The Berlin Social Support Scales: Validation of the Received Support Scale in a Canadian sample of patients affected by melanoma.

The purpose of this study was to examine the reliability and validity of the Received Support Scale of the Berlin Social Support Scales in a Canadian sample of English and French language melanoma patients (N = 137). Participants received a skin self-examination education and completed self-report questionnaires. Exploratory factor analyses, reliability analyses, and independent samples t-tests were conducted. Findings support the unidimensionality of the Received Support Scale of the Berlin Social Support Scales. The psychometric similarities of the French and English versions of the scale, its strong internal consistency, as well as its convergent and discriminant validity support the use of the Received Support Scale of the Berlin Social Support Scales in patients with melanoma.

Intentional partnering: a grounded theory study on developing effective partnerships among nurse and physician managers as they co-lead in an evolving healthcare system.

AIM: The aim of this study was to describe the process of how nurse and physician managers in formalized dyads work together to address clinical management issues in the surgical division of one hospital setting. BACKGROUND: Nurse and physician managers are uniquely positioned to co-lead and transform healthcare delivery. However, little is known about how this management dyad functions in the healthcare setting. DESIGN: A constructivist grounded theory approach was used to investigate the process of how nurse and physician managers work together in formalized dyads in an urban Canadian university affiliated teaching hospital. METHODS: Data collection occurred from September 2013-August 2014. Data included participant observation (n = 142 hours) and intensive interviews (n = 36) with nurse-physician manager dyads (12 nurses, 9 physicians) collected in a surgical department. Theoretical sampling was used to elaborate on properties of emerging concepts and categories. RESULTS/FINDINGS: A substantive theory on 'intentional partnering' was generated. Nurses' and physicians' professional agendas, which included their interests and purposes for working with each other served as the starting point of 'intentional partnering'. The theory explains how nurse and physician managers align their professional agendas through the processes of 'accepting mutual necessity', 'daring to risk (together)' and 'constructing a shared responsibility'. Being credible, earning trust and safeguarding respect were fundamental to communicating effectively. CONCLUSION: Intentional partnering elucidates the relational components of working together and the strategizing that occurs as each partner deliberates on what he or she is willing to accept, risk and put into place to reap the benefits of collaborating.

Return visits to the emergency department: what can we learn from older adults' experiences?

Unscheduled return visits to the emergency department (ED) represent a considerable segment of older adults' total visits to the ED. This study explores the factors that led to early return visits to the ED by older adults. Using a qualitative descriptive design, semi-structured interviews were conducted in a large teaching hospital with 15 older adults who returned to the ED within 2 weeks after an initial visit. From the interviews, three major themes emerged as precipitants that led older adults to return to the ED. These were Managing the Symptoms, Care Curing the Initial ED Visit, and Who I Am. The findings suggest that the main reason for older adults' return to the ED is the severity of the symptoms they experienced. Ensuring the timeliness of follow-up appointments and the provision of resources to support the transition home are identified as interventions that would improve the care provided in EDs.

Exploring the nature of facilitating interprofessional learning: findings from an exploratory study.

With the growing complexity in managing multiple disease and illness-related problems, increased attention is being paid to the importance of interprofessional education (IPE) in preparing students for working collaboratively with different professionals. Educational activities for mixed groups of health professional students are increasing, and facilitation of learning in interprofessional student groups is now acknowledged as an essential part of successful interprofessional learning activities. However, little is known about the strategies used by facilitators with students from different professions, and how they promote learning. Using data obtained through an analysis of videos taken as part of a large study of IPE and interprofessional practice, this study aimed to identify the pedagogical strategies and behaviours of facilitators participating in seven different learning activities with health care students from five different professions. The data captured student reactions and behaviours and provided insight into the dynamics of the interprofessional encounters. The findings showed that facilitating groups involved a complex interchange of three types of interaction between facilitators and students: facilitator-controlled interaction, facilitator-driven interaction and student-driven interactions. The findings also suggest that faculty development programs should assist facilitators to re-examine teaching approaches and encourage students to assume the responsibility for discussing issues and collaborating with others in all their interprofessional contacts. Continuity and stability in faculty development activities will better prepare clinical educators and young professionals to become interprofessional champions.

Psychosocial adjustment of men during the first year of prostate cancer.

BACKGROUND: The psychosocial dimension of prostate cancer has received increased attention over the past 2 decades. OBJECTIVES: The objectives of the study were to investigate the men's psychosocial adjustment over the course of the first year of prostate cancer and to examine the sense of coherence, couple cohesion and adaptability, sexual and urinary symptoms, and mood disturbance as predictors of their adjustment. METHODS: There were 81, 69, and 61 men visited at home prior to treatment (T1), 3 months later (T2), and 1 year after the first visit (T3), respectively. Repeated-measures analyses of variance were used to examine adjustment over time. Multiple regressions determined whether the predictors were associated with the adjustment domains. RESULTS: Sexual relationship deteriorated and social environment improved between T1 and T2. Between T1 and T3, sexual, domestic, and family relationships deteriorated, whereas social environment improved. Mood disturbance, sense of coherence, couple cohesion, and couple adaptability were predictors of psychological, vocational, and domestic domains at T1. At T2, mood disturbance and sexual functioning were predictors of healthcare, vocational, social, psychological, and family domains. At T3, couple cohesion and adaptability and urinary functioning were predictors to vocational, domestic, social, and psychological adjustment. CONCLUSIONS: During the first year of prostate cancer, men showed deterioration in sexual, close-family, and extended-family relationship domains. IMPLICATIONS FOR PRACTICE: Sexuality is an important topic, and spousal communication should be encouraged throughout the first year following diagnosis. Preparedness for the changes associated with prostate cancer along with continuing support to couples, rather than to patients only, might be the strongest approach to enhancing men's adjustment.

Do men and their wives see it the same way? Congruence within couples during the first year of prostate cancer.

OBJECTIVE: The purpose of this study was to determine the psychosocial adjustment congruence within couples through the first year of prostate cancer experience, and to explore the personal variables that could predict congruence within couples. METHOD: Eighty-one couples were interviewed at the time of diagnosis; 69 participated at 3 months and 61 at 12 months. Paired t-tests were used to examine dyadic congruence on seven domains of psychosocial adjustment. Repeated Measures ANOVAs were used to examine the congruence over time. Multiple regressions were used to determine whether mood disturbance, urinary and sexual bother, sense of coherence, and social support were predictors of congruence within couples on each of the adjustment domains. RESULTS: At time 1, couples had incongruent perceptions in 3 of 7 domains: health care, psychological, and social adjustment. Three months later, health care, psychological, and sexual domains showed incongruence within couples. One year after the diagnosis, there were incongruent perceptions only in sexual and psychological domains. There was little variation of the congruence within couples over time. Husbands and wives' mood disturbance, urinary and sexual bother, sense of coherence, and social support accounted for 25-63% of variance in couple congruence in the adjustment domains in the study periods. CONCLUSION: The findings suggested that there is couple congruence. Domains in which incongruence was observed are important targets for clinical interventions. Greater attention needs to be directed to assisting couples to recognize the differences between their perceptions, especially the ones related to the sexual symptoms and psychological distress.

Striving to respond to palliative care patients' pain at home: a puzzle for family caregivers.

PURPOSE/OBJECTIVES: to describe the types of pain patients in palliative care at home experience and how family caregivers assess them and intervene. RESEARCH APPROACH: qualitative using grounded theory. SETTING: family caregivers' homes. PARTICIPANTS: 24 family caregivers of patients with advanced cancer receiving palliative care at home. METHODOLOGIC APPROACH: semistructured interviews and field notes. Data analysis used Strauss and Corbin's recommendations for open, axial, and selective coding. MAIN RESEARCH VARIABLES: pain, pain management, family caregivers, palliative care, and home care. FINDINGS: caregivers assessed different types of pain and, therefore, were experimenting with different types of interventions. Not all family caregivers were able to distinguish between the different pains afflicting patients, and, consequently, were not selecting the most appropriate interventions. This often led to poorly managed pain and frustrated family caregivers. CONCLUSIONS: The accurate assessment of the types of pain the patient is experiencing, coupled with the most appropriate intervention for pain control, is critical for optimal pain relief as well as supporting the confidence and feelings of family caregivers who are undertaking the complex process of cancer pain management. INTERPRETATION: nurses involved with patients receiving palliative care and their family caregivers should be aware of all types of pain experienced by the patient and how caregivers are managing the pain. Nurses should be knowledgeable about different pain relief interventions to help family caregivers obtain accurate information, understand their options, and administer these interventions safely and effectively.

Family caregivers of palliative cancer patients at home: the puzzle of pain management.

The purpose of this grounded theory study was to understand the processes used by family caregivers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled "the puzzle of pain management," which includes four main processes: "drawing on past experiences"; "strategizing a game plan"; "striving to respond to pain"; and "gauging the best fit," a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.

Agreement on perceptions of quality of life in couples dealing with infertility.

OBJECTIVE: To examine the extent to which men and women seeking treatment for infertility were able to accurately perceive their partners' ratings of their quality of life (QOL). DESIGN: Cross-sectional prospective study. Quality of life was measured as a multidimensional construct. SETTING: Assisted reproduction clinic of a university hospital. PARTICIPANTS: One hundred and sixty-two couples participated. The men's and women's mean ages were 36.1 and 32.1 years, respectively. Most participants had no children, and no previous assisted reproduction attempts. METHODS: Men and women completed the World Health Organization-Quality of Life-Brief (WHOQOL-Brief) and the Beck Depression Inventory independently. Paired t tests were used to explore men's perceptions of their wives' QOL ratings and wives' perceptions of their husbands' ratings. Multiple regression and repeated-measures ANCOVA were used to examine the role of depression. RESULTS: Proxy assessments were consistently lower than self-reports on the domains of QOL. The influence of depression on agreement was minimal, and no gender effect was observed. CONCLUSION: Findings indicated little agreement in perceptions of the partner's QOL, with each partner tending to underrate the other's view. Practitioners need to consider the differences between partners to enable partners to better understand and support each other.

Family caregivers of palliative cancer patients at home: the puzzle of pain management.

The purpose of this grounded theory study was to understand the processes used by family caregivers to manage the pain of cancer patients at home. A total of 24 family caregivers participated. They were recruited using purposeful then theoretical sampling. The data sources were taped, transcribed (semi-structured) interviews and field notes. Data analysis was based on Strauss and Corbin's (1998) requirements for open, axial, and selective coding. The result was an explanatory model titled "the puzzle of pain management," which includes four main processes: "drawing on past experiences"; "strategizing a game plan"; "striving to respond to pain"; and "gauging the best fit," a decision-making process that joins the puzzle pieces. Understanding how family caregivers assemble their puzzle pieces can help health care professionals make decisions related to the care plans they create for pain control and help them to recognize the importance of providing information as part of resolving the puzzle of pain management.

Strategizing a game plan: family caregivers of palliative patients engaged in the process of pain management.

BACKGROUND: When cancer patients at the end of life stay at home, family caregivers are often directly implicated in the care. One challenge is pain management. They are often unprepared and unsupported as they attempt to meet this responsibility. There are few studies that examine what this responsibility entails. OBJECTIVE: The purpose of this article was to present one important process extracted from the results of a grounded theory study of family caregiver management of the pain of palliative cancer patients at home. Specifically, it will look at how family caregivers strategize to plan for pain management. METHODS: Twenty-four family caregivers participated. They were recruited using purposeful and then theoretical sampling. The data sources were taped, transcribed, semistructured interviews and field notes. Data analysis used Strauss and Corbin's open, axial, and selective coding. RESULTS: The process "strategizing a game plan," which includes the subprocesses of "accepting responsibility," "seeking information," and "establishing a pain management relationship" will be presented in this article. These processes were integral to pain management at home. CONCLUSIONS: These results highlight that, even when family caregivers accept responsibility for pain management, they are not always well prepared and require appropriate support to ensure optimal pain control. IMPLICATIONS FOR PRACTICE: Understanding that family caregivers are continuously engaging in specific processes as they prepare for and implement pain management strategies can help health care providers tailor their interventions to specific parts of the complex process of family caregiver management of palliative care cancer patients' pain.

Investigating quality of life and health-related quality of life in infertility: a systematic review.

OBJECTIVE: To review the findings on quality of life (QOL) and health-related quality of life (HRQOL) among infertile women, men and couples. DESIGN: Systematic review. METHODS: Publications between January 1980 and July 2009 in Medline, PsycInfo, Embase and Health and Psychosocial Instruments were compiled using the following inclusion criteria: papers published in peer-reviewed journals; written in English, French, Spanish or Portuguese; presented original findings; assessed quality of life or health-related quality of life as an outcome; included infertile subjects without other clinical conditions; used validated measures. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Quality of life and health-related quality of life. RESULTS: Fourteen studies were included in the review. Educational level, will to have children, poor marital relationship, previous in-vitro fertilisation attempt and duration of the infertility were predictors of lower mental health scores in infertile men. Women had significant lower scores on mental health, social functioning and emotional behaviour. Among infertile subjects, women had lower scores in several QOL or HRQOL domains in comparison to men. CONCLUSIONS: Evidences indicate important QOL or HRQOL impairments in infertile women. Among men, it does not appear to be intense. There is scarce knowledge regarding the impact of infertility on couples.

Psychological distress as predictor of quality of life in men experiencing infertility: a cross-sectional survey.

BACKGROUND: Infertility is associated with impairment in human life. The quality of life (QOL) construct allows measuring the impact of health conditions in a broader way. The study aimed to explore the impact of the psychological distress on QOL's dimensions in men experiencing infertility. METHODS: 162 men were completed a socio-demographic form, SF-36, WHOQOL-BREF, Beck Anxiety Inventory and Beck Depression Inventory. Hierarchical regressions included demographic and clinic variables, and subsequently depression and anxiety were added. RESULTS AND DISCUSSION: Model 1 was not accurate in predicting QOL. R2 values ranged from 0.029 (Social Functioning) to 0.149 (Mental Health). Eight domains were not associated with any of the predictors. In the second model, a R2increase was observed in all domains. R2 of QOL scores ranged from .209 (Role Physical) to .406 (Social Functioning). The intensity of the depression was a significant predictor for all outcomes. The load of depression was higher than the ones of the socio-demographic and clinical variables. Anxiety levels have also presented the same effect, but with less intensity. CONCLUSION: Subthreshold depression and anxiety were major predictors of QOL in men experiencing infertility. Health professionals need to include assessment of psychological symptomatology to plan more efficient interventions to infertile patients.

A conceptual framework contributing to nursing administration and research.

The health care system has undergone major changes in the last decade. With greater acuity and complexity of illness, the adoption of innovative technologies and the shortage of health care personnel, the coordination and integration of health care services has become increasingly demanding for administrators. Growing dissatisfaction and concerns about safety issues are being expressed by the users of care who need to navigate through an increasingly complex system and by health care personnel who feel less efficient within the organization. Nursing administrators have a responsibility to address these issues but there is little scientific evidence to guide their actions. There are also few comprehensive models highlighting the main components of nursing administration - models that could guide nursing administration research. This paper presents a conceptual framework for nursing administration and research that links patient health care needs, nursing resources and the nursing care processes to the context of the health care system, and the social, political and cultural environments of care. A selected review of the oncology and cancer care literature is presented to demonstrate how this framework can organize existing knowledge about these concepts in the context of cancer care.

Adaptation of wives to prostate cancer following diagnosis and 3 months after treatment: a test of family adaptation theory.

BACKGROUND: Prostate cancer challenges not only the men with the disease, but also their partners. Existing studies have focused on the relationship between type of treatment and sexual and urinary function in men, with recent qualitative work suggesting that men and their spouses have differing responses to the illness. Factors predicting women's adaptation to prostate cancer have not been examined. OBJECTIVES: Using a model derived from family stress and adaptation theory, this study examined (1) the contribution of urinary and sexual symptoms, sense of coherence, marital resources and situational appraisal to wives' global adaptation (PAIS) and emotional adaptation (POMS), and (2) the role of situational appraisal as a mediator between the set of independent variables and PAIS and POMS. DESIGN: In a prospective, correlational design, data were collected from 70 women following their partners' diagnosis and again 3 months later. METHODS AND RESULTS: Using a path analysis approach, between 30% and 62.7% of the variance in global adjustment and mood disturbance was explained across model tests. Sense of coherence was a strong and consistent predictor. Appraisal acted as a mediator only at time 2, mediating the effect of symptom distress on global adaptation. Change in sense of coherence and change in family resources predicted global adaptation and emotional adaptation at time 2, and predicted the change between time 1 and 2 in those variables. CONCLUSIONS: The findings suggest nursing interventions that mobilize and build wives' sense of the manageability, meaningfulness and comprehensibility of life events, and that foster cohesion and flexibility within the marital relationship. Interventions that mitigate the impact of urinary symptoms and the appraisal of threat in the illness event are also indicated. Additional model-testing studies based on family adaptation theory with patients and family members in other types of cancer would help build nursing knowledge for interventions in cancer.

My love is hurting: the meaning spouses attribute to their loved ones' pain during palliative care.

The purpose of this qualitative study was to develop our knowledge of the pain experiences of family members by addressing the meaning of cancer pain to the spouse of a patient receiving palliative care. In particular, this study explored factors associated with the meanings the spouses ascribe to the experience of pain during palliative care and whether the meanings the patients attributed to pain were similar to the meanings held by the spouse. Two different states emerged, the "in-pain state" and the "out of pain state". The spouses described feelings of helplessness, fear, and unfairness when witnessing their loved one in pain. Once the pain had been controlled, spouses described feelings of peace and relaxation, and felt this meant that the couple could return to their old routines because their spouse was still alive. It was discovered that the meanings placed on the cancer pain differed for the spouse and the patient, with the spouse focusing on future consequences. Implications and suggestions for nursing practice and future research are proposed.

Living in it, living with it, and moving on: dimensions of meaning during chemotherapy.

PURPOSE/OBJECTIVE: To explore the meanings assigned to the experience of receiving chemotherapy. DESIGN: Descriptive exploratory. SETTING: An oncology outpatient clinic in a university hospital in Montreal, Quebec, Canada. SAMPLE: Ten women with breast cancer who experienced chemotherapy for the first time. METHODS: Semistructured interview using a grounded theory approach. FINDINGS: Women described three dimensions of their experience with breast cancer and chemotherapy: "living in it," "living with it," and "moving on." Existential and situational meanings were an integral part of their experience. The existential meaning seemed to be present in varying degrees of intensity throughout the treatment, whereas the situational meanings were predominant at the beginning of the treatment phase and became less important as the treatment progressed. CONCLUSIONS: The intrapersonal and interpersonal dimensions of the chemotherapy experience as well as the capacity to move on evolve within a context of both situational and existential meanings. IMPLICATIONS FOR NURSING PRACTICE: The study results suggest the potential value of exploring each woman's inner world of meanings in relation to her sense of self, relationships with others, resources, and coping strategies during treatment for breast cancer. Because existential and situational meanings are an integral part of women's experience, the nurse's role is to create an environment that permits and facilitates dialogue about these dimensions of meaning.