Measuring symptom occurrence and symptom distress: development of the symptom experience index.

AIM: This paper is a report of a study to assess reliability and construct validity of revised and refined version of the Adapted Symptom Distress Scale: the Symptom Experience Index (SEI). BACKGROUND: The development of the SEI, a 41-item Likert Scale assessing 20 symptoms, was based on self-regulation theory and an integrative conceptual analysis of symptom assessment and management. The model emphasizes the difference between the occurrence of a symptom (or multiple symptoms) and the distress (emotional) response to the occurrence of a symptom. It is the distress from symptom occurrence that promotes a person to take action and use known coping strategies to prevent the symptom occurrence or alleviate the distress from the symptom. METHOD: A contrast-group and test-retest approach was used to assess construct validity and reliability with a convenience sample of 158 patients at United States of America in 2003-2004. RESULTS: The SEI demonstrated reasonable internal consistency with a Cronbach's alpha of 0.91 for symptom experience, 0.85 for symptom occurrence and 0.84 for symptom distress. Test-retest reliability was supported by high intra-class correlation coefficients (symptom experience r = 0.93; symptom occurrence r = 0.94; symptom distress, r = 0.92). Construct validity was supported by statistically significant differences between patients and healthy adults. CONCLUSION: The SEI can be used as a baseline and outcome measure to assess the impact of multiple symptoms on patients, and the effectiveness of interventions to manage these symptoms.

Putting evidence into practice: evidence-based interventions to prevent, manage, and treat chemotherapy-induced nausea and vomiting.

Chemotherapy-induced nausea and vomiting (CINV) continues to have a considerable effect on the physical and psychological well-being of patients with cancer, despite significant advances in antiemetic drugs since the 1990s. This article reviews and summarizes past and current empirical evidence related to interventions for CINV. A resource that summarizes evidence-based interventions for CINV is critical for effective management of this distressing symptom. Pharmacologic and nonpharmacologic interventions are appraised. Finally, gaps in the literature and opportunities for research, education, and practice changes are discussed.

Introducing baccalaureate student nurses to gerontological nursing.

The faculty at the University of Missouri-Columbia Sinclair School of Nursing (MUSSON) developed and implemented a gerontological nursing care course, with support from the Health Resources and Services Administration, the American Association of Colleges of Nursing, and the John A. Hartford Foundation. The course, with both didactic and clinical components, was mandatory for all students in the baccalaureate program. The course drew on two resources unique to the MUSSON: Senior Care, the school's home care agency, and TigerPlace, a retirement community closely linked to the school. Goals of the course were to increase knowledge of gerontology and gerontological nursing and to promote more positive student attitudes toward older adults. Evaluation of six semesters of pretest and posttest data found that knowledge increased although attitudes toward older adults did not become more positive. However, despite the lack of quantifiable improvement in attitudes, some students wrote positive comments on end-of-semester course evaluations about experiences and interactions with older adults during the course.

Building research productivity in an academic setting.

This article describes the methods that one academic nursing unit used to move from receiving no National Institutes of Health funding to a top-20 ranking. A 1995 school task force recommended changes to move toward greater research productivity, including increased external funding. The school created a research infrastructure to support both the scientific development of research studies and the production of high-quality external grant applications. Barriers to research productivity were successfully managed. The research culture dramatically changed to emphasize innovation, autonomy, peer support and review, long-term investment in research productivity, penetration of research throughout school activities, and public display of research accomplishments. Academic nursing units can develop research cultures to support meaningful research that secures major external funding.

An integrated approach to an analysis of symptom management in patients with cancer.

PURPOSE/OBJECTIVES: To provide a definition, describe uses, and identify essential attributes of symptom management by emphasizing the philosophical base for the concept. DATA SOURCES: 51 references (i.e., books and articles) published from 1980-2003 and located through the Ovid database. DATA SYNTHESIS: Symptoms are subjective and personal phenomena, incorporating the dimensions of symptom occurrence, symptom distress, and symptom experience. Symptom management has been conceptualized and described as self-activity. Symptom status is the direct outcome of symptom management, with symptom distress, quality of life, and performance as major indicators. CONCLUSIONS: The essential attributes of symptom management in patients with cancer are subjectivity, experientiality, intentionality, multidimensionality, dynamic process, and positive and negative outcomes. IMPLICATIONS FOR NURSING: Findings can help oncology nurses and other healthcare professionals to better understand the process of managing a symptom and the influential factors that affect positive outcomes. The information from this analysis can be used to design educational and interventional programs for symptom management. Future research is needed to establish interventions that relieve and decrease the distress from or prevent the occurrence of symptoms.

Chemotherapy-induced nausea and vomiting.

Nausea and vomiting (N&V) is among the most distressing side effects of chemotherapy, despite the development of more efficacious antiemetic agents. As many as 60% of patients who receive cancer chemotherapy experience some degree of N&V. However, the actual incidence is difficult to determine with accuracy because of the variety of drugs, doses, and health conditions of the patients who receive cancer treatments. This article examines the state of the science related to chemotherapy-induced nausea and vomiting and reviews both pharmacologic and behavioral strategies that have demonstrated efficacy in managing these distressing symptoms.