Palliative radiotherapy: what do nurses know?

BACKGROUND: palliative radiotherapy can improve quality of life for patients who are symptomatic of advanced cancers. However, this treatment modality is underused and is often mistimed, which negates its potential benefit. AIM: the aim of this study was to assess nursing knowledge of palliative radiotherapy in the context of caring for patients with a cancer diagnosis. METHODS: a quantitative method of research was employed using a questionnaire to assess palliative radiotherapy knowledge among a purposive sample of 162 oncology and palliative care nurses. FINDINGS: the response rate was 48.14%. More than half of respondents reported their knowledge of radiotherapy as insufficient for their practice and almost all agreed they would benefit from more education. CONCLUSION: nurses require more training to identify when palliative radiotherapy would be an effective symptom control option; specific areas of focus for developing future radiotherapy educational programmes are highlighted.

Experiência da radioterapia na perspectiva do paciente com câncer de cabeça e pescoço: revisão integrativa / Radiotherapy experiences from the perspective of head and neck cancer patients: integrative literature review / Experiencia del la radioterapia en la perspectiva del paciente con câncer de cabeza y cuello: revisión integrativa

Objective: The study's purpose has been to summarize the knowledge about primary studies that investigated radiotherapy experiences from the perspective of head and neck cancer patients. Methods: It is an integrative literature review. Results: The final sample consisted of 13 studies that were published from 1998 to 2015. Through the studies thematic analysis were identified four major themes, as follows: "physical consequences of radiotherapy", "psychological and emotional repercussions of radiotherapy", "lack of information about the treatment and posture of the health professional regarding the treatment adverse effects" and "support networks". Conclusion: The studies showed that the radiotherapy treatment had important negative repercussions in the patients' life regarding the reactions and readjustments, and also the roles played family wise, all due to the treatment. There was also an important knowledge gap on the subject, then demonstrating the need for new studies with a qualitative approach, aiming to better understand this experience, therefore, producing care improvement

Objetivo: Sintetizar o conhecimento de estudos primários que investigaram a experiência da radioterapia, na perspectiva do paciente com câncer de cabeça e pescoço. Método: Revisão integrativa da literatura. Resultados: Amostra final composta por 13 estudos publicados entre 1998 a 2015. Pela análise temática dos estudos foram identificados quatro temas maiores: "repercussões físicas da radioterapia", "repercussões psicológicas e emocionais da radioterapia", "falta de informação sobre o tratamento e a postura do profissional de saúde perante os efeitos adversos do tratamento" e "redes de apoio". Conclusão: Os estudos evidenciaram que o tratamento radioterápico trouxe repercussões negativas importantes na vida dos pacientes frente às reações e rearranjos na vida e nos papéis desempenhados dentro da família, decorrentes do tratamento. Verificou-se também uma lacuna importante de conhecimento sobre a temática, demonstrando a necessidade de novos estudos, com abordagem qualitativa, para melhor compreensão desta experiência, refletindo em aprimoramento da assistência

Objetivo: Sintetizar el conocimiento de estudios primarios que investigaron la experiencia de la radioterapia, en la perspectiva del paciente con cáncer de cabeza y cuello. Método: Revisión integrativa de la literatura. Resultados: La muestra final consistió en 13 estudios publicados entre 1998 y 2015. En el análisis temático de los estudios se identificaron cuatro temas más grandes: "repercusiones físicas de la radioterapia", "repercusiones psicológicas y emocionales de la radioterapia", "falta de información sobre el tratamiento y la la postura del profesional de la salud ante los efectos adversos del tratamiento y las redes de apoyo. Conclusión: Los estudios evidenciaron que el tratamiento radioterápico trajo repercusiones negativas importantes en la vida de los pacientes frente a las reacciones y reajustes en la vida y en los papeles desempeñados dentro de la familia, derivados del tratamiento. Se verificó también una laguna importante de conocimiento sobre la temática, demostrando la necesidad de nuevos estudios, con abordaje cualitativo, para una mejor comprensión de esta experiencia, reflejando en el perfeccionamiento de la asistencia

Consulta de enfermagem na radioterapia de câncer de cabeça e pescoço: análise dentro do conceito custo-utilidade em saúde / Nursing consultation in the head and neck cancer radiotherapy: a cost-health utility relationship analysis / Consulta de enfermería en la radioterapia de cáncer de cabeza y cuello: análisis dentro del concepto costo-utilidad en salud

Objetivo: Descrever o uso do Questionário de Qualidade de Vida da Universidade de Washington, específico para Câncer de Cabeça e Pescoço, na consulta de enfermagem em Radioterapia. Método: Estudo transversal, prospectivo, de abordagem quantitativa do tipo descritiva-exploratório com 10 pacientes em radioterapia de cabeça e pescoço atendidos num Serviço de Radioterapia de um Hospital Universitário, entre 35 a 70 anos de idade, em início de radioterapia, com estadiamentos: III, IVA, IVB ou IVC, entre agosto e dezembro de 2016. CEPHUPE parecer 1.649.577. Resultados: A diferença de utilidade encontrada no início e ao final do tratamento foi importante para quantificar o impacto da consulta de enfermagem. O aumento da Utilidade acompanhou a diminuição dos eventos adversos da terapêutica, durante a consulta de Enfermagem. Conclusão: Este estudo possibilitou ao enfermeiro, a utilização do conceito de Utilidade para quantificar e acompanhar a melhora da Qualidade de vida, nas consultas de Enfermagem na Radioterapia

Objetivo: Describir el uso del Cuestionario de Calidad de Vida de la Universidad de Washington, específico para Cáncer de Cabeza y Cuello, en la consulta de enfermería en Radioterapia. En el presente trabajo se analizaron los resultados obtenidos en el análisis de los resultados obtenidos en el estudio de los resultados obtenidos en el estudio, III, IVA, IVB o IVC, entre agosto y diciembre de 2016. CEPHUPE opinión 1.649.577. Resultados: La diferencia de utilidad encontrada al inicio y al final del tratamiento fue importante para cuantificar el impacto de la consulta de enfermería. El aumento de la Utilidad acompañó la disminución de los eventos adversos de la terapéutica, durante la consulta de Enfermería. Conclusión: Este estudio posibilitó al enfermero, la utilización del concepto de Utilidad para cuantificar y acompañar la mejora de la Calidad de vida, en las consultas de Enfermería en la Radioterapia

Objective: This study aimed to describe the use of the University of Washington Quality of Life Questionnaire, limited to head and neck cancer, in nursing consultation applied to radiotherapy. Methods: A cohort and prospective study with a descriptive/exploratory quantitative approach was carried out with 10 patients under head and neck radiotherapy assisted at the Radiotherapy Service in a University Hospital, aged from 35 to 70 years old, at the treatment onset and in the cancer stages III, IVA, IVB or IVC from August to December 2016. Results: The difference in utility in the start and final stages of the treatment was important to quantify the nursing consultation impact. The Utility increased as the adverse events of therapeutics decreased during the nursing consultation. Conclusion: This study made possible the utilization of the concept of Utility by the nurses during nursing consultation applied to radiotherapy, in order to quantify and follow up the enhancement of the life quality

Information Sharing and the Nursing Practice for the Certified Nurse in Radiation Therapy Nursing.

This study is conducted in order to clarify, however practice and get or sharing information in the Radiation Therapy Nursing of Certified Nurses. We have the group interviews from the four members the Certified Nurses in Radiation Therapy Nursing. It was found that Certified Nurses in Radiation Therapy Nursing felt that don't have the information about the patients who receives radiation therapy. In addition, they thought not able to even determine about whether time required, and not provide the professional nursing care practice. They say that we need the time, place and information. They were determined to be there to be necessary in for exhibiting their abilities. In particular, the most important problems that there aren't systematic information of the patients who receives radiation therapy. It's mean that, not have described the information for Radiation Therapy Nursing, and not obviously structure of nursing process or important assessment's, yet.

Assistência de enfermagem a pacientes com câncer de cabeça e pescoço submetidos à radioterapia / Atención de enfermería a pacientes con cáncer de cabeza y cuello sometidos a radioterapia / Nursing care to patients with head and neck cancer undergoing radiotherapy

Objective: developing the main diagnoses and nursing interventions related to complications of radiotherapy in patients with head and neck cancer. Method: a descriptive study developed in three stages: literature review in the databases MEDLINE and LILACS; identification of complications reported at least in 50% of the articles, which were xerostomia and mucositis and composition of diagnoses and nursing interventions according to the International Classification for Nursing Practice. Results: there were formulated the diagnoses: “Low Salivation” and “Inflammation of the Oral Mucous Membrane” and 40 nursing interventions. Conclusion: this study contributed in the organization of nursing care through the use of a standardized terminology for diagnoses and nursing interventions that support the nursing consultation in the sector of radiotherapy.

Objetivo: elaborar os principais diagnósticos e as intervenções de enfermagem relacionados às complicações da radioterapia em pacientes com câncer de cabeça e pescoço. Método: estudo descritivo desenvolvido em três etapas: revisão da literatura nas bases de dados MEDLINE e LILACS; identificação das complicações citadas, no mínimo, em 50% dos artigos, as quais foram xerostomia e mucosite e composição dos diagnósticos e intervenções de enfermagem de acordo com a Classificação Internacional para a Prática de Enfermagem. Resultados: foram formulados os diagnósticos “Salivação diminuída” e “Inflamação da membrana mucosa oral” e 40 intervenções de enfermagem. Conclusão: esse estudo contribuiu na organização da assistência de enfermagem através do uso de uma terminologia uniformizada para diagnósticos e intervenções de enfermagem que embasam a consulta de enfermagem no setor de radioterapia.

Objetivo: desarrollar los principales diagnósticos e intervenciones de enfermería relacionados con complicaciones de la radioterapia en pacientes con cáncer de cabeza y cuello. Método: se trata de un estudio descriptivo, desarrollado en tres etapas: la revisión de la literatura en las bases de datos MEDLINE y LILACS; la identificación de las complicaciones informadas de al menos el 50% de los artículos, que eran la xerostomía y mucositis y la composición de los diagnósticos y las intervenciones de enfermería de acuerdo con la Clasificación Internacional para la Práctica de Enfermería. Resultados: se formularon los diagnósticos: “Disminución de la salivación” y “La inflamación de la membrana mucosa bucal” y 40 intervenciones de enfermería. Conclusión: este estudio contribuyó en la organización de la atención de enfermería a través de la utilización de una terminología estandarizada para diagnósticos e intervenciones de enfermería que apoyan la consulta de enfermería en el sector de la radioterapia.

Validação semântica de instrumento para identificação da prática de enfermeiros no manejo das radiodermatites / Semantic validation of an instrument to identify the nursing practice in the management of radiodermatitis

Objetivou-se validar semanticamente o questionário ͞Cuidados com a pele nas radiodermatites͟, desenvolvido no Brasil, para identificar a prática dos enfermeiros relacionada à prevenção e ao manejo das radiodermatites. O processo de validação semântica ocorreu em um hospital especializado em oncologia tendo como amostra 27 enfermeiros. O questionário foi bem aceito e considerado importante para avaliar a assistência prestada. Identificou-se dificuldade de compreensão referente a alguns itens além de ter sido atribuído pequena importância àqueles que indicavam produtos não recomendados na prática. Concluiu-se que a etapa de validação semântica, para a conclusão da elaboração do questionário ͞Cuidados com a pele nas radiodermatites͟, foi imprescindível na medida em que criou um espaço em que os enfermeiros puderam dar sugestões, expor suas dificuldades de entendimento e também demonstrar aspectos considerados importantes por eles. Sua utilização permitirá identificar como o cuidado tem sido realizado e contribuirá para uma prática clínica baseada em evidências científicas.

The objective was to semantically validate the questionnaire ͞Skincare for radiodermatitis͟, developed in Brazil, to identify the nursing practice related to prevention and management of radiodermatitis. The semantic validation process occurred in a specialized oncology hospital with a sample of 27 nurses. The questionnaire was well accepted and it was considered important to assess the provided assistance. We identified difficulty to comprehend few items and little importance was given to those indicating non-recommended products in practice. We finished the semantic validation step for the conclusion of the questionnaire creation ͞Skincare for radiodermatitis͟ which is indispensable at the measure that a space was created for nurses to give suggestions, to expose their understanding difficulties and also to demonstrate aspects considered important by them. Its use will allow identification of how care has been provided and it will contribute for an evidence-based clinical practice.

Evaluación de la efectividad de un extracto de aceite de rosa mosqueta (ARM) en la prevención de la epitelitis por radioterapia (RT) en pacientes afectos de cáncer de cabeza y cuello (CCC) / Evaluation of the effectiveness of an oil extract of rosehip in the prevention of epithelitis due toradiotherapy in patients with head and neck cancer

Introducción. La epitelitis es un efecto secundario frecuente en el tratamiento con radioterapia (RT). Objetivo. Evaluar la efectividad del aceite de rosa mosqueta (ARM, RepavarR) en la prevencion de epitelitis en pacientes con cancer de cabeza y cuello (CCC) tratados con radioterapia de intensidad modulada (IMRT). Material y métodos. Estudio clinico, intervencionista, prospectivo, exploratorio, controlado y abierto. Entre mayo y octubre de 2013 se incluyeron en el estudio 28 pacientes. Tras firmar el consentimiento informado, se les proporciono ARM para aplicarselo 2 veces/dia desde el inicio del tratamiento. Todo tenian prescritas dosis de IMRT ≥ 60 Gy. Enfermeria los evaluo semanalmente. Se realizo un seguimiento fotografico de la piel que registro el grado de epitelitis y la aparicion de dolor u otros. El grupo control lo constituyeron 34 pacientes consecutivos con CCC tratados con IMRT los meses previos al estudio, cuyo tratamiento topico se realizo con otros productos. Resultados. Ambos grupos son comparables (edad, sexo, localización y dosis RT). En el grupo de estudio (ARM) fue menor el numero de curas por paciente (p = 0.3) y los dias naturales de curas por paciente (p = 0.38); tambien fue menor el numero de pacientes que preciso curas y padecio radiodermitis grado III-IV. Probablemente, el limitado tamano muestral haya influido en la significacion estadistica. Conclusiones. La efectividad del ARM en la prevencion de la epitelitis grave en pacientes con CCC tratados con RT es al menos tan eficaz (probablemente mas) que la de los tratamientos topicos habituales. Seria deseable un estudio leatorizado para confirmar dichos hallazgos (AU)

Introduction. Epithelitis is a frequent side effect in radiotherapy treatments (RT). Objective. To evaluate the effectiveness of Rosehip Oil (ARM, Repavar) in the prevention of epithelitis in patients with head and neck cancer (HNC) treated with intensity modulated radiotherapy (IMRT). Material and methods. An interventionist, prospective, exploratory, controlled and open clinical study. Between May and October 2013, 28 patients were included in the study. After signing the informed consent form, the patients were provided with ARM to apply this twice daily from the beginning of the treatment. All of them had a prescribed dose of IMRT ≥ 60 Gy. They were evaluated weekly by nurses on the ward. A photographic monitoring of the skin with a registered grade of epithelitis and with signs of pain or other was carried out. The control group was formed of 34 consecutive patients with HNC treated with IMRT months prior to the study, whose skin treatment had been different products. Results. Both groups were comparable (age, sex, region and RT dose). In the study group (ARM), the number of treatments per patient (p = 0.3) and the natural days for treatment per patient (p = 0.38) were less; also, the number of patients who required treatments and who suffered from radiodermitis of III-IV grade, were less. It is probable that the limited specimen size may have influenced in the statistics. Conclusions. The effectiveness of ARM in the prevention of severe epithelitis in patients with HNC treated with RT is, at least, as effective (or more effective) as other and more common skin treatments. A randomized study would be required to confirm these findings (AU)

Elaboração de instrumento para identificação da prática de enfermeiros nas radiodermatites / Development of an instrument to identify nurses' practice in radiodermatitis / Desarrollo de instrumento para identificación de la práctica de enfermeros en radiodermiti

Trata-se de estudo descritivo realizado entre os meses de janeiro e setembro de 2011, em Ribeirão Preto, e que teve por objetivo descrever as etapas metodológicas iniciais da construção de um instrumento para a identificação da prática dos enfermeiros na prevenção e no manejo das radiodermatites. Na primeira etapa, identificaram-se os itens considerados relevantes para compor o instrumento, os quais foram agrupados em sete partes e totalizaram 74 itens. Após sua estruturação, o instrumento foi submetido à validação de conteúdo e de aparência por sete juízes. Os resultados apontaram que, no geral, o instrumento foi considerado claro, objetivo e bem-estruturado. Esta etapa foi fundamental no processo de validação. Um instrumento válido e confiável permitirá uma coleta de dados sistematizada, com consequente identificação de como o cuidado tem sido dispensado.

This descriptive study conducted between January and September 2011 in Ribeirão Preto aimed to describe the basic methodological steps in constructing an instrument to identify nurse's practice in prevention and management of acute skin reactions caused by radiation. In the first step, important items to compose the instrument were identified and assembled into seven groups totaling 74 items. Once structured, the instrument was submitted to content and appearance validation by seven judges. The results of this stage showed that, overall, the instrument was considered clear, objective and well structured, an essential step in the validation process. A valid, reliable instrument will allow systematic collection of information and consequent identification of how care has been performed.

Se trata de un estudio descriptivo realizado entre los meses de enero a septiembre de 2011, en Ribeirão Preto, y tuvo como objetivo: describir las etapas metodológicas básicas de la construcción de un instrumento para la identificación de la práctica de los enfermeros en la prevención y tratamiento de las radiodermitis. En la primera etapa, se han identificado los ítems que se consideran relevantes para componer el instrumento. Estos fueron agrupados en siete partes, en un total de 74 ítems. Después de la estructuración del instrumento, fueron validados su contenido y su aspecto por siete jueces. Los resultados mostraron que, en general, el instrumento fue considerado claro, objetivo y bien estructurado. Esta etapa fue esencial en el proceso de validación. Un instrumento válido y fiable permitirá una recolección de datos sistematizada con una consecuente identificación de cómo la atención ha sido prestada.

Polymeric membrane dressings for radiotherapy-induced skin damage.

Radiotherapy is one of the mainline treatments for cancer. One of the side effects associated with radiotherapy includes skin problems, which range from mild (dull erythema and tightening of the skin) to severe (moist desquamation resulting in open wounds that can be very painful associated with sloughy and, in some severe cases, necrosis). The increased use of advanced radical treatments, such as intensity-modulated radiotherapy treatment (IMRT), can also result in a higher number of patients experiencing skin reactions. It is estimated that approximately 87% of patients will experience a moderate-to-severe skin reaction (Harris et al, 2011) An evaluation was undertaken in 20 patients with head and neck cancer following a prescribed treatment of radiotherapy to compare a polymeric membrane dressing (PolyMem®) against the standard treatment. The standard treatment consisted of topical aqueous cream at the start of radiotherapy with the addition of paraffin gauze when moist desquamation occurred. A bespoke evaluation form was completed for a period of 4 weeks or until healed. Patients were asked to complete both qualitative descriptions and numerical scores of pain for symptoms and procedural pain. Analgesia and sleep patterns were logged and, in addition, free text diaries were provided for up to 4 weeks. Common themes were identified and qualitative data analysed.

Comparison of groups with different patterns of symptom cluster intensity across the breast cancer treatment trajectory.

BACKGROUND: Comparing subgroups with different patterns of change in symptom intensity would assist in sorting out individuals at risk for more severe symptoms and worse functional outcomes. OBJECTIVES: The objectives of this study were to identify and compare subgroups of breast cancer patients with different patterns of change in a psychoneurological symptom cluster intensity across the treatment trajectory. METHODS: This secondary analysis used the data from 160 breast cancer patients undergoing chemotherapy or radiation treatment. Psychoneurological symptom cluster intensity was a composite score of 5 symptoms (depressed mood, cognitive disturbance, fatigue, insomnia, and pain) in a psychoneurological cluster at each of 3 time points (ie, at baseline and at 2 follow-ups after chemotherapy or radiation treatment). RESULTS: Five distinct subgroups representing different patterns of psychoneurological symptom cluster intensity during breast cancer treatment were identified: the gradually increasing pattern subgroup (group 1), the constantly low pattern subgroup (group 2), the start low with dramatic increase and decrease pattern subgroup (group 3), the constantly high pattern subgroup (group 4), and the start high with dramatic decrease and leveling pattern subgroup (group 5). Patients without previous cancer treatment experience, with higher level of education, treated with chemotherapy, and/or with more limitations at the baseline were more likely to follow the pattern group 4. Patients in group 4 had the most serious functional limitations measured at the second follow-up time point. CONCLUSION: The results suggest the need to evaluate interventions for specific subgroups and to examine the causal mechanisms underlying a psychoneurological symptom cluster. IMPLICATION: Clinicians should consider these diverse symptom experiences for assessment/management.

Radioterapia en el cáncer de mama. Educación y cuidados enfermeros / Prevalence and profile of the elderly home care valid suffering in a private residence falls

El cáncer de mama es la neoplasia más frecuente en la mujer. Una de cada diez deberá afrontarlo a lo largo de su vida. La radioterapia constituye una parte esencial en el tratamiento. El 87% de las pacientes sometidas a radioterapia desarrollará radiodermitis. El cuidado durante el tratamiento forma parte de la práctica diaria del personal de enfermería. En la consulta, la enfermera ofrece a la paciente unas recomendaciones de autocuidado. Es importante que las siga adecuadamente para intentar prevenir la aparición de los posibles efectos secundarios (AU)

Breast cancer is the most common malignancy in women. One in ten women must face breast cancer during her life. Radiotherapy is an essential part of the treatment. 87% of patient undergoing Radiotherapy will experience radiodermitis. The care during the treatment is part of the daily practice of the nursing staff. In the nursing consultation nurses give to the patient self-care recommendations. It´s important that the patient follows these recommendations given by the nurse in order to prevent the appearance of the possible side effects (AU)

Adverse effects and appetite suppression associated with particle beam therapy in patients with head and neck cancer.

AIM: This purpose of this study was to investigate the relationship between the appetite and various factors that are associated with particle beam therapy, including the adverse effects of radiation, dry-mouth period, analgesic medication use, frequency of oral care, and participants' characteristics, in 121 patients with head and neck cancer. METHODS: A path analysis was used to evaluate the causal relationship of the factors that affected the participants' appetite. RESULTS: At a cumulative dose of 40 GyE, the factors that impacted the participants' appetite included xerostomia, oral mucositis, age, frequency of oral care, and analgesic medication use. At a cumulative dose of 50 GyE, the factors that affected the participants' appetite were xerostomia, sensitivity to taste, oral mucositis, dry-mouth period (in the morning), frequency of oral care, number of artificial teeth, and analgesic medication use. The results indicate that interventions to avoid appetite suppression during particle beam therapy will differ according to a radiation schedule of 40 GyE, compared to 50 GyE. CONCLUSIONS: These results are important to consider when deciding how best to maintain the dietary intake of patients who are receiving particle beam therapy.

Perspectives on coping among patients with head and neck cancer receiving radiation.

PURPOSE/OBJECTIVES: To describe coping among patients with laryngeal and oropharyngeal cancer during definitive radiation with or without chemotherapy. RESEARCH APPROACH: Qualitative content analysis conducted within a larger study. SETTING: Two radiation oncology outpatient clinics in Baltimore, MD. PARTICIPANTS: 21 patients with oropharyngeal or laryngeal cancer. METHODOLOGIC APPROACH: Interviews with open-ended questions were conducted during treatment. Questions covered topics such as coping during treatment, treatment-related issues, and resources. MAIN RESEARCH VARIABLES: Coping, treatment, and coping resources. FINDINGS: Patients' self-assessments suggested they were coping or that coping was rough or upsetting. Issues that required coping varied over four time points. Physical side effects were problematic during and one month after treatment completion. Patients used coping to manage the uncertainties of physical and psychological aspects of their experience. Family and friend support was a common coping strategy used by patients, with the intensity of side effects corresponding with the support provided across time points. CONCLUSIONS: Findings confirm previous research, but also provide new information about ways in which patients with head and neck cancer cope with their illness experience. Emergent themes provide insight into patients' feelings, issues, and assistance received with coping. INTERPRETATION: Patients with head and neck cancer need education on the amount and severity of side effects and should be appraised of potential difficulties with scheduling, driving, and other logistic issues. Patients also should be informed of helpful types of support and coping strategies. Additional research is needed to expand the findings related to patients' coping with treatment and to explore the experiences of family and friends who provide social support.

Vínculos de los Clientes oncológicos y familiares: una dimensión para ser observada / Bonds of oncologic clients and relatives: a dimension to be known

Introducción: El perfil de la población brasileña ha ido cambiando con el aumento de enfermedades crónicas. Entre ellos, está el cáncer que ocupa la segunda causa de muerte por enfermedad en Brasil, siendo considerado un grave problema de salud pública. Objetivos: Conocer a los bonos que los clientes y sus familias establecen en la vivencia con el cáncer. Metodología: La investigación cualitativa, exploratoria y descriptiva. Dieciocho clientes y dos familiares participaron en el estudio. Fue usada la entrevista semi-estructurada, con la redacción de genograma y ecomapa. Resultados: En el discurso de los sujetos, surgieron dos grupos temáticos: el fortalecimiento de los vínculos y lazos rotos por la enfermedad y tratamiento. Conclusión: Los resultados ayudaron a reflexionar sobre el cuidado de enfermería en el tratamiento con radioterapia del cáncer y, en colaboración con los posibles cambios en la práctica de la enfermera en oncología cerca de estos clientes (AU)

Aims: To ascertain the bonds that the oncologic clients and their relatives establish when living with cancer. Methodology: a qualitative, exploratory and descriptive research. Eighteen clients in radiotherapy treatment and two relatives participated in the research. The semi-structured interview was used, with the elaboration of genogram and ecomap. Results: In the speech of the subjects, two thematic nuclei emerged: strengthened bonds and bonds broken by the disease and treatment. Conclusions: The results contributed to considerations on nursing care inthe radiothreapytreatment of cancer, and in collaboration with possible changes in the nurse in care oncology close to these clients (AU)

Human reliability assessment of a critical nursing task in a radiotherapy treatment process.

Radiotherapy treatment, like many other fields of medicine, has changed significantly in the last decade with the introduction of more advanced technology and automation. This change has often resulted in aspects of the system which cannot be automated due to technological feasibility and local implementation constraints. This has resulted in a requirement for significant human interaction. This combination of human operations and automation has introduced new error pathways. Traditionally, recommendations to improve the safety of such systems are typically made after the analysis of an adverse event or a significant series of incidents. In contrast, adopting a proactive approach to safety would enable prior identification of potential errors and the specification of appropriate defences against them, thus avoiding costs associated with adverse outcomes. In this paper, a modified version of the proactive Human Reliability Assessment (HRA) method Human Error Assessment and Reduction Technique (HEART) was used to analyse a critical nursing task within a modern radiotherapy system. The modified technique used a participative team approach to complete the assessment in contrast to the normal approach, which uses a single expert assessor. The HEART technique quantifies the likelihood of unreliability of a task and ranks the conditions which most affect the successful completion of that task. HEART has been proposed as a potentially useful HRA tool for applications in healthcare, but such applications have not previously been formally documented. As a result of the modified HEART analysis reported in this paper, remedial measures were identified which were both cost effective and easy to implement.