[The contibution of concept development to nursing knowledge? The example of transitoriness]. / Wissensvermehrung durch Konzeptentwicklung? Das Beispiel Vergänglichkeit.

To provide nursing practice with evidence, it is important to understand nursing phenomena in detail. Therefore, good descriptions including the identification of characteristics and attributes of nursing phenomena on various levels of abstraction, i. e., concepts, are needed. In this article the significance of concept development for nursing science will be demonstrated by drawing on the example of 'transitoriness'. The evolutionary concept analysis proposed by Rodgers (2000) is introduced in more detail. Drawing on transitoriness, the phenomenon is presented with the help of the evolutionary concept analysis by Rodgers (2000). The phenomenon's characteristics and attributes are identified, as well as potential areas of application. Moreover, areas are outlined, in which interventions for nursing practice can be developed, implemented and evaluated. Thus, nursing practice is updated to include new findings and innovation. Through concept analysis nursing phenomena can be described in more detail, enhanced or broadened for use in nursing practice. Such structured processes as concept analysis can be employed successfully for other nursing phenomena. Concept analyses can lead to the identification of tasks for the respective scientific discipline and professionals. Thus, concept analyses can lead to the concretisation of tasks in nursing.

Quality of life for caregivers of people with Alzheimer's disease.

AIM: This paper is a report of a study to describe the meaning of quality of life for caregivers of patients with Alzheimer's disease and to identify factors that affect their quality of life. BACKGROUND: The burden for informal caregivers and change in their quality of life can lead to patients being placed in nursing homes. Factors found to worsen caregivers' quality of life include strained finances, poor family functioning, difficult patient behaviour, financial burdens and the amount of time caregivers spend caring for family members with Alzheimer's disease. METHOD: A hermeneutic phenomenological design was used to study 32 informal caregivers of patients with Alzheimer's disease. Data were collected using interviews between November 2004 and June 2005. FINDINGS: Caregivers associated good quality of life with serenity, tranquility, psychological well-being, freedom, general well-being, good health and good financial status. Factors that caregivers said improved their quality of life were good health of the patient, independence from the patient, and more help in caregiving. Factors that worsened their quality of life were worries about the future and progression of the patient's illness and stress. CONCLUSION: Our findings may help healthcare professionals have a deeper understanding of the meaning caregivers give to quality of life and thereby aid in the design of strategies to maintain or improve quality of life. Intervention research is needed for caregivers in countries where this has not yet been performed. Researchers should also investigate whether different types of caregivers (spouse, adult child and friend) have different needs or problems.

Phase I participants' views of quality of life and trial participation burdens.

PURPOSE: Participants' perception of quality of life (QOL) and respondent burden have significant implications for investigators' ethical responsibilities to their subjects in phase I cancer trials. To address these responsibilities, analysis was conducted on participants' views of their experiences of a phase I trial, including the associated burdens and what constitutes QOL. PATIENTS AND METHODS: One hundred potential participants of the endostatin trial were surveyed. Sixteen of the 18 trial participants were interviewed extensively about their experiences on the trial. RESULTS: Participants described 'normality' as a baseline ability to function, be productive, and be free from symptoms of disease and side effects of treatment. Reflecting the relative nontoxicity of the study drug, participants contrasted their current QOL with their negative experience of previous cancer treatments and viewed their QOL as fairly good. However, participants emphasized that indirect and procedural burdens of trial participation had a significant impact on their current QOL. CONCLUSIONS: Candid descriptions of a trial's practical demands, in addition to potential physical complications in a trial, could improve the quality of informed consent.

Group dream work: a holistic resource for oncology nurses.

PURPOSE/OBJECTIVES: To explore dream work as a possible means for nurses to increase self-understanding and problem solving in personal and professional life. DESIGN: Hermeneutic phenomenologic, descriptive, and interpretive. SETTING: A comprehensive cancer center in the southern United States. SAMPLE: Six nurses with a mean age of 40 and 1-10 years of oncology nursing experience. METHODS: Interviews, guided by descriptive and interpretive phenomenology, were conducted with nurses before and one and six months after they participated in eight weekly sessions of a group focused on dream work. Phenomenologic analysis was done on verbatim transcriptions of all interviews. FINDINGS: Nurses found value in participating in dream groups, including having more open discussions about feelings and death, managing difficult situations, and attending to patients in the present. CONCLUSIONS: The value of learning to attend to dreams may be subtle but has value to nurses. IMPLICATIONS FOR NURSING: Incorporating dream work is one holistic intervention that may be useful to improve job satisfaction, communication, and relationships in this time of nursing shortage.

Cancer pain management and the JCAHO's pain standards: an institutional challenge.

Unrelieved pain is a major medical problem. In response to this problem, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) launched new standards for pain management in 1999. A review was conducted in five hospitals of 117 charts of 80 inpatients and 37 outpatients with cancer who had pain documented in their medical records to determine whether application of these JCAHO standards was documented. Pain assessment and management were not documented for most patients. Pain intensity was noted for 57% of outpatients and 53% of inpatients. When pain was documented, treatment was noted in 86% of outpatients' charts and 89% of inpatients' charts. Of those patients with documented pain, reassessment after treatment was reported in 34% of the outpatient charts and 44% of the inpatient charts. Work to properly manage cancer pain needs to continue, and the JCAHO standards provide a mechanism to evaluate practice documentation in order to improve care.

The experience of Italians caring for family members with Alzheimer's disease.

PURPOSE: To obtain a more complete understanding of the experience of Italian caregivers of people with Alzheimer's Disease (AD). DESIGN AND METHODS: In this phenomenological study of AD Italian caregivers, the participants were 26 family caregivers (6 men and 20 women, of whom 19 were spouses and 7 were children). FINDINGS: Six themes were identified in this analysis: changes in relationships, changes in lifestyle, difficulties in caring, hopes and fears for the future, family duty, and respectful treatment. Caregivers experienced profound changes in their lives, including changes in their relationships with patients, in their lifestyles, and in their relationships with other family members. Caregivers experienced difficulties in caring because of their lack of knowledge about the illness and the lack of support from the National Health System. Participants hoped to not see their loved ones' conditions worsen and hoped to see positive results from prescription medications. Moreover, they hoped that God would help them go on. Some caregivers feared that the illness was hereditary and that they would not be able to cope with it. The Italian caregivers' respectful treatment of the patients demonstrated their profound sense of family duty, which included encouraging the patients to do self-care and occupational activities. CONCLUSIONS: Similarities and differences among Italian caregivers and those in other countries are discussed, and implications for Italian health professionals and directions for future research are addressed.

Making use of qualitative research.

Many have discussed the importance of using research in practice. To understand this issue, we examined what authors of qualitative research in oncology said about the uses of their research findings. Analysis ofthe authors' implications sections was conducted with 42 articles published between 1995 and 2001 and indexed in either Medline or CINAHL The two categories from this analysis were implications for future research and communication. The categories and related subcategories are illustrated with selected quotes from some of the articles. Findings confirm the importance of language in health and illness.