Developing and using preparatory information for women undergoing radiation therapy for cervical or uterine cancer.

PURPOSE/OBJECTIVES: To describe symptoms associated with radiation therapy necessary to develop preparatory concrete, objective information for women with cervical or uterine cancer. DESIGN: Prospective, descriptive. SETTING: University-affiliated radiation oncology department in the mid-south. SAMPLE: 49 of 52 women undergoing external beam radiation and low-dose rate brachytherapy for cervical or uterine cancer. Stage of disease ranged from I-IIIA. Mean age of subjects was 54 years; mean years of education was 11. METHODS: Investigator-developed symptom checklist based on prior research. MAIN RESEARCH VARIABLES: Symptom reports. FINDINGS: At least 40% of the women reported difficulty sleeping, fatigue, diarrhea, anorexia, nausea, urinary frequency, dysuria, vaginal discharge, and perineal irritation. Incidence and timing of symptoms varied by operative status and brachytherapy timing. CONCLUSIONS: Findings confirm and clarify the symptoms women associate with radiation treatment for cervical or uterine cancer. IMPLICATIONS FOR NURSING PRACTICE: Assessing research findings for relevance to the care of patients in specific settings is necessary. These findings are appropriate for developing preparatory information for women undergoing external beam radiation and low-dose rate brachytherapy.

Evidence-based practice and the advanced practice nurse: a curriculum for the future.

The concept of evidence-based practice has gained increased attention throughout the 1990s as a strategy for linking the best scientific findings with clinical judgment to improve health outcomes. Because the concept implies finding, evaluating, summarizing, and using research results, a high level of clinical reasoning skills is required. Effective evidence-based practice also requires the incorporation of new practices into clinical and organizational settings, thereby demanding advanced leadership skills. Competencies in clinical reasoning, leadership, and clinical practice are critical for advanced practice nurses. This article describes a master's-level curriculum supportive of evidence-based practice and includes recommendations for developing curricula of this type.

Integrin signaling, free radicals, and tyrosine kinase mediate flow constriction in isolated cerebral arteries.

Isolated, cannulated, and pressurized (100 mmHg) middle cerebral arteries from adult cats were perfused intraluminally at rates from 0 to 4 ml/min with heated and gassed physiological saline solution. An electronic system held pressure constant by changing outflow resistance. The arteries constricted 18.1 +/- 0.95% in response to flow and depolarized from -54 +/- 0.51 to -40 +/- 1.26 mV (P < 0.05). Constriction was independent of a functional endothelium but was eliminated by superoxide dismutase or tyrosine kinase inhibitors. Luminal perfusion with a synthetic extracellular matrix Arg-Gly-ASP (RGD) peptide that binds with integrin significantly reduced constriction to flow. Neither reducing intraluminal pressure nor increasing tone or shear stresses altered constriction to flow. Flow-induced constriction did not impede the ability of the arteries to dilate to hypercapnia, and inhibiting flow-induced constriction did not alter contractile responses to other agonists. These data suggest that, in vitro, middle cerebral arteries constrict to flow through a mechanism involving free radicals and tyrosine kinase and that flow shear stresses resulting in constriction are transduced by integrin signaling.

Uncertainty and adjustment during radiotherapy.

The relationships among uncertainty, hope, symptom severity, control preference, and psychosocial adjustment were examined in persons having radiotherapy for cancer. After 15 days of radiotherapy, both uncertainty (17%) and hope (16%) explained significant amounts of the variance in adjustment. At the end of treatment, uncertainty (18%), hope (11%), and symptom severity (7%) all significantly increased the explained variance in adjustment. Greater uncertainty and less hope were associated with more adjustment problems; symptom severity increased the explanation of adjustment difficulty at treatment completion. There was no evidence that uncertainty had positive effects in this sample. Findings also showed that control preference was unrelated to the concepts of interest in this sample.

Uncertainty, coping, and distress following myocardial infarction: transition from hospital to home.

The purpose of this study was to examine the influence of uncertainty in illness and use of coping methods on emotional distress and recovery following myocardial infarction. A longitudinal exploratory design with measures obtained at three times was used; multiple regression was used to analyze the data. Uncertainty explained a significant amount of the variance in emotional distress prior to hospital discharge (21%), and 1 (16%) and 4 (26%) weeks after discharge. Patients reporting greater uncertainty also reported more emotional distress. One week after discharge, coping behaviors significantly added to the variance explained in distress (27%). Greater use of emotive coping behaviors was associated with higher levels of emotional distress and accounted for the majority of the variance explained by coping behaviors (23%). The findings are discussed in terms of the nature of uncertainty in health care and future model development.

The cardiac patient and exercise: a sociobehavioral analysis.

Health beliefs (health motivation, perceptions of illness, perceptions of resusceptibility, efficacy of treatment, barriers to treatment, and cues to taking health-related action), HLOC, patient satisfaction, social support, and self-motivation were studied in a group of cardiac patients (N = 41; 39 men and two women) who initiated and completed a phase II outpatient cardiac exercise program. Twenty-three had MI and 18 had CABG. They ranged in age from 34 to 75 years with a mean age of 53 1/2 years. Regarding health beliefs, the only subscales not reflecting the tendency toward compliant behavior were general health motivation and cues to taking health-related action. Scores on the remaining measures revealed a tendency for subjects to be externally controlled, satisfied with the program and staff, recipients of social support, and self-motivated. Although it was anticipated that patients with MI would differ significantly from patients who had CABG regarding these measures, this was not found to be true. A correlation matrix revealed that the most remarkable relationships were those between perceptions of severity of illness and general health motivation; HLOC and general health motivation; perceptions of severity and resusceptibility; cues to taking health-related action and satisfaction with the program staff; and satisfaction with the program and the program staff. Interestingly, perceptions of resusceptibility were negatively related to social support and self-motivation.

Personal control interventions: short- and long-term effects on surgical patients.

A randomized 2 X 3 X 2 factorial design was used to evaluate the short- and long-term effects of interventions that provided different means of exerting personal control over postoperative experiences in a sample of 121 black and 47 white hysterectomy patients. One variable was the presence or absence of the description of the experience in concrete sensory terms; the second variable was instruction in a cognitive-coping strategy, instruction in a behavior-coping strategy, or no instruction; and the third variable was experimental or control information about the posthospital experience. There was support for the coping processes that concrete sensory information was expected to stimulate, but no significant effects on resumption of usual life activities as was expected. The behavioral-coping technique was associated with a reduction in pain medication. The cognitive-coping technique was associated with reports of better physical recovery during hospitalization, but longer hospitalization. Posthospitalization recovery data, collected 2, 4, and 12 weeks after discharge, showed a different pattern of effects for the interventions than observed during hospitalization.

Post hoc tests following analysis of variance.

Review of nursing research literature revealed that post hoc comparisons of mean differences were not consistently reported, although their use was warranted. This paper describes the critical features of post hoc procedures and offers guidelines for selecting one method over another. Particular attention is given to how various procedures control Type 1 error. Selection of post hoc procedures considering the investigator's desire for control of Type 1 and Type 2 error also is presented.

Surgical implants. Psychological responses.

Coping with stress is a process. The perceived degree of stress and methods of coping may, therefore, change as one progresses through an experience. This may increase the difficulty a nurse has in attempting to understand the patients' responses. We need to learn more about these psychological processes as they relate to implants so that more effective nursing approaches may be developed. Perioperative nurses must understand the mechanisms underlying psychologic responses to surgery as we do those underlying physiologic and pathologic responses. The framework presented can be used as a guide to assess and understand patients' psychologic responses to surgical implants. It may also stimulate questions and investigation of patients' responses to surgical implantation.