Oncology Nurses' Knowledge, Confidence, and Practice in Addressing Caregiver Strain and Burden

OBJECTIVES: To describe nurses' practices, confidence, and knowledge of evidence-based interventions for cancer caregiver strain and burden and to identify factors that contribute to these aspects. 
. SAMPLE & SETTING: 2,055 Oncology Nursing Society members completed an emailed survey.
. METHODS & VARIABLES: Pooled analysis of survey results. Variables included the baseline nursing assessment, intervention, confidence, knowledge, strategies used, and barriers encountered. 
. RESULTS: Nurses tend to overestimate the strength of evidence for interventions not shown to be effective and have moderate confidence in assessing and intervening with caregivers. Having been an informal caregiver and having received care from an informal caregiver were associated with higher reported practice and confidence. Major strategies used were referral to social workers and others. Barriers reported were financial, caregiver emotional responses, and distance. 
. IMPLICATIONS FOR NURSING: An opportunity exists to increase nurses' knowledge and confidence in assessment and intervention with caregivers. Greater use of technology may help nurses overcome some barriers to working with caregivers. Findings can be used to plan continuing education, develop clinical processes, and identify resources nurses need to address strain and burden among informal caregivers.

Nursing knowledge, practice patterns, and learning preferences regarding chemotherapy-induced peripheral neuropathy.

PURPOSE/OBJECTIVES: To explore nurses' practice patterns, knowledge, and barriers related to chemotherapy-induced peripheral neuropathy (CIPN). DESIGN: Descriptive, cross-sectional. SETTING: The United States. SAMPLE: 408 oncology nurses. METHODS: A team of eight experts met and developed the CIPN nurse knowledge and preferences survey, which was electronically sent to randomly selected nurses. MAIN RESEARCH VARIABLES: The survey assessed nurses' knowledge and practice patterns regarding assessment strategies and barriers, evidence-based interventions, preferences for education, and perceived gaps in scientific knowledge. FINDINGS: Nurses in the survey lacked knowledge regarding neurotoxicity of specific agents and evidence-based treatments. CIPN-focused physical examinations and standardized measurement tools were infrequently used during assessment. The most frequently reported barriers to CIPN assessment included lack of access to measurement tools, lack of specialized skills needed for assessment, lack of confidence, and lack of time. Recommendations for future research included CIPN prevention research, exploration of CIPN-related effects on quality of life, and alternative treatments of CIPN. The majority of participants preferred online educational opportunities. CONCLUSIONS: Nurses do not consistently integrate evaluation and management of CIPN in their practices. IMPLICATIONS FOR NURSING: Educational offerings should incorporate web-based CIPN assessment and management content.

Professional nursing societies and evidence-based practice: strategies to cross the quality chasm.

The Institute of Medicine (IOM) published Crossing the Quality Chasm: A New Health Care System for the 21st Century nearly 10 years ago. Nursing societies are in a unique position to promote evidence-based practice (EBP). The purpose of this article is to describe EBP strategies that nursing societies can use to improve the quality of health care, thus decreasing the gap between research knowledge and practice. Nursing societies can take the lead in two key EBP activities: (1) development of evidence-based syntheses, systematic reviews, and guidelines for EBP; and (2) development, implementation, and testing strategies for these EBP resources to become available and used in clinical decision-making. The Oncology Nursing Society will be discussed as an exemplar of developing EBP programs and increasing knowledge of EBP and practice change resources for its members. The discussion stresses the importance of nursing society members and leaders in guiding their societies to contribute to the closing of the US health care quality chasm.

Symptom clusters in adults with chronic health problems and cancer as a comorbidity.

PURPOSE/OBJECTIVES: To identify and compare symptom clusters in individuals with chronic health problems with cancer as a comorbidity versus individuals with chronic health problems who do not have cancer as a comorbidity and to explore the effect of symptoms on their quality of life. DESIGN: Secondary analysis of data from two studies. Study 1 was an investigation of the efficacy of an intervention to improve medication adherence in patients with rheumatoid arthritis (RA). Study 2 was an investigation of the efficacy of an intervention for urinary incontinence (UI) in older adults. SETTING: School of Nursing at the University of Pittsburgh. SAMPLE: The sample for study 1 was comprised of 639 adults with RA. The sample for study 2 was comprised of 407 adults with UI. A total of 154 (15%) subjects had a history of cancer, 56 (9%) of the subjects with RA and 98 (25%) of the subjects with UI. METHODS: Analysis of existing comorbidity and symptom data collected from both studies. MAIN RESEARCH VARIABLES: Symptom clusters, chronic disease, and cancer as a comorbidity. FINDINGS: Individuals with chronic health problems who have cancer may not have unique symptom clusters compared to individuals with chronic health problems who do not have cancer. CONCLUSIONS: The symptom clusters experienced by the study participants may be more related to their primary chronic health problems and comorbidities. IMPLICATIONS FOR NURSING: Additional studies are needed to examine symptom clusters in cancer survivors. As individuals are living longer with the disease, a comprehensive understanding of the symptom clusters that may be unique to cancer survivors with comorbidities is critical.

Sleep wake disturbances in people with cancer and their caregivers: state of the science.

PURPOSE/OBJECTIVES: To review the state of the science on sleep/wake disturbances in people with cancer and their caregivers. DATA SOURCES: Published articles, books and book chapters, conference proceedings, and MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and the Cochrane Library computerized databases. DATA SYNTHESIS: Scientists have initiated studies on the prevalence of sleep/wake disturbances and the etiology of sleep disturbances specific to cancer. Measurement has been limited by lack of clear definitions of sleep/wake variables, use of a variety of instruments, and inconsistent reporting of sleep parameters. Findings related to use of nonpharmacologic interventions were limited to 20 studies, and the quality of the evidence remains poor. Few pharmacologic approaches have been studied, and evidence for use of herbal and complementary supplements is almost nonexistent. CONCLUSIONS: Current knowledge indicates that sleep/wake disturbances are prevalent in cancer populations. Few instruments have been validated in this population. Nonpharmacologic interventions show positive outcomes, but design issues and small samples limit generalizability. Little is known regarding use of pharmacologic and herbal and complementary supplements and potential adverse outcomes or interactions with cancer therapies. IMPLICATIONS FOR NURSING: All patients and caregivers need initial and ongoing screening for sleep/wake disturbances. When disturbed sleep/wakefulness is evident, further assessment and treatment are warranted. Nursing educational programs should include content regarding healthy and disrupted sleep/wake patterns. Research on sleep/wake disturbances in people with cancer should have high priority.