ABSTRACT
OBJECTIVES: Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. DESIGN: Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. SETTING: Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. PARTICIPANTS: Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). RESULTS: Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. CONCLUSIONS: Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway.
Subject(s)
Dementia/diagnosis , Health Services Needs and Demand , Neoplasms/diagnosis , Patient Education as Topic , Adult , Aged , Aged, 80 and over , Caregivers , Cross-Sectional Studies , Decision Making , Dementia/therapy , England , Female , Humans , Male , Middle Aged , Neoplasms/therapy , Patient Education as Topic/standards , Qualitative ResearchABSTRACT
AIM: The aim of the study was to investigate the relationship between personality traits, perception of workplace stress and coping among intensive care unit (ICU) nurses. BACKGROUND: Research has indicated that ICUs are stressful environments. There is a tendency for research studies to investigate causes of stress and ways of coping, but few studies, particularly in recent years, have considered the personality traits of the staff who thrive in this challenging environment, the work stress they perceive and the coping strategies they use. METHOD: A convenience sample of critical care nurses (n = 46) completed three standardised questionnaires during September 2007: the revised NEO personality inventory (NEO-PI-R); the nurses stress scale (NSI) and the Brief Coping Orientations to Problems Experienced (COPE) scale. FINDINGS: ICU nurses did not perceive their workplaces to be stressful. Certain personality traits, openness, agreeableness and conscientiousness, were associated with problem-solving coping strategies such as active planning and reframing. Openness and extraversion were associated with less perceived stress from the 'patients and relatives' dimension of the NSI; there were also negative correlations between conscientiousness and the 'workload stress' and stress from lack of 'confidence and competence' dimensions of the NSI. CONCLUSION: Certain personality traits may have a buffering effect on workplace stress. Pre-employment screening to identify staff that exhibit personality and coping traits associated with low perceived stress may be considered as part of the recruitment strategy to address problems relating to stress, sickness and retention. RELEVANCE TO CLINICAL PRACTICE: The retention and recruitment of staff who have lower perceived workplace stress and who utilise problem-focused coping may result in less reported absences and fewer critical incidents and errors.
Subject(s)
Adaptation, Psychological , Attitude of Health Personnel , Burnout, Professional/psychology , Critical Care/psychology , Nursing Staff, Hospital/psychology , Personality , Adult , Avoidance Learning , Burnout, Professional/diagnosis , Burnout, Professional/etiology , Burnout, Professional/prevention & control , Clinical Competence , Critical Care/organization & administration , Emotions , England , Female , Humans , Male , Nursing Methodology Research , Nursing Staff, Hospital/education , Nursing Staff, Hospital/organization & administration , Personnel Selection , Problem Solving , Self Efficacy , Statistics, Nonparametric , Surveys and Questionnaires , Workplace/organization & administration , Workplace/psychologyABSTRACT
In 2003 an audit was carried out on an ICU which demonstrated that the incidence of constipation was high and that this could contribute to the failure to wean patients from mechanical ventilation (Mostafa et al, 2003). A protocol was introduced to standardise the assessment and management of constipation. This article explores why patients in intensive care are at risk of constipation and presents the results of a second audit, carried out after the protocol was introduced, to assess its impact on patients.
Subject(s)
Constipation/prevention & control , Critical Illness , Humans , Intensive Care Units , Nursing Audit , Risk AssessmentABSTRACT
The palliative care needs of people with dementia have received little attention to date. In the early days of the disorder some drugs may assist with the cognitive and behavioural symptoms. However, as the disease progresses people with dementia become increasingly dependent on carers. Evidence suggests that a palliative care approach from diagnosis is beneficial because it addresses people's emotional needs as well as those of their families and carers.
Subject(s)
Dementia/therapy , Needs Assessment/organization & administration , Palliative Care/organization & administration , Aged , Aged, 80 and over , Dementia/diagnosis , Dementia/epidemiology , Dementia/psychology , Disease Progression , Evidence-Based Medicine , Humans , Male , Models, Organizational , Nursing Assessment , Palliative Care/psychology , Patient Care Team/organization & administration , Philosophy, Medical , Prevalence , United Kingdom/epidemiologyABSTRACT
Evidence from several studies suggests that general nurses and acute health care staff do not always have an adequate understanding of the needs of people with dementia. This has major implications for the quality of care that is delivered and the well-being of people with dementia and a concurrent medical or surgical condition. This article describes how the creation of the role of nurse educator in dementia care helped to address this problem in one NHS trust.
Subject(s)
Dementia/nursing , Education, Nursing/methods , Nursing Staff, Hospital/education , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Nurse's Role , Staff Development , State Medicine , United KingdomABSTRACT
Dementia care has been seen as a low priority, but with an estimated 700,000 people in the UK with dementia and an ageing population this is changing. The Alzheimer's Society will be holding events this week to raise awareness of dementia, sending a strong message to policy makers that dementia is a serious health issue. Nurses have also become active in fighting the old degenerative model of dementia and promoting the concept of person-centred care.
