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1.
Clin Nurse Spec ; 35(6): 300-302, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606209

RESUMO

PURPOSE: The purpose of this article is to present how metrics and dashboards, using the SMART model, are used to articulate the clinical nurse specialist (CNS) nurse researcher role. DESCRIPTION OF THE PROJECT: Following the SMART model, a dashboard was created highlighting measurable metrics for each of the 3 spheres of impact to align with the center's nursing strategic plan and initiatives, including Magnet redesignation. OUTCOME: Metrics reflecting the 3 spheres of impact and corresponding dashboard with successfully met outcomes are presented for the CNS nurse researcher. CONCLUSION: Metrics and dashboards are important tools that CNSs can use to capture their activities, set goals, and articulate their unique roles to both internal and external stakeholders. Dashboards, such as the one presented, are easily adaptable and can be updated on a regular basis.


Assuntos
Enfermeiras Clínicas , Papel do Profissional de Enfermagem , Pesquisa em Enfermagem , Pesquisadores , Benchmarking , Humanos
2.
J Palliat Med ; 2021 Sep 22.
Artigo em Inglês | MEDLINE | ID: mdl-34551271

RESUMO

Objective: To examine the effect of Accelerated Resolution Therapy (ART) on the quality of life (QOL) of older adults with complicated grief (CG) over time. Design: Subanalysis of a randomized controlled trial. Setting/Subject: Older adult, former caregivers were recruited from a large hospice in the southeastern United States to be treated with ART for CG. Measurement: The CDC Health-Related Quality of Life (HRQOL) Healthy Days Module was administered pre-, post-, and eight weeks after therapy. Results: The subsample consisted of 27 older adults. A multilevel model indicated a statistically significant, negative difference of 8.21 (improvement) in QOL scores for each period of data collection (ß = -8.21, t = 4.02, p < 0.001). Both the intervention (11%, p = 0.013) and time (7.8%, growth curve p = 0.014) contributed significantly. Conclusion: There was a significant large effect of ART on CG. This study supports concurrent improved patient-related outcome-QOL.

3.
Clin J Oncol Nurs ; 25(5): 563-570, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34533519

RESUMO

BACKGROUND: Family support and patient outcomes are linked to nurses' attitudes toward families' importance in patient care. OBJECTIVES: The purpose of this study was to characterize inpatient oncology nurses' attitudes toward families' importance in nursing care and determine characteristics related to these attitudes. METHODS: A descriptive, cross-sectional design was used with a single set of measurements from inpatient oncology nurses at a comprehensive cancer center in the southeastern United States. Nurse characteristics were summarized using frequency and percentages. Time variables were summarized using median and interquartile range. There were five primary outcomes. FINDINGS: Nurses considered the role of the family important, but level varied by FINC-NA item. Characteristics related to family importance overall included hospital unit and general approach to care.

4.
Dimens Crit Care Nurs ; 40(5): 301-307, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34398568

RESUMO

BACKGROUND: Moral distress (MD) has been linked to health care professional burnout, intent to leave, and decreased quality of care. OBJECTIVES: The aim of this study was to describe the perceptions of MD among critical care interdisciplinary team members and assess the association of MD with team member characteristics. METHODS: A descriptive cross-sectional design was used with interdisciplinary team members in an intensive care unit setting at an NCI-designated Comprehensive Cancer Center in the southeastern United States. The Measure of Moral Distress for Healthcare Professionals was provided to registered nurses, oncology technicians, providers, respiratory therapists, and ancillary team members (social workers, pharmacists, dietitians). RESULTS: A total of 67 team members completed the survey. Mean responses for 3 items were higher than 8 (halfway point of scale): "Follow family's insistence to continue aggressive treatment even though I believe it is not in the best interest of patient" (mean [SD], 11.4 [4.8]); "Continue to provide aggressive treatment for a patient most likely to die regardless of this treatment when no one will make a decision to withdraw it" (mean [SD], 10.5 [5.3]); and "Witness providers giving 'false hope' to patient/family" (mean [SD], 9.0 [5.3]). Higher responses on the "Continuing to provide aggressive treatment" item was associated with having "considered leaving due to MD" (P = .027) and "considering leaving now due to MD" (P = .016). Higher total scores were related to having left or considered leaving a job (P = .04). When examining education level, registered nurses with a master's degree (n = 5) exhibited the most MD (P = .04). CONCLUSION: This study suggests that the Measure of Moral Distress for Healthcare Professionals is useful in identifying areas for focused efforts at reducing MD for interdisciplinary teams.


Assuntos
Esgotamento Profissional , Neoplasias , Atitude do Pessoal de Saúde , Cuidados Críticos , Estudos Transversais , Humanos , Princípios Morais
5.
Hosp Top ; : 1-11, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34218752

RESUMO

Perceptions of oncology health care providers use of telehealth to provide care to patients during the COVID-19 pandemic were explored. A qualitative study using semi-structured interviews and purposive sampling (N = 30) was conducted. Four themes emerged: 1) telehealth provided continuity of cancer care and used to decrease the risk of COVID-19 exposure; 2) advantages brought about convenience and inclusion of family caregivers; 3) telehealth revealed geographic, aging, and racial/ethnic disparities and digital illiteracy; and 4) rapid implementation was challenging. Telehealth provides a number of opportunities to support care for vulnerable cancer patients during this health crisis; however, disparities must be addressed.

6.
J Nurs Manag ; 29(6): 1375-1384, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34174005

RESUMO

AIM: To explore oncology health care professionals' perceptions of the COVID-19 pandemic response. BACKGROUND: The pandemic has created health care delivery challenges globally and many countries have exhibited low readiness and emergency preparedness. METHODS: A descriptive design using a qualitative approach was employed. Semi-structured interviews, which were completed via telephone, were audio recorded and transcribed verbatim. A thematic analysis was conducted. RESULTS: Participants (N = 30) were mostly registered nurses (70%). Three themes emerged: (1) ability to adapt and operationalize disaster planning, training and restructure nursing models (subtheme: reactive vs. proactive approach to emergency preparedness); (2) COVID-19 task forces and professional organisations were critical for valid information surrounding the pandemic; and (3) recommendations for emergency preparedness/planning for future pandemics. CONCLUSION: Oncology organisations adapted during the pandemic, but policies and procedures were perceived as reactive and not proactive. Recommendations for planning for future pandemics included (1) adequate personal protective equipment, (2) developing cancer-specific guidelines/algorithms and (3) telehealth training related to billing/reimbursement. Professional organisations were reliable resources of information during the pandemic, but oncology professionals ultimately trusted employers and administration to distribute information needed for safe patient care. IMPLICATIONS FOR NURSING MANAGEMENT: Frontline nurses should hold positions on task forces to develop future emergency preparedness.


Assuntos
COVID-19 , Defesa Civil , Humanos , Pandemias/prevenção & controle , Percepção , SARS-CoV-2
7.
J Geriatr Oncol ; 12(7): 1010-1014, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33814340

RESUMO

PURPOSE: The optimal time to assess older adults during cancer treatment regimen has not been established. This research study evaluated different points in time to reassess the geriatric oncology patient undergoing treatment. METHODS: This study included 250 patients who were new to the Senior Adult Oncology Clinic. Inclusion criteria were actively receiving treatment of chemotherapy, hormone therapy, radiation or other targeted therapies; age 65 or older if head and neck cancer diagnosis and age 70 or older with other malignancies referred to the program; and able to read and understand English. The SAOP3 is a two-page tool consisting of eleven questions and three instructional items followed by a scoring threshold, that was repeated at the patient's three- and six-month visits. RESULTS: Two hundred and thirty-eight patients completed the SAOP3 at baseline; 112 completed the SAOP3 at three months; and 90 completed the SAOP3 at six months. Fifty-four patents completed the SAOP3 at all three timepoints. Overall, SAOP3 results indicated referral for 42% (95% confidence interval = 36-49%) of patients at baseline. For the 54 patients that completed the SAOP3 at all timepoints, referrals decreased across the timepoints for the two most common referrals: nutritionist which was statistically significant (p = 0.03); and social worker which was not (p = 0.08). CONCLUSION: Utilizing the objective findings related to functional and cognitive status can aid in treatment planning and guide goals of care discussions with patients and families. Review of the follow-up screens at three- and six-months during the treatment process demonstrated the impact of cancer treatments in the older adult.

9.
Hosp Top ; : 1-7, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33749530

RESUMO

A descriptive, cross sectional design was used to compare perceptions of compassion and well-being of volunteers with and without a personal history of cancer. Most (79%) were >60 years of age, female (63%), married (75%), White (88%), and Non-Hispanic (79%). Thirteen (54%) had a history of cancer; two were still on treatment. Compassion scores were similar between groups. Volunteers with a history of cancer scored higher (p = 0.04) on General Well-being than those without a history of cancer. Understanding volunteer perceptions of compassion and well-being can guide our support structure and psychoeducation. Future studies could examine patient outcomes related to volunteerism.

11.
Clin Nurs Res ; 30(5): 680-689, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33218253

RESUMO

Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.

12.
Clin J Oncol Nurs ; 24(5): 489-494, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32945795

RESUMO

BACKGROUND: Falls experienced by patients undergoing blood and marrow transplantation or treatment with cellular immunotherapy (BMT-CI) may result in injury or death. An algorithm was developed using the patient fall circumstances identified in a chart analysis from 2016. OBJECTIVES: This study aimed to determine if the Moffitt BMT-CI Orthostatic Vital Signs Algorithm could decrease inpatient falls. METHODS: A pre-/post-test program evaluation was conducted for one year pre- and postimplementation of the algorithm on newly admitted inpatients. Adherence rate of nurses using the algorithm was monitored. FINDINGS: Overall falls decreased from 5.38% to 3.44%, with zero falls or injuries related to orthostasis for newly admitted patients. Adherence of nurses using the algorithm increased from 60% to 93%. The fall rate has been sustained less than baseline with 100% adherence, and the algorithm has been adopted as standard of practice.

13.
Omega (Westport) ; : 30222820947241, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32757692

RESUMO

Complicated grief is a significant health concern for older adults, resulting in significant psychological and physical morbidity. Elements of post traumatic stress disorder (PTSD) are often present in individuals with complicated grief. Accelerated Resolution Therapy (ART) is a brief form of psychotherapy that utilizes the techniques of imaginal exposure, rescripting of events, and lateral eye movements that may be useful in complicated grief with PTSD symptoms. Two cases where ART was used for complicated grief with PTSD are presented. Both individuals had attempted to come to terms with their loss through traditional grief therapy with an inadequate response and substantial residual grief symptoms. These cases illustrate how ART can be used to address CG and PTSD and describe situations where it may be appropriate. Clinical and research implications are also discussed.

14.
J Soc Work End Life Palliat Care ; 16(2): 151-174, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32233740

RESUMO

Complicated grief (CG) poses significant physical, psychological, and economic risks to bereaved family caregivers. An integrative review of the literature published 2009-2018 on CG associated with caregiving was performed using PubMed, PsychINFO, and Web of Science. The search returned 1428 articles, of which 32 were included in the review. Sixteen studies described risk and protective factors and 16 described interventions for CG. Caregiver-related risk factors included fewer years of education, depression, anxiety, poor physical health, and maladaptive dependency and attachment traits. Additional risk factors included lower perceived social support, family conflict at end-of-life, and family having difficulty accepting death. Care recipient-related risk factors are younger age, fear of death, and place of death. Protective factors included hospice utilization in reducing fear of death, high pre-bereavement spiritualty, and satisfaction with palliative care. Complicated grief treatment was the most widely-studied intervention. Social Workers and other clinicians can use this information to identify family caregivers at increased risk for CG and refer or implement an early intervention to lessen its impact.


Assuntos
Cuidadores/psicologia , Família/psicologia , Pesar , Adaptação Psicológica , Fatores Etários , Atitude Frente a Morte , Luto , Feminino , Nível de Saúde , Cuidados Paliativos na Terminalidade da Vida/psicologia , Humanos , Masculino , Saúde Mental , Cuidados Paliativos/psicologia , Fatores Socioeconômicos
15.
Am J Hosp Palliat Care ; 37(10): 791-799, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31960705

RESUMO

BACKGROUND AND OBJECTIVES: Complicated grief (CG) is severe, prolonged (>12 months) grieving. Complicated grief disproportionately affects older adults and is associated with negative physical/psychological effects. Although treatment options exist, those which do are time-intensive. We report on a randomized clinical trial (RCT) which examined whether accelerated resolution therapy (ART), a novel mind-body therapy, is effective in treating CG, post-traumatic stress disorder (PTSD), and depression among hospice informal caregivers. RESEARCH DESIGN AND METHODS: Prospective 2 group, wait-listed RCT. All participants were scheduled to receive 4 ART sessions. INCLUSION: ≥60 years, inventory of CG >25, and PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition >33 or Psychiatric Diagnostic Screen Questionnaire PTSD subscale >5. EXCLUSION: Major psychiatric disorder, other current psychotherapy treatment. Depression was measured by the Center for Epidemiologic Studies Depression. RESULTS: Mean (standard deviation [SD]) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Participants assigned to ART reported significantly greater mean (SD) CG reduction (-22.8 [10.3]) versus Wait-list participants (-4.3 [6.0]). Within-participant effect sizes (ESs) for change from baseline to 8-week post-treatment were CG (ES = 1.96 (95% confidence interval [CI]: 1.45-2.47; P < .0001), PTSD (ES = 2.40 [95% CI: 1.79-3.00]; P < .0001), depression (ES = 1.63 [95% CI: 1.18-2.08; P < .0001). Treatment effects did not substantially differ by baseline symptom levels. DISCUSSION AND IMPLICATIONS: Results suggests that ART presents an effective and less time-intensive intervention for CG in older adults. However, it should undergo further effectiveness testing in a larger, more diverse clinical trial with a focus on determining physiological or behavioral mechanisms of action.

16.
J Clin Nurs ; 28(9-10): 1680-1684, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30653769

RESUMO

AIMS AND OBJECTIVES: The purpose of this article was to compare surgical oncology nurses caring behaviours to perceptions of their surgical oncology inpatients and determine internal consistency of the CAT-Nurse. BACKGROUND: Nursing practice at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, FL is guided by Duffy's Quality-Caring Model© . No study using Duffy's model for both oncology nurses and patients has been found. DESIGN: A descriptive correlation design was used adhering to the STROBE guidelines. Data were collected using CAT-Nurse and compared to data from a previous study using CAT (version V). METHODS: Item responses were compared between nurses and patients using t tests. RESULTS: Patients scored higher on perceptions of caring behaviours. Mutual problem solving was an area for improvement. The CAT-Nurse demonstrated internal consistency reliability. CONCLUSION: Results from this study can make nurses more aware of the caring perceptions that are not as strong as others, and therefore may have the ability to promote transformation. RELEVANCE TO CLINICAL PRACTICE: The results can serve as foundational knowledge for action plans aimed at increasing nurse comfort addressing lower scoring caring behaviours that would then result in improving patient perceptions which could be linked to patient satisfaction and reimbursement.


Assuntos
Empatia , Neoplasias/psicologia , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Enfermagem Oncológica/métodos , Adulto , Competência Clínica , Feminino , Humanos , Masculino , Neoplasias/enfermagem , Qualidade da Assistência à Saúde , Reprodutibilidade dos Testes , Inquéritos e Questionários
17.
J Am Psychiatr Nurses Assoc ; 25(3): 181-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30358486

RESUMO

BACKGROUND: The loss of a loved one, especially by a caregiver, can be stressful. Grief can affect one emotionally, mentally, behaviorally, spiritually, and physically and affects individuals differently. Complicated grief (CG), especially for a caregiver, can be intense, prolonged, and interfere with normal activities accompanied by destructive thoughts and behaviors. AIM: To synthesize the available research on persons experiencing CG and the effect on cortisol levels. METHODS: A literature search for articles published on CG and cortisol was performed using PubMed, Cochrane Library, PsychINFO, and Web of Science. Search terms included CG, cortisol, and their variants. No date limitations were applied. In accordance with PRISMA, articles were sorted and evaluated against specific inclusion and exclusion criteria. RESULTS: The search yielded 18 articles, of which 5 were included in the review. CONCLUSIONS: Cortisol levels and diurnal patterns are shown to be affected in individuals experiencing CG. With prolonged bereavement and dysregulated cortisol, physical and mental health outcomes may result warranting a need for effective stress reduction therapies for this population.


Assuntos
Cuidadores/psicologia , Pesar , Hidrocortisona/metabolismo , Humanos , Saliva/metabolismo
18.
ANS Adv Nurs Sci ; 42(3): 255-265, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30531354

RESUMO

Grieving is a normal reaction to loss; however, not everyone is able to recover from grief and adjust to a life after the loss. "Complicated grief" (CG) is a term used to describe intense and prolonged bereavement after the loss of a loved one that interferes with normal activities accompanied by destructive thoughts and behaviors. In practice and research, the concept of CG varies in definition and instruments used to measure. This concept analysis examines relevant research related to CG experienced by caregivers to provide a clear, comprehensive definition. Implications for nursing practice and research are explored.


Assuntos
Atividades Cotidianas/psicologia , Adaptação Psicológica , Atitude Frente a Morte , Luto , Cuidadores/psicologia , Família/psicologia , Pesar , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
19.
Clin J Oncol Nurs ; 22(5): 529-533, 2018 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-30239505

RESUMO

BACKGROUND: Height measurement is a key clinical component to measure body mass index and body surface area used for patient care, including calculating chemotherapy doses. Some patients cannot feasibly or safely stand for height measurement because of a number of diseases and disabilities. The literature is unclear regarding alternatives to standing height for patients unable to stand. OBJECTIVES: The purpose of this research study was to test equivalence of a number of measurements to find a reliable alternative to standing height for ambulatory oncology clinic patients who are unable to or cannot safely stand. METHODS: A repeated-measures design was used to measure the height of 60 volunteer adult participants using a convenience sample of 30 men and 30 women. Standing height was compared to self-reported height, recumbent length, arm span, half-arm span, demispan, and knee height measurements. FINDINGS: Results indicated that demispan was equivalent to standing height with a mean difference of -0.69. A practice change to use demispan in patients who cannot stand has been proposed and accepted at the authors' organization. The use of demispan was a feasible alternative to standing height in cost of supply and technique.


Assuntos
Assistência Ambulatorial/métodos , Antropometria/métodos , Estatura , Enfermagem Oncológica/métodos , Adolescente , Adulto , Idoso , Estudos Transversais , Precisão da Medição Dimensional , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
J Hosp Palliat Nurs ; 20(2): 129-136, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30063566

RESUMO

Integration of palliative care (PC) in oncology requires changes in delivery and processes of care, such as implementation of comprehensive, evidence-based interdisciplinary plans of care (IPOCs). A multidisciplinary design team partnered with an electronic health record company and an information analytics company that specializes in online clinical practice guidelines. The team sought to develop electronic IPOCs that address the unique needs of oncology inpatients, attend to PC needs, and reflect the interdisciplinary team's contribution to quality patient outcomes. Our cancer center had paper-based care plans that were not well integrated into workflow, did not represent comprehensive PC, did not reflect interdisciplinary care, and did not guide evidence-based practice at point of care. The team designed IPOCs to be incorporated into each discipline's workflow and unique documentation and established clinical decision support tools to suggest appropriate IPOCs. Thirty-five IPOCs were developed and included all domains of quality PC. Evaluation of IPOC use indicated incomplete, but improving, adoption of PC-specific IPOCs with engagement in collaborative care planning by a variety of disciplines and across oncology nursing subspecialties.


Assuntos
Registros Eletrônicos de Saúde/instrumentação , Serviço Hospitalar de Oncologia/tendências , Cuidados Paliativos/normas , Planejamento de Assistência ao Paciente/tendências , Documentação/métodos , Documentação/normas , Humanos , Cuidados Paliativos/métodos , Sistemas Automatizados de Assistência Junto ao Leito/normas
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