Self-disclosure in Adult Patients With Cancer: Structural Equation Modeling.

BACKGROUND: Health-related self-disclosure has been studied in various aspects, as has self-disclosure of cancer patients. However, any theoretical models that comprehensively include self-disclosure events, factors associated with self-disclosure, and the outcomes of self-disclosure of cancer patients have not yet been presented. OBJECTIVE: The purpose of this study was to explore the relationships between self-disclosure, perception toward cancer, intention for self-disclosure, level and range of self-disclosure, social support, and well-being in adult patients with cancer. METHODS: Data were collected from adult cancer patients via an online survey using self-report questionnaires and analyzed using structural equation modeling. The data from 359 participants were included in the final analysis. RESULTS: Positive intention for self-disclosure was a significant predictor of both self-disclosure level and range, whereas negative perception toward cancer significantly decreased self-disclosure level. The self-disclosure level significantly improved both social support and well-being, whereas the self-disclosure range did not present a significant impact on social support and well-being. CONCLUSION: Self-disclosure is closely associated with social support and well-being, and self-disclosure can be promoted by improving negative perceptions and positive intentions about self-disclosure. In addition, to improve the social support and well-being of cancer patients, it suggests increasing the self-disclosure depth level rather than widening the range of self-disclosure. IMPLICATIONS FOR PRACTICE: The results of this study can be used as evidence for the development of nursing intervention programs to reduce negative perceptions toward cancer and improve positive intentions and levels of self-disclosure among cancer patients.

Adaptation of families of adult patients with brain tumor: Partial least squares structural equation modeling.

Brain tumor patients experience physical, psychological, social, and cognitive changes. These changes are challenging for both the patients and their families. These patients and their families need to adapt together on the cancer treatment path. This study aimed to identify the factors affecting adaptation in families of adult patients with brain tumors. A quantitative, cross-sectional study of 165 families of adult patients with primary brain tumors was conducted using a self-administered questionnaire. Partial least squares structural equation modeling was used to test a hypothetical model. The results showed that family stress, family functioning, and family resources influenced on family adaptation in families of adult patients with primary brain tumors. Among these factors, family resources were identified to be the strongest factor associated with family adaptation. The results of this study may be utilized as a theoretical basis in nursing to improve the family adaptation of patients with brain tumors. Regarding nursing practices, the results suggest that nurses should provide family-centered nursing interventions and promote family resources to help brain tumor patients and their families to adapt.

Supportive Care Needs Survey: A reliability generalization meta-analysis.

OBJECTIVES: The purpose of this study is to investigate the reliability generalization of 2 forms of the Supportive Care Needs Survey (SCNS), the questionnaires commonly used to assess the unmet needs of cancer patients. METHODS: Reviewed articles were retrieved through databases including PubMed, Ovid, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science, Scopus, and ProQuest. The inclusion criteria were quantitative studies that assessed the unmet needs of cancer patients using the SCNS and presented reliability coefficients with sample size. Two independent reviewers examined the studies according to inclusion criteria and quality. The final studies included in the meta-analysis were determined by consensus. A random effects model was adopted for the analysis. To estimate reliability coefficients, the alpha coefficients for each study were transformed into the Z statistic for normalization and back to alpha. The values were weighted by the inverse of the studies' variance. The Higgins I2 statistic was used to test for heterogeneity, and the Egger's test and funnel plot were performed to evaluate publication bias. RESULTS: Out of 12,522 studies, 26 studies were included in the meta-analysis. The overall mean weighted effect size of the SCNS long-form (LF) was 0.90 and the subdomains ranged from 0.90 to 0.97. The overall alpha for the SCNS short-form (SF) was 0.92, and the alphas for the subdomains were between 0.81 and 0.92. The estimated reliability coefficients in both LF and SF were highest in psychological and health information needs and lowest in sexuality. No publication bias was indicated in this study. SIGNIFICANCE OF RESULTS: In this study, the overall reliability of SCNS was presented and the factors affecting the reliability of SCNS were identified. The results of this study may help clinicians or researchers make decisions about selecting tools to measure unmet needs of cancer patients.

The Effect of Dignity Therapy on Terminally-Ill Adult Patients: A Systematic Review and Meta-Analysis.

Background: We aimed to evaluate the effect of dignity therapy on the dignity, distress, and quality of life of terminally-ill adult patients. Methods: All randomized controlled trials published prior to Jan 2021 were searched through database, including PubMed, Medline, OVID, Cochrane Library, CINAHL, Web of Science, Scopus, ProQuest Central, KMBASE, KoreaMed, NDSL, and RISS. The RoB 2 was used to assess risk of bias. Effect sizes, Hedge's g and Higgins I 2 -statistics were used for meta-analysis. Results: We finally identified 10 studies for a systematic review, and eight studies out of them were selected for a meta-analysis. Overall, 776 participants were included in the meta-analysis. There were significant differences between with and without dignity therapy groups in dignity and anxiety (SMD = -0.3805, Cl = -0.5606, -0.2004; SMD = -0.1932, Cl = -0.3774, -0.0090, respectively) while there was no significant difference in quality of life and depression (SMD=0.4678, Cl = -0.0989, 1.0345; SMD= -0.0513, Cl= -0.2461, 0.1434, respectively). Conclusion: Dignity therapy may be effective for terminally ill patients on dignity and anxiety. We suggested further empirical studies with dignity therapy and repetitive meta-analysis in the future due to heterogeneity of the studies.

The Effect of a Multidimensional Home Rehabilitation Program for Post-Total Knee Arthroplasty Elderly Patients.

Patients with total knee arthroplasty (TKA) experience pain, decreased muscle strength, and decreased knee function, resulting in increases in depression and decreased subjective well-being. A multidimensional home program may prevent these adverse events. The aim of this study was to test the effect of a home rehabilitation program that included education, exercise, aroma massage, and phone counseling for post-TKA patients. We used a randomized control group pretest/posttest design. Fifty-nine patients participated, with 29 in the experimental group and 30 in the control group. Pain, knee joint range of motion (ROM), quadriceps strength, depression, and subjective well-being were measured as outcome variables. Data were analyzed using repeated-measures analysis of variance and generalized estimating equations. The experimental group showed significant improvement in knee pain, active ROM, muscle strength, depression, and subjective well-being with no significant between-groups difference in passive ROM. The multidimensional home rehabilitation program can be an effective nursing intervention for physical and emotional recovery of patients with TKA.

Development and evaluation of virtual reality simulation education based on coronavirus disease 2019 scenario for nursing students: A pilot study.

AIM: This research is designed to establish and evaluate the effectiveness of a virtual reality simulation program using COVID-19 scenario for nursing students. DESIGN: This is a quasi-experimental study using a non-equivalent control group pre-test-posttest design. METHODS: The participants were 65 students in their fourth year in nursing college. The knowledge about communicable infectious diseases in the respiratory system, self-efficacy, clinical reasoning capacity and learning satisfaction was evaluated. RESULTS: The experimental group showed a significantly higher learning satisfaction (t = 3.01, p = .004). Both groups presented statistically significant differences in knowledge on infectious respiratory diseases, self-efficacy and clinical reasoning between pre-test and posttest. However, knowledge (t = 0.47, p = .643), self-efficacy (t = 0.70, p = .944) and clinical reasoning were not different between the groups.

Unmet Needs and Quality of Life of Cancer Patients and Their Families: Actor-Partner Interdependence Modeling.

Unmet needs and quality of life (QOL) are important nursing issues for both patients and their families. However, studies into their direct association, considering the dyadic relationship between them, have not been done. We investigated the associations using the actor-partner interdependence modeling for dyadic data. Data were collected from 115 patient-family dyads at a tertiary teaching hospital. The study variables were assessed using the questionnaires and clinical data. To analyze patient-family dyad data, the actor-partner interdependence modeling and structural equation modeling were used. The cancer patients and their families experienced diverse and high levels of unmet needs that affected their quality of life, both physically and mentally. The cancer patients' unmet needs decreased their physical and mental quality of life, while those of their families had a negative impact on their own physical and mental quality of life. However, the cancer patients' unmet needs did not have partner effects on their families' quality of life, and vice versa. Therefore, unmet needs played important roles in their QOL taking into dyadic relationships in the model. The results suggest that nursing intervention programs to meet the needs of both patients and their families are required to improve their quality of life.

Pain condition and sex differences in the descending noradrenergic system following lateral hypothalamic stimulation.

The lateral hypothalamus (LH) is known to modulate nociception via the descending noradrenergic system in acute nociception, but less is known about its role in neuropathic pain states. In naïve females, LH stimulation produces opposing effects of α-adrenoceptors, with α2-adrenoceptors mediating antinociception, while pronociceptive α1-adrenoceptors attenuate the effect. Whether this opposing response is seen in neuropathic conditions or in naïve males is unknown. We used a mixed factorial design to compare male and female rats with chronic constriction injury (CCI) to naïve rats, measured by Total Paw Withdrawal (TPW) responses to a thermal stimulus. Rats received one of three doses of carbachol to stimulate the LH followed by intrathecal injection of either an α1- or an α2-adrenoceptor antagonist (WB4101 or yohimbine, resp.) or saline for control. Overall, naïve rats showed a more pronounced opposing alpha-adrenergic response than CCI rats (p < 0.04). Naïve male and female rats demonstrated antinociception following α1-adrenoceptor blockade and hyperalgesia following α2-adrenoceptor blockade. Male CCI rats also showed dose dependent effects from either WB4101 or yohimbine (p < 0.05), while female CCI rats had significant antinociception from WB4101 (p < 0.05), but no effect from yohimbine. These results support the idea that peripheral nerve damage differentially alters the descending noradrenergic modulatory system in male and female rats, and notably, that female CCI rats do not show antinociception from descending noradrenergic input. These findings are suggestive that clinical therapies that recruit the descending noradrenergic system may require a different approach based on patient gender.

Comparisons of laboratory results between two blood samplings: Venipuncture versus peripheral venous catheter-A systematic review with meta-analysis.

AIMS AND OBJECTIVES: To compare the results of haematology, blood chemistry and coagulation tests between two blood sampling methods via venipuncture and peripheral venous catheter. BACKGROUND: Laboratory results of the previous studies on blood sampling methods through peripheral venous catheter versus venipuncture are inconsistent. Therefore, it is necessary to better understand the discrepancies between the two blood sampling methods and to provide evidence for practice. DESIGN: Systematic literature review and meta-analysis were conducted in accordance with the PRISMA reporting guideline. METHODS: Reviewed articles for this study were searched through database, including PubMed, Cochrane Library, EMBASE, SCOPUS, Web of Science, ProQuest Dissertations & Theses, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and ERIC (Educational Resource Information Centre). Hand-searching was also conducted. RESULTS: We finally identified 17 studies for a systematic review, and 10 studies out of them were selected for a meta-analysis. A total of 678 participants were included in the meta-analysis. Overall, there was no significant difference in haematology, blood chemistry and coagulation test values between two sampling methods via venipuncture and peripheral venous catheter. CONCLUSION: Findings of this study provide substantial evidence that most blood tests via venipuncture and peripheral venous catheter would not be different. Patients will be benefitted by reducing the number of venipuncture if a series of blood tests can be conducted by using peripheral venous catheter. Thus, healthcare providers may refer to more reliable laboratory results on using peripheral venous catheter for without increasing the risk of bleeding events and pain on blood sampling sites due to frequent phlebotomies. RELEVANCE TO CLINICAL PRACTICE: The results of this study will be a good evidence to decide blood sampling methods in clinical practice.

Quality of Life in Patients With Non-Small Cell Lung Cancer: Structural Equation Modeling.

BACKGROUND: Quality of life (QOL) is important for cancer patients, even for survival. However, factors affecting QOL of non-small cell lung cancer (NSCLC) patients have not been studied sufficiently. OBJECTIVE: The aims of this study were to understand the relationships among social support, resilience, distress, and symptom and to identify predictors of QOL for NSCLC patients. METHODS: Participants were 212 adult patients who visited an outpatient department at a tertiary hospital located in Seoul, Korea. Data were collected using self-reported questionnaires and clinical records. RESULTS: Social support, resilience, distress, symptom burden, and QOL explained 99.9% of the variance in QOL. Social support was not a significant predictor of distress and QOL, but a significant predictor of resilience. Resilience was a significant predictor of both distress and QOL. Distress was not a significant predictor of QOL, but a significant predictor of symptom burden. Symptom burden was a significant predictor of QOL and had the largest direct effect on QOL. Resilience also had an important impact on QOL because resilience influenced QOL in various paths. CONCLUSION: This study suggests that social support, resilience, distress, and symptom burden are predictors of QOL in an NSCLC population. These predictors had direct and indirect effects on each other and on QOL. IMPLICATIONS FOR PRACTICE: Developing an interventional program to increase resilience and social support as well as to decrease symptom burden and distress may be necessary to improve QOL of NSCLC patients.

Application and Interpretation of Hierarchical Multiple Regression.

The authors reported the association between motivation and self-management behavior of individuals with chronic low back pain after adjusting control variables using hierarchical multiple regression (). This article describes details of the hierarchical regression applying the actual data used in the article by , including how to test assumptions, run the statistical tests, and report the results.

Motivation and Self-Management Behavior of the Individuals With Chronic Low Back Pain.

Self-management behavior is an important component for successful pain management in individuals with chronic low back pain. Motivation has been considered as an effective way to change behavior. Because there are other physical, social, and psychological factors affecting individuals with pain, it is necessary to identify the main effect of motivation on self-management behavior without the influence of those factors. The purpose of this study was to investigate the effect of motivation on self-management in controlling pain, depression, and social support. We used a nonexperimental, cross-sectional, descriptive design with mediation analysis and included 120 participants' data in the final analysis. We also used hierarchical multiple regression to test the effect of motivation, and multiple regression analysis and Sobel test were used to examine the mediating effect. Motivation itself accounted for 23.4% of the variance in self-management, F(1, 118) = 35.003, p < .001. After controlling covariates, motivation was also a significant factor for self-management. In the mediation analysis, motivation completely mediated the relationship between education and self-management, z = 2.292, p = .021. Motivation is an important part of self-management, and self-management education is not effective without motivation. The results of our study suggest that nurses incorporate motivation in nursing intervention, rather than only giving information.

Lateral Hypothalamic Stimulation Reduces Hyperalgesia Through Spinally Descending Orexin-A Neurons in Neuropathic Pain.

No evidence to date shows that lateral hypothalamic (LH) stimulation produces orexin-A-mediated antinociception in the spinal cord dorsal horn (SCDH) in a model of neuropathic pain. We conducted experiments to examine the effect of orexin-A-mediated LH stimulation in female rats with chronic constriction injury (CCI) on thermal hyperalgesia. Rats receiving carbachol into the LH demonstrated antinociception on both the left CCI and right nonligated paws (p < .05). Rats were given carbachol in the LH followed by intrathecal injection of the orexin-1 (OX1) receptor antagonist SB-334867, which blocked LH-induced antinociception compared with control groups (p < .05) in the left paw, but not in the right paw. These findings support the hypothesis that LH stimulation produces antinociception in rats with thermal hyperalgesia from neuropathic pain via an orexin-A connection between the LH and the SCDH. Identification of this pathway may lead to studies using orexins to manage clinical pain.

A Web-based health promotion program for patients with metabolic syndrome.

PURPOSE: The population of metabolic syndrome is increasing in Korea. The prevalence is related to lifestyle, such as lack of physical activity and irregular diet. Most patients with metabolic syndrome know that lifestyle intervention is important to managing the condition. However, they do not always follow the intervention for various reasons, including lack of knowledge on how to change their lifestyle and lack of accessibility to that knowledge. The purpose of this study was to test the web-based health promotion program we developed. METHODS: Fifty-six adult workers from eight areas of business were recruited. They all had a confirmed metabolic syndrome diagnosis after being registered at a university hospital for annual health checkups. Twenty-nine workers were assigned to the experimental group, and the others were assigned to the control group. The web-based program was applied to the experimental group as an intervention for 8 weeks. Waist circumference, fasting blood glucose, triglyceride, high-density lipoprotein cholesterol, and blood pressure were measured before and after the program. Data were analyzed using chi-square test, Fisher's exact test, and t test. RESULTS: There were statistically significant differences between the two groups in waist circumference and high-density lipoprotein cholesterol (t = -4.43, p < .001; t = 2.22, p = .031, respectively). Of the 29 participants, 13 (44.83%) in the intervention group had less than two indices for metabolic syndrome. CONCLUSIONS: This study suggests that a web-based program is useful for patients with metabolic syndrome to improve physiologic parameters related to metabolic syndrome. The web-based program may be easily applicable to community as well as clinical setting.

Job analysis of clinical research coordinators using the DACUM process.

PURPOSE: This study was done to analyze the job of clinical research coordinators (CRCs). METHODS: Through the "developing a curriculum (DACUM)" workshop, the definition of CRCs' role was described and CRCs' duties and tasks were identified. Finally, the developed duties and tasks were validated for importance, difficulty, and frequency. RESULTS: A CRC is defined as the one who coordinates and performs tasks related to clinical research/trials among investigators, participants, and sponsors according to the Good Clinical Practice at institutions conducting clinical trials. Twelve duties and 78 tasks were identified on the DACUM chart which represented the importance, difficulty, and frequency of tasks represented as A, B, and C respectively. Based on determinant coefficient (DC) of the task, the highest ranked task was confirming the eligibility of participants for research (DC=8.03) and the lowest was inventory management for clinical study materials (3.95). CONCLUSION: In this study, the job of a CRC was analyzed through the DACUM process and it was found that CRCs were doing various duties and tasks. Based on these results, it is suggested that it is necessary to develop CRC education programs considering the career ladder of CRCs.

An NK1 receptor antagonist microinjected into the periaqueductal gray blocks lateral hypothalamic-induced antinociception in rats.

Substantial data are accumulating that implicate the lateral hypothalamus (LH) as part of the descending pain modulatory system. The LH modifies nociception in the spinal cord dorsal horn partly through connections with the periaqueductal gray (PAG), an area known to play a central role in brainstem modulation of nociception. Early work demonstrated a putative substance P connection between the LH and the PAG, but the connection is not fully defined. To determine whether LH-induced antinociception mediated by the PAG is neurokinin1 (NK1) receptor-dependent, we conducted behavioral experiments in which the cholinergic agonist carbachol (125 nmol) was microinjected into the LH of lightly anesthetized female Sprague-Dawley rats (250-350 g) and antinociception was obtained on the tail flick or foot withdrawal tests. Cobalt chloride (100 nM), which reversibly blocks synaptic activation, blocked LH-induced antinociception. In another set of experiments, the specific NK1 receptor antagonist L-703,606 (5 microg) was microinjected in the PAG following LH stimulation with carbachol abolished LH-induced antinociception as well. Microinjection of cobalt chloride or L-703,606 in the absence of LH stimulation had no effect. These behavioral experiments coupled with earlier work provide converging evidence to support the hypothesis that antinociception produced by activating neurons in the LH is mediated in part by the subsequent activation of neurons in the PAG by NK1 receptors.

Lateral hypothalamic-induced alpha-adrenoceptor modulation occurs in a model of inflammatory pain in rats.

Previous work from our lab showed that stimulation of the lateral hypothalamus (LH) produces analgesia (antinociception) in a model of thermal nociceptive pain. This antinociceptive effect is mediated by alpha2-adrenoceptors in the spinal cord dorsal horn. However, a concomitant, opposing hyperalgesic (pro-nociceptive) response also occurs, which is mediated by alpha1-adrenoceptors in the dorsal horn. Antinociception predominates but is attenuated by the pronociceptive response. To determine whether such an effect occurs in a model of inflammatory pain, we applied mustard oil (allyl isothiocyanate; 20 microl) to the left ankle of female Sprague-Dawley rats. We then stimulated the LH using carbamylcholine chloride (carbachol; 125 nmol). The foot withdrawal latencies were measured. Some rats received intrathecal alpha-adrenoceptor antagonists to determine whether the opposing alpha-adrenoceptor response was present. Mustard oil application produced hyperalgesia in the affected paw, while the LH stimulation increased the foot withdrawal latencies for the mustard oil paw as compared to the control group. Following carbachol microinjection in the LH, WB4101, an alpha1-adrenoceptor antagonist, produced significantly longer foot withdrawal latencies compared to saline controls, while yohimbine, an alpha2-antagonist, decreased the foot withdrawal latencies from 10 min postinjection (p < .05). These findings support the hypothesis that the LH-induced nociceptive modulation is mediated through an alpha-adrenoceptor opposing response in a model of inflammatory pain.

Commonly used preclinical models of pain.

Pain cuts across gender, age, and disease and is the most common reason people seek health-related treatment. Certain pain states do not respond to standard therapies, leaving nurses with few options to successfully care for patients in pain. Preclinical studies use many models to investigate the mechanisms and treatments for pain states similar to those encountered in humans. Within Cervero and Laird's conceptual framework of experimental pain, the authors present several commonly used preclinical models. Phase 1 pain models measure responses to a brief, controlled stimulus that minimizes tissue damage. Phase 2 pain models use topical or injected irritants, which cause inflammation and persistent pain that change peripheral and central neuronal responses. Phase 3 pain models produce neuropathic pain through partial or complete ligation of peripheral nerves. The use of preclinical models of pain can lead to the development of better pharmacological and nonpharmacological therapies that enhance nursing practice.

Needs for home care nursing in the vulnerable elderly.

PURPOSE: The purpose of this study was to determine the subjects' health status according to the needs of visiting health and the function of the family in home care nursing. SAMPLE AND METHOD: The data collection period was from 07/01/04 to 10/31/04 and the subjects were 488 of those above 60 years of age staying at home or living alone who registered at a visiting health service of public health center at an urban area in Korea. This survey was carried out by visiting health nurses and participation was agreed on by the elderly people. RESULTS: The extent of the subjects' total health status to the general characteristics had differences according to the age, sex, monthly income, perceived health status, known functional disorder, and yes-or-no for disease. At all health status domains, visiting health need care in the group I was very lower than one in II, III, or IV groups. Also the severe dysfunctional family was lower than lightly dysfunctional family and normal functional family in all health status domains. CONCLUSION: Nurses must provide their characteristics considered nursing intervention for the elderly who have high visiting health needs and severe dysfunctional family with vulnerable health care.

The endogenous opioid system and clinical pain management.

The endogenous opioid system is one of the most studied innate pain-relieving systems. This system consists of widely scattered neurons that produce three opioids: beta-endorphin, the met- and leu-enkephalins, and the dynorphins. These opioids act as neurotransmitters and neuromodulators at three major classes of receptors, termed mu, delta, and kappa, and produce analgesia. Like their endogenous counterparts, the opioid drugs, or opiates, act at these same receptors to produce both analgesia and undesirable side effects. This article examines some of the recent findings about the opioid system, including interactions with other neurotransmitters, the location and existence of receptor subtypes, and how this information drives the search for better analgesics. We also consider how an understanding of the opioid system affects clinical responses to opiate administration and what the future may hold for improved pain relief. The goal of this article is to assist clinicians to develop pharmacological interventions that better meet their patient's analgesic needs.