Comparing the meanings of fatigue in individuals with cancer in Thailand and Canada.

BACKGROUND: Illness is experienced in social contexts; its meaning is rooted in local beliefs and values as well as one's personal and family situation. Health professionals are steeped in knowledge of disease but know much less about illness. OBJECTIVES: The objective of the study was to learn more about the social construction of illness by comparing the meanings of fatigue in Thai and Canadian individuals with cancer. METHODS: Using an ethnoscience design, 10 Thai adults receiving chemotherapy for advanced lung cancer or colorectal cancer were interviewed twice. They were asked to sort words and phrases about fatigue from their first interview using Q-sort, triadic, and dyadic approaches; to name each pile; and to describe the similarities and differences between the piles. The card sorts were used to understand the relationships among key ideas in each interview. A table summarizing the card sorts was constructed, and patterns in the data were identified. RESULTS: Two segregates in the Thai data were identified: essential/constant and intermittent, with essential/constant including 2 segregates (feeble and altered cognition), and intermittent including 2 segregates (loss of mental strength and difficulty sleeping). The primary meanings of fatigue in the Thai data were related to temporality, whereas the primary meanings of fatigue in the Canadian data were related to the location of the fatigue (mind/body). CONCLUSION: These findings help us understand the social construction of fatigue, a common symptom in cancer. IMPLICATIONS FOR PRACTICE: Further research in relation to links between fatigue and other related-symptoms is needed with the goal of developing cross-cultural interventions for managing fatigue in the future.

Factors influencing advanced practice nurses' ability to promote evidence-based practice among frontline nurses.

BACKGROUND: Advanced practice nurses (APNs) have an important role in promoting evidence-based practice (EBP) among frontline nurses (FLNs). Factors influencing FLNs' engagement with EBP are well documented but little is known about factors that affect APNs' ability to facilitate evidence in practice. AIMS: To identify factors that influence APNs' ability to promote EBP among FLNs. METHODS: A multiple case study of 23 APNs from hospital and primary care settings across seven English health authorities was undertaken. Data collection comprised interviews and observation of APNs and interviews with FLNs and other healthcare professionals. Data were analysed using the Framework approach. FINDINGS: Four groups of influencing factors were identified: (1) Personal attributes of APNs included knowledge and skills in EBP, clinical credibility with frontline staff and leadership style. (2) Relationships with stakeholders included APNs' interactions with FLNs and the level of support from managers and medical colleagues. (3) Aspects of the APN role included their sphere of responsibility and workload. (4) Organisational context included the organisational culture, FLNs' workload, professional networks and available resources. IMPLICATIONS: Educational preparation for APNs should enable them to develop expertise in EBP plus interpersonal and leadership skills to manage relational dynamics in clinical settings. APN role specifications should provide the opportunity to promote EBP. The organisational culture should be conducive to enabling EBP with managers supportive of this aspect of the APNs' role. CONCLUSIONS: APNs need to be supported to address the individual, interpersonal and organisational factors, which influence their ability to promote EBP. Organisational commitment at the highest level is key to APNs' ability to fulfil this aspect of their role.

Effects of patient death on nursing staff: a literature review.

UNLABELLED: There were 509090 deaths recorded in England and Wales for 2008 (Office for National Statistics, 2010); of these, over 56% (260000) occurred in NHS hospitals. The death of a patient is an event that most, if not all, nursing staff will encounter during their work. This experience can elicit physical, cognitive, behavioural, spiritual and emotional responses (Parkes, 1998). AIM: The aim of this literature review is to explore how the death of patients in a hospital setting impact on nursing staff. METHOD: A review of the literature was undertaken using the online databases CINAHL, Medline and PsychInfo. The search was limited to articles in the English language and those from peer-reviewed journals. RESULTS: Themes arising from the literature review included: the theoretical context; the emotional impact; the culture of the healthcare setting; staff's previous life experiences; and support available for healthcare staff. CONCLUSIONS: The death of patients does have an impact on nurses. This can affect them both in their work environment and outside of work. Education around grief theory and support from others are helpful for staff in developing strategies for coping with patient deaths.

The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses.

AIM: To identify approaches used by advanced practice nurses to promote evidence-based practice among clinical nurses. BACKGROUND: Barriers encountered at individual and organizational levels hinder clinical nurses in their ability to deliver evidence-based practice. Advanced practice nurses are well placed to promote evidence-based practice through interactions with clinical nurses. However, little is understood about how advanced practice nurses might realize this potential. METHOD: A multiple instrumental case study of 23 advanced practice nurses from hospital and primary care settings across seven Strategic Health Authorities in England was undertaken in 2006. Data collection comprised interviews and observation of advanced practice nurses and interviews with clinical nurses and other healthcare professionals. Data were analysed using the Framework approach. FINDINGS: Advanced practice nurses acted as knowledge brokers in promoting evidence-based practice among clinical nurses. Knowledge management and promoting the uptake of knowledge were key components of knowledge brokering. Knowledge management involved generating different types of evidence, accumulating evidence to act as a repository for clinical nurses, synthesizing different forms of evidence, translating evidence by evaluating, interpreting and distilling it for different audiences and disseminating evidence by formal and informal means. Advanced practice nurses promoted the uptake of evidence by developing the knowledge and skills of clinical nurses through role modelling, teaching, clinical problem-solving and facilitating change. CONCLUSION: The role of advanced practice nurses in knowledge brokering is complex and multi-faceted. It extends beyond the knowledge management, linkage and capacity building identified in the literature to include active processes of problem-solving and facilitating change.

Factors influencing the contribution of advanced practice nurses to promoting evidence-based practice among front-line nurses: findings from a cross-sectional survey.

AIM: This paper is a report of a study to identify factors influencing advanced practice nurses' contribution to promoting evidence-based practice among front-line nurses. BACKGROUND: Despite widespread recognition that care should be evidence-based, nurses experience challenges implementing evidence-based practice. As opinion leaders, advanced practice nurses can influence the practice of front-line nurses by promoting research use. Little is known about how advanced practice nurses use evidence and their influence on care given by front-line nurses. METHOD: A cross-sectional survey of 855 advanced practice nurses working in 87 hospital/primary care settings in England. The questionnaire examined understandings of evidence-based practice, sources of evidence used, ways of working with front-line nurses, perceived impact on front-line nurses, skills in evidence-based practice and barriers to promoting evidence-based practice. Data were collected in 2005 and analysed using descriptive statistics. Comparisons were made between advanced practice nurses with Masters qualifications and those with lower qualifications. FINDINGS: Advanced practice nurses used different sources of evidence. They engaged in various activities to promote evidence-based practice and had a positive influence on front-line nurses' practice. Advanced practice nurses' skills in evidence-based practice varied with few considering themselves expert. Advanced practice nurses with Masters qualifications perceived themselves to be more skilled in all aspects of evidence-based practice than those with lower qualifications. CONCLUSION: Advanced practice nurses are well placed as clinical leaders to promote evidence-based practice by frontline nurses but require further development of their skills in evidence-based practice. In order to maximize their potential, advanced practice nurses require Master's preparation.

Cancer-related fatigue: a review of nursing interventions.

Fatigue is a common and distressing symptom that is a concern for cancer patients, their families, carers and health professionals. Cancer-related fatigue is a multidimensional phenomenon that is self-perceived and includes physical, emotional, cognitive and behavioural components. It can be unrelenting, disrupts daily life, fosters helplessness and may culminate in despair. The many causes of cancer-related fatigue stem from the disease itself, the cancer treatments and their side effects. The conclusion from a recent critical review of research evidence is that physical exercise and the treatment of underlying problems, such as anaemia or clinical depression, are effective interventions. However, a wide range of practical interventions and complementary therapies are likely to be helpful such as: acupressure and acupuncture, stress management and relaxation, energy conservation measures, anticipatory guidance and preparatory information, and attention-restoring activities. This article will provide a comprehensive review of current knowledge surrounding cancer-related fatigue and the nursing interventions that can be implemented in community practice.

Translation to practice: a randomised, controlled study of an evidence-based booklet for breast-care nurses in the United Kingdom.

BACKGROUND: In the United Kingdom (UK), it was documented that a problem of knowledge transfer existed within the speciality of breast-cancer care, thus depriving patients of receiving optimal care. Despite increasingly robust research evidence indicating recommendation of whole body exercise for people affected by breast cancer, commensurate changes to practice were not noted amongst breast-care nurses (BCNs). AIM: To evaluate the effect of a targeted booklet, Exercise and Breast Cancer: A Booklet for Breast-Care Nurses, on changes in knowledge, reported practice, and attitudes of BCNs in the UK. METHOD: A prospective, experimental approach was used for designing a pre- and post-test randomised controlled study. Comparisons of knowledge, reported practice, and attitudes based on responses to a questionnaire were made at two time-points in two groups of BCNs (control and experimental). The unit of randomisation and analysis was hospital clusters of BCNs. The sample comprised 92 nurses from 62 hospitals. Analysis consisted of descriptive statistics and clustered regression techniques: clustered logistic regression for knowledge items, clustered linear regression for knowledge scores, ologit for attitude and reported practice items, and clustered multiple regression for paired and multiple variable analysis. RESULTS: A statistically significant increase in knowledge and changes in reported practice and attitudes were found. Robust variables affecting knowledge acquisition were: promotion of health, promotion of exercise, and understanding how exercise can reduce cancer-related fatigue. DISCUSSION: The study has shown that evidence-based printed material, such as an information booklet, can be used as an effective research dissemination method when developed for needs, values, and context of a target audience. CONCLUSIONS: This practical approach to research dissemination could be replicated and applied to other groups of nurses.

A review of the benefits of whole body exercise during and after treatment for breast cancer.

AIM: A current critical review of the literature was deemed necessary to evaluate the strength of evidence to inform clinical practice. BACKGROUND: Recently, there has been a noticeable increase in empirical literature surrounding the benefits of exercise for breast cancer patients. METHODS: A systematic search strategy was used to identify relevant literature. Twenty-nine articles were retained for critical review, appraised for quality and synthesized. RESULTS: Many early studies had limited internal and external validity. Recent studies were considerably more rigorous and robust. Consistent support for all types of aerobic exercise was most evident in studies of patients during adjuvant cancer treatments (chemotherapy and radiotherapy), compared with post-treatment studies. The evidence which suggested that aerobic exercise limits cancer-related fatigue was particularly strong. For other patient concerns, the empirical support was less robust, however, the potential for beneficial and measurable patient outcomes was indicated for cardiopulmonary function, overall quality of life, global health, strength, sleep, self-esteem and reduced weight gain, depression, anxiety and tiredness. CONCLUSIONS: Additional studies with higher methodological quality are required in this clinically relevant area to substantiate current indications particularly for patient subgroups (e.g. older people, those with advanced cancer and the disadvantaged). RELEVANCE TO CLINICAL PRACTICE: It is important for all healthcare professionals involved in the care of individuals affected by breast cancer to be aware of the evidence surrounding the benefits of exercise and to encourage patients to increase physical activity and improve their overall health and well-being.

Promoting physical exercise in breast cancer care.

This article is intended to promote awareness of physical exercise as a safe, advantageous and feasible intervention for a patient with breast cancer or recovering from it. The numerous and varied benefits of exercise and the implications for nursing practice in light of current research evidence are discussed.