals and values of health care; participating in the patients' experiences; and reconciling the health care values and the patients' experiences (ie, the other two roles). Aspects that are rewarding are also difficult and individual experiences and perceptions changed the meaning of work, the needs nurses have, and the care they provide. The work of nursing may be most satisfying when nurses can articulate the meaning of their work and most effective when they understand how these meanings affect patient care.

The meaning of oncology nursing: a phenomenological investigation.

PURPOSE: To describe the method used in a multisite study of the meaning of oncology nursing from the oncology nurses' perspectives. DESIGN: Multi-institutional, descriptive, qualitative. SETTING: Six sites in different regions of the United States; rural and urban cancer and noncancer centers. SAMPLE: 38 oncology nurses (mean age = 35 years; average time in nursing = 10 years and in oncology = 7 years; 47% bachelor's degree in nursing, 29% diploma, 13% associate degree in nursing, and 11% master's prepared). METHODS: Phenomenological; content analysis of interviews. FINDINGS: Nurses' experiences in caring for people with cancer have many similarities despite the differences among these nurses or their work settings. These similarities are described in this supplement. IMPLICATIONS FOR NURSING PRACTICE: Many nurses said they had not described their experiences to interested listeners before. Providing these descriptions helped the nurses to see their work in new ways and led some of them to make changes in their personal and professional lives.