Patients' and healthcare providers' opinions regarding advance directives.

PURPOSE/OBJECTIVES: To gain a better understanding of patients' and healthcare providers' preferences regarding when, how, and by whom advance directive information should be given and to explore the nursing role in advance directives. DESIGN: A qualitative study using focus group methodology. SETTING: A National Cancer Institute-designated comprehensive cancer center located within a large, university-affiliated, tertiary care hospital in the northeastern United States. SAMPLE: Two samples participated in the study: eight adult ambulatory patients with cancer and 15 healthcare providers (4 physicians, 10 nurses, and 1 social worker). METHODS: Separate patient and provider focus groups were conducted in private rooms by experienced facilitators using an interview guide with questions based on the literature, the hospital's advance directive materials, and the investigators' experience; sessions were audio-taped, transcribed, and analyzed using qualitative data analysis techniques. FINDINGS: Patients and healthcare providers discussed focus group questions and commented that advance directive discussions should be provided early in the treatment or illness, presented in a short and simple format with reading materials at a level appropriate for the patient, and continued throughout the illness with those who desire follow-up. Nurses, doctors, social workers, or a designated/trained advance directive person were individuals that the patients identified as people with whom they could have advance directive discussions. CONCLUSIONS: Results suggested that advance directive information should be given prior to hospital admission, be provided in a variety of formats, and that nurses, social workers, doctors, or designated staff representatives could all be part of the advance directive process. NURSING IMPLICATIONS: Nursing roles should include early assessment of patients to determine needs for discussion, advocacy on behalf of patients, and provision of information. Future research should examine use of specific personnel for facilitating advance directives and compare different formats for presenting advance directive information to patients.

A survey of research-related activities and perceived barriers to research utilization among professional oncology nurses.

PURPOSE/OBJECTIVES: To identify nursing staff members' current research-related activities, knowledge of research utilization, and perceived barriers to using research in practice. DESIGN: Descriptive, cross-sectional survey design with self-report questionnaires. SETTING: National Cancer Institute-designated comprehensive cancer center located in a mid-Atlantic metropolitan area. SAMPLE: Convenience sample of 82 registered nurses employed in the cancer center who completed and returned the questionnaire; the majority had baccalaureate degrees or higher, were an average of 33 years old, were nurses for a mean of 8.8 years, and worked at the center a mean of 5.6 years. METHODS: Four-part, 38-item, self-report questionnaires were distributed to nursing staff and a leadership group by members of the departmental Nursing Research Committee; respondents returned completed questionnaires to designated locations in the center. MAIN OUTCOME MEASURES: Knowledge and attitudes about research utilization, perceived barriers to using research in practice, and current research-related activities. FINDINGS: Most respondents were familiar with the concept of research utilization and found research to be of value to their practice. They cited a number of barriers to using research findings and reported little participation in research-related activities. Advanced clinical practitioners with master's degrees tended to participate more frequently in research-related activities. CONCLUSIONS: Although nurses appeared to be aware of research utilization and value it, they perceived barriers to using research findings in practice and did not routinely participate in research-related activities. The findings support other research in this area and reveal educational needs. IMPLICATIONS FOR NURSING PRACTICE: The findings provided baseline information for a departmental research utilization program and suggested strategies and activities that could be incorporated into the program.

The clinical application of research utilization: amphotericin B.

PURPOSE/OBJECTIVES: To describe the first application of the research utilization process by clinical nurses using the Stetler-Marram Model of Research Utilization to the practice of amphotericin B administration; to share the findings; and to discuss issues encountered in the process and their solutions. DATA SOURCES: Published articles identified through computerized literature searches, published abstracts and books, personal communication with one author, and an informal survey of other cancer centers' amphotericin B infusion practices; research articles were selected for review if studies included settings and patient populations similar to those of the authors and if they used experimental designs. DATA SYNTHESIS: Studies were reviewed for scientific merit and clinical applicability according to the Stetler-Marram model; findings were used to develop a specific nursing protocol for infusion times of amphotericin B based on clinical criteria. CONCLUSIONS: The Stetler-Marram model helped staff nurses decide how to apply research findings to practice, although using it was difficult and required mentorship. A research base exists for amphotericin B administration time but not for test doses or premedications to prevent or minimize side effects. IMPLICATIONS FOR NURSING PRACTICE: Staff nurses can use the Stetler-Marram model but need resources and support from individuals, committees, and administration. A specific protocol representing a practice change was implemented and may be applicable to other settings.