O cuidado de enfermagem à pessoa em tratamento quimioterápico: narrativas de vida / Nursing care for the person undergoing chemotherapy: life narratives

As pessoas com câncer e seus familiares são vulneráveis aos danos e agravos à saúde, gerando dificuldades, sofrimento durante todo o processo, da descoberta do diagnóstico ao tratamento, o que remete à necessidade de atenção, promoção da saúde e acompanhamento ao longo de todo o processo. Nessa perspectiva, surgiram as seguintes questões norteadoras: Qual o entendimento do paciente com câncer de pulmão em tratamento quimioterápico sobre o seu processo de adoecimento e cuidado? De que maneira os pacientes com câncer de pulmão em tratamento quimioterápico enfrentam o adoecimento? Para tanto, os objetivos são: Identificar nas narrativas de vida dos pacientes com câncer de pulmão em tratamento quimioterápico o entendimento sobre promoção da saúde, processo de adoecimento e cuidado; discutir as ações de enfrentamento do adoecimento por estes pacientes e as adequações ao novo modo de vida. Estudo qualitativo, descritivo, guiado pelo método narrativa de vida, desenvolvido em uma clínica de oncologia no Rio de Janeiro, de fevereiro a junho de 2017, com 20 pacientes com câncer de pulmão em tratamento quimioterápico. A técnica de produção de dados foi a entrevista, gravada em aparelho de MP4 e transcrita na íntegra. Após a transcrição das entrevistas e organização dos dados, o processo analítico empregado foi a análise temática, originando duas categorias: as etapas do adoecimento e cuidado de enfermagem, e o enfrentamento do adoecer; e as adaptações à nova condição de vida. A partir das narrativas de vida, foi possível identificar que os modos como entendem o processo de adoecimento e cuidado estão diretamente ligados à descoberta da doença, os sinais e sintomas, como tosse, fadiga incluindo os exames e a terapêutica realizada. No contexto do enfrentamento, vários sentimentos e reações como o estresse, depressão, desânimo, sensação de desalento, raiva, ansiedade e irritabilidade foram identificados. Mas a religiosidade, a fé, o auxílio da família e a vontade de continuar a viver foram destacados como aspectos de proteção. Além disso, percebe-se nas narrativas que os fatores protetores contribuíram de forma essencial, criando alternativas e instrumentos de adaptações capazes de oferecer à pessoa com câncer de pulmão em tratamento quimioterápico melhores condições de vida, como manter suas atividades laborais, culturais e sociais. Isso se dá com ações de promoção da saúde que, direcionadas para uma avaliação dos fatores psicológicos, incluindo a autoestima e a automotivação do paciente, contribuem para a previsão do comportamento de saúde que se quer alcançar. Conclui-se que o método de narrativa de vida foi capaz de levantar as características individuais, as experiências vividas e os comportamentos específicos na perspectiva do paciente, ressaltando as ações promotoras da saúde que, por meio da consulta de enfermagem, foram implementadas desde o início da quimioterapia e durante todo o processo de tratamento de modo potencial e favorável para que não ocorressem intercorrências previstas. Assim, entender o modo como este processo é concebido pelos sujeitos por meio das narrativas de vida merece atenção e outros estudos.

People with cancer and their families are vulnerable to health grievances, resulting in difficulties and suffering throughout the process, from the discovery of the diagnosis to treatment, which refers to the need for attention, health promotion and follow-up throughout the entire process. From this perspective the following guiding questions emerged: What is the understanding of the patient with lung cancer, in chemotherapy treatment about their process of falling ill and being cared for? How do patients with lung cancer undergoing chemotherapy cope with their illness? To that end, the objectives are: To identify, in the life narratives of patients with lung cancer in chemotherapy, their understanding about health promotion and the process of illness and care; to discuss the coping actions of these patients and their adjustment to the new life condition. A qualitative, descriptive study, guided by the narrative of life research method, conducted at an oncology clinic in Rio de Janeiro, from February to June 2017, with 20 lung cancer patients undergoing chemotherapy. The data production technique was the interview, recorded in an MP4 device and transcribed in full. After interviews were transcribed and data organized, the analytical process employed was the thematic analysis giving rise to two categories: the stages of the illness and the nursing care; and coping with the illness and the adjustments to the new life condition. From the life narratives, it was possible to identify that the ways in which they understand the process of illness and care are directly related to the discovery of the disease, the signs and symptoms, such as cough, fatigue, including the exams and the therapy performed. In the context of coping , various feelings and reactions such as stress, depression, despondency, discouragement, anger, anxiety, irritability were identified. But religiosity, faith, family support, and the will to continue living were highlighted as aspects of protection. In addition, it can be seen in the narratives that the protective factors contributed in an essential way creating alternatives and instruments of adjustment capable of offering the chemotherapy lung cancer patient better living conditions, such as maintaining their work, cultural and social activities. This is done through actions of health promotion directed to an evaluation of the psychological factors, including patient self-esteem and self-motivation, thus contributing to the prediction of the health behavior that one wants to achieve. It is concluded that the life narrative method was able to raise individual characteristics, lived experiences and specific behaviors from the perspective of the patient, highlighting the health promoting actions, which were implemented through the nursing consultation since the onset of chemotherapy and throughout the treatment process in a potential and favorable way so that no predicted intercurrences occurred. Thus, understanding how this process is conceived by the subjects through life narratives which warrants attention and deserves greater study.

Family caregiver burden: the burden of caring for lung cancer patients according to the cancer stage and patient quality of life / Sobrecarga do cuidador familiar: a sobrecarga de cuidar de pacientes com câncer de pulmão, de acordo com o estágio do câncer e a qualidade de vida do paciente

ABSTRACT Objective: Patients with lung cancer experience different feelings and reactions, based on their family, social, cultural, and religious backgrounds, which are a source of great distress, not only for the patients but also for their family caregivers. This study aimed to evaluate the impact that lung cancer stage and quality of life (QoL) of lung cancer patients have on caregiver burden. Methods: This was a prospective cross-sectional study. Consecutive patient-caregiver dyads were selected and asked to complete the Hospital Anxiety and Depression Scale and the Medical Outcomes Study 36-item ShortForm Health Survey (SF-36). Family caregivers also completed the Caregiver Burden Scale. Group-based modeling was used in order to identify patients with early- or advanced-stage cancer (IA to IIIA vs. IIIB to IV) plus non-impaired or impaired QoL (SF36 total score > 50 vs. ≤ 50). Patient-caregiver dyads were stratified into four groups: early-stage cancer+non-impaired QoL; advanced-stage cancer+non-impaired QoL; early-stage cancer+impaired QoL; and advanced-stage cancer+impaired QoL. Results: We included 91 patient-caregiver dyads. The majority of the patients were male and heavy smokers. Family caregivers were younger and predominantly female. The burden, QoL, level of anxiety, and level of depression of caregivers were more affected by the QoL of the patients than by their lung cancer stage. The family caregivers of the patients with impaired QoL showed a higher median burden than did those of the patients with non-impaired QoL, regardless of disease stage. Conclusions: Caregiver burden is more affected by patient QoL than by lung cancer stage.

RESUMO Objetivo: Pacientes com câncer de pulmão vivenciam diferentes sentimentos e reações, dependendo de sua formação familiar, social, cultural e religiosa, que são fonte de grande sofrimento, não só para os pacientes mas também para seus cuidadores familiares. Este estudo objetivou avaliar o impacto do estágio do câncer de pulmão e da qualidade de vida (QV) dos pacientes com câncer de pulmão na sobrecarga do cuidador. Métodos: Estudo prospectivo transversal. Díades paciente-cuidador foram selecionadas consecutivamente e solicitadas a preencher a Hospital Anxiety and Depression Scale e o Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). Os cuidadores familiares também preencheram a Caregiver Burden Scale. Utilizou-se a modelagem de grupos para identificar pacientes com câncer em estágio inicial ou avançado (IA a IIIA vs. IIIB a IV) mais QV não comprometida ou comprometida (pontuação total no SF36 > 50 vs. ≤ 50). As díades paciente-cuidador foram estratificadas em quatro grupos: câncer em estágio inicial+QV não comprometida; câncer em estágio avançado+QV não comprometida; câncer em estágio inicial+QV comprometida; e câncer em estágio avançado+QV comprometida. Resultados: Foram incluídas 91 díades paciente-cuidador. A maioria dos pacientes era do sexo masculino e grande fumante. Os cuidadores familiares eram mais jovens e predominantemente do sexo feminino. A sobrecarga, QV, nível de ansiedade e nível de depressão dos cuidadores foram mais afetados pela QV dos pacientes do que pelo estágio do câncer de pulmão. Os cuidadores familiares dos pacientes com QV comprometida apresentaram maior mediana de sobrecarga do que os dos pacientes com QV não comprometida, independentemente do estágio da doença. Conclusões: A sobrecarga do cuidador é mais afetada pela QV do paciente do que pelo estágio do câncer de pulmão.

Análisis numérico de una prótesis endobronquial utilizada para el tratamiento de cáncer pulmonar / Numerical analysis of intrabronchial prosthesis used for the treatment of lung cancer

En México, la mortalidad debido a enfermedades bronco-respiratorias se ubica en el sexto lugar según datos estadísticos dados por el Instituto Nacional de Enfermedades Respiratorias (INER). Esto genera la necesidad de incrementar la eficiencia en la aplicación de los tratamientos usados para este tipo de patología. Algunos de los métodos utilizados con mayor frecuencia para el tratamiento de estas dolencias hacen uso de micro dispositivos, también conocidos como válvulas endobronquiales. Este es un sistema alternativo que evita cirugías invasivas y logra prolongar e incrementar la calidad de vida de los pacientes. En este trabajo se presenta el análisis del desempeño de la válvula IBV®. Para el desarrollo del estudio numérico se determinaron las dimensiones y propiedades mecánicas del modelo a partir de catálogos del fabricante. Se desarrolló un modelo para el cual se consideraron las propiedades del Nitinol® y Silastic®. Asimismo, se propusieron dos condiciones de operación para la válvula, una anclada en el bronquio y la otra en la condición en la que se encuentra plegada dentro del broncoscopio. Se utilizó el Método del elemento finito (MEF) para simular las condiciones de trabajo de la válvula. Los resultados encontrados muestran el funcionamiento estructural y el nivel de los esfuerzos generados en el implante durante el ciclo de respiración forzada del individuo. Además, se proporcionan las bases para generar un nuevo dispositivo que pueda emular el funcionamiento de este tipo de implantes y aumente la eficiencia del tratamiento de dicha patología.

In Mexico, the mortality rate due to bronchial respiratory sickness is placed in the sixth position, according to statistics from the National Institute of Breathing Sickness (INER), so it is convenient to increment the efficiency of treatments for those pathologies. The intrabronchial valve is a recommended alternative method; being it main objective to avoid invasive surgery and increase the time and quality of patient´s life. Within this work a biomechanical analysis of an IBV® valve is carried out. Regarding the numerical analysis, the dimensions and mechanical properties of the valve were proposed based on catalogues published by the manufacturer as more reliable information was not available in the open literature. As a result, a new model was developed in which both materials Nitinol® and Silastic® are considered as the main valve materials. The proposed working conditions assume that the valve is implanted in folded form at the bronchus and then anchored when it is unfolded. Finite Element Method (FEM) was used to simulate the proposed working conditions. Results obtained show the structural performance and the level of stress generated in the implant during the breathing cycle. In addition, it provides the knowledge to generate a new device that could emulate the performance of these implants and develop a more efficient treatment this disease.

Validity and Reliability of a Clinical Performance Examination using Standardized Patients / 간호학회지

PURPOSE: The purpose of this study was to test the validity of a modified clinical performance examination (CPX) for preclinical students in nursing. METHOD: 70 nursing students in their second semester of the junior year at C University participated in CPX. Scenarios and checklists were developed by our research team from September to October 2005. Six stations were organized. Evaluation included physical examination of a patient with lung cancer, education on usage of a metered dosage inhaler, and lobectomy postoperative care. Students were randomly assigned to a station. RESULT: There was a difference in the CPX scores according to stations. The agreement of scoring between trained faculty members and SPs was more than moderate (r=.647). The correlation between the CPX score and the average grade in the previous semester and between the CPX score and the average grade of a paper and pen test of the pulmonary system of adults was low (r=.276; r=.048). CONCLUSION: Traditional CPX is generally recommended, however, modified CPX is appropriate for preclinical students in the current Korean Nursing school setting if there are additional scoring systems to balance the testing level at each station.

physical, psychological and interactional suffering associated with lung cancer patients

The purpose of the study was to investigate the physical, psychological and interactional suffering associated with lung cancer patients. A sample of 50 adults with primary lung cancer obtained from Surgical Specialties Hospital in Baghdad city from March 1999-Augut 2000, two parts instrument was constructed and consisted of a personal and demographic data sheet that included descriptive information about patients. Other instrument was to assess the physical, psychological and interactional aspects for patients who suffering from lung cancer. A three-point Likert-type scale was used and weight was calculated to know the priority of the suffering for those patients. The results of the study revealed that the highest clause weight of physical suffering were for coughing [1.56], disability and loss of appetite [1.22] then for pain and fatigue [1.12]. The psychological suffering results revealed that the highest weight were for restless, unstable [1.18], fear of change in daily activities [1.08] then for worry about family and fear of recurrence [1.06]. About the interactional suffering the highest weights were for financial problems [1.18], and for the job problems [0.96]. According to the results of this study it recommended that to carry out other studies to investigate the changes in reported suffering as a course of the disease progressed in spite of that to replicate this study with subjects obtained from a variety of treatment sources with a large sample size to allow for comparisons of group by sex, educational level, and socioeconomic level, and the Institution of Service Education Programme for nurses to have adequate knowledge that enable them to find out the patients problem and to give effective care