Nausea, vomiting, and retching: complex problems in palliative care.

Patients with advanced cancer commonly experience nausea, vomiting, and/or retching (NVR) as a result of the malignant process and its treatment. Recently, increasing attention is being focused on end-of-life care, which includes relief or reduction of symptoms such as NVR. Pre-chemotherapy preparation and patient education in the palliative care setting are essential to preventing acute and delayed distress from NVR, as well as anticipatory symptoms. Careful assessment of chemotherapy-related symptoms should distinguish between the three phenomena rather than taking a global approach. Strategies for preventing anticipatory nausea, for instance, may differ significantly from those designed to reduce frequency of vomiting. Management of anticancer treatment-related NVR should incorporate both pharmacologic and nonpharmacologic approaches, whenever appropriate, with the overall goal of improving and/or maintaining the patient's quality of life.

An instrument to measure symptom experience. Symptom occurrence and symptom distress.

This article describes the development of an instrument that measures symptom experience (symptom occurrence and symptom distress). The Adapted Symptom Distress Scale-2 (ASDS-2), adapted from the McCorkle and Young Distress Scale, is a 31-item, 5-point, self-report paper-and-pencil instrument that measures patients' perception of the occurrence and distress of 14 symptoms: nausea, vomiting, pain, eating, sleep, fatigue, bowel elimination, breathing, coughing, concentration, lacrimation, changes in body temperature, appearance, and restlessness. Use of the instrument yields a total score for symptom experience, scores for symptom occurrence, scores for symptom distress, and subscale scores for six symptom categories: gastrointestinal, fatigue/restlessness, concentration, pain/discomfort, respiratory, and appearance. Reliability and validity were determined with well adults (n = 97), medical-surgical patients (n = 82), and oncology patients (n = 175). Findings revealed a Cronbach's alpha of 0.91 for symptom experience, 0.90 for symptom occurrence, and 0.76 for symptom distress. Cronbach's alpha for the subscales ranged from 0.38 for appearance symptoms to 0.83 for gastrointestinal symptoms. Inclusion of symptoms reported by patients with cancer strengthened content validity. A contrasted groups approach was used to demonstrate construct validity.

The Index of Nausea, Vomiting, and Retching: a new format of the lndex of Nausea and Vomiting.

PURPOSE/OBJECTIVES: To determine the reliability of the Index of Nausea, Vomiting, and Retching (INVR), a new format of the Rhodes Index of Nausea and Vomiting Form 2 (INV-2). DESIGN AND SETTING: A parallel form study was conducted at a large, Midwestern teaching hospital and a cancer center. SAMPLE: Convenience sample of 159 subjects: 40 obstetrical, 60 oncological, 59 medical/surgical. METHODS: Two instruments, the INVR and the INV-2, were administered approximately 30-60 minutes apart. One-half of the subjects completed the INVR first, and the other half completed the INV-2 first. MAIN OUTCOME MEASURES: Equivalency measures of reliability correlation coefficients for both instruments. FINDINGS: A high rate of agreement was found in the responses between the two forms. In cases of clear disagreement, the responses to the INVR were more frequently consistent than the responses to the original form. CONCLUSIONS: INVR has tested reliability and is more user friendly for the patient and the healthcare provider. IMPLICATIONS FOR NURSING PRACTICE: Nurses have a focal role in managing symptoms. Managing nausea, vomiting, and retching requires excellent assessment skills of the patient's personal symptom experience and knowledge of pharmacology. Efficient, cost-saving assessments require accurate self-report instruments that permit patients to quantify their symptom experiences. The INVR can provide a scientific base from which to prescribe and teach patients and may improve their quality of life. Reliable and valid self-reporting instruments are essential for managing these adverse symptoms.

Hospice patients' and nurses' perceptions of self-care deficits based on symptom experience.

Although the relief and/or control of physically, emotionally, and spiritually distressing symptoms are the hallmarks of hospice care, accurate assessment of the individual's unique and often rapidly changing symptom experience is lacking. The purpose of this descriptive, correlational study was to assess and quantify hospice patients' perceptions of their symptom experiences and those of the hospice nurse assessing them. A convenience sample of 53 hospice patients (32 males, 21 females), with a mean age of 69 years, from a large midwestern home-based hospice completed the Adapted Symptom Distress Scale Form 2 (ASDS-2) at admission, and at 2 and 4 weeks after admission. The Hospice Admission Intake was completed at admission. Individual hospice nurses completed the ASDS-2 within 24 hours of their hands-on assessment, in addition to the demographic characteristics profile. Findings indicated an improvement in symptom experience, distress, and occurrence scores from admission to week 2, and in the symptom experience and distress scores from admission to week 4. Hospice nurses tended to give higher symptom experience scores than the patients gave to themselves. These findings demonstrate the importance of obtaining information about symptom experience from the patient as well as the nurse.

Development of a preparatory sensory information videotape for women receiving chemotherapy for breast cancer.

This study describes the development and testing of a preparatory sensory information (PSI) videotape for women receiving chemotherapy for breast cancer. In telephone interviews, 40 women described the sensations they experienced before, during, and after receiving chemotherapy. Sensations described by the women were linked with procedural and temporal elements identified by certified advanced practice oncology nurses to develop a script for the PSI videotape. Women currently receiving chemotherapy or who had completed chemotherapy within the last 6 months were asked to share their experiences on videotape. After editing, a 20-minute PSI videotape was produced. Pilot testing with a group of 20 women demonstrated that the intervention helped to prepare them for the sensory experiences associated with chemotherapy and was helpful in developing anticipatory coping and self-care behaviors.

Partnership for health care. An academic nursing center in a rural community college.

Academic nursing centers, owned and administered by schools of nursing, provide ambulatory care in settings in which nurses are both health care providers and clinic managers. Such centers are growing in number within the United States (1,2). In contrast to academic health centers that are based on a medical model, they "give the client direct access to professional nursing services ... using nursing models of health" (3). Academic nursing centers provide accessible and affordable health care services to a variety of clients, including women and children, the elderly, the homeless, minorities, and low-income and underserved persons. They are based in diverse settings--schools of nursing, senior or neighborhood centers, public housing projects, storefronts, churches, schools, and mobile vans--and in some instances, they serve as home care providers (4). They have in common their ownership by schools of nursing.

Symptom experience.

OBJECTIVE: To provide an overview of symptom experience, symptom occurrence, and symptom distress. DATA SOURCES: Published articles relating to the symptom experience, symptom occurrence, and symptom distress of patients with cancer. CONCLUSIONS: Symptom experience must include both the occurrence and distress associated with the symptom. To adequately assess symptom experience, obtaining information from patient about the occurrence and distress of the symptom experience is essential. IMPLICATIONS FOR NURSING PRACTICE: Nurses and other health care professionals can perform an essential role in the identification and management of symptom experience, thereby improving patient quality of life.

Nausea, vomiting, and retching: the management of the symptom experience.

OBJECTIVES: To examine the physiology of nausea, vomiting, and retching (NVR); the impact of NVR on the patient: current measures to control NVR; and selfcare interventions. DATA SOURCES: Research studies, abstracts, and review articles relating to NVR associated with cancer treatment as well as pharmacological and nonpharmacological interventions. CONCLUSIONS: Management of the individual symptoms of NVR require expert, ongoing assessment of the patient's symptom experience that extends beyond the clinic or hospital visit. Although a number of pharmacological antiemetic agents are currently available and additional antiemetic drugs are in phase II or II trials, nonpharmacological interventions are essential to achieve effective management. IMPLICATIONS FOR NURSING PRACTICE: Continual assessment of the individual's symptom experience is imperative. Effective management of the symptom experience depends on the oncology nurses's ability to implement current knowledge of antiemetic, and other drugs; non-pharmacological interventions; and cost-effective and clinically useful patient outcomes.

Nurses' perceptions of antiemetic effectiveness.

PURPOSES: To determine which antiemetics are being used with ondansetron (Zofran, Cerenex Pharmaceuticals, Research Triangle Park, NC) for patients receiving emetogenic chemotherapy, identify the more frequently administered antiemetic regimens, and ascertain nurses' perceptions of the effectiveness of these regimens. DESIGN: Descriptive survey. SETTING: Continental United States. SAMPLE: A random sample (N = 962) of Oncology Nursing Society members who designate themselves as practicing in the area of chemotherapy. METHODS: The Antiemetic Drug(s)/Drug Combination(s) Inventory, an open-ended questionnaire soliciting information on first- and second-line antiemetic regimens for emetogenic chemotherapy protocols, was mailed to 5,950 oncology nurses. Descriptive statistics and nondistributive analysis were used to analyze the data. FINDINGS: Ondansetron was used in 7 of 10 antiemetic regimens, which accounted for 50% of the most frequently used regimens. Nurses rated first-line antiemetic combinations as highly effective. Ondansetron alone was ranked as the seventh most effective first-line antiemetic for cisplatin protocols and fifth for noncisplatin protocols. Nurses noted limitations of ondansetron use, which included delayed nausea and vomiting and the drug's high cost. CONCLUSIONS: Study participants indicated that a variety of drugs were used in antiemetic regimens. Ondansetron use has improved the control of post-chemotherapy nausea, vomiting, and retching. IMPLICATIONS FOR NURSING PRACTICE: Antiemetics are administered regularly in the hospital and home to decrease chemotherapy-related nausea, vomiting, and retching. Managing these side-effects requires superior assessment skills and extensive knowledge of pharmacologic actions. Patient and family education on antiemetics is essential in light of increased administration of outpatient chemotherapy.

Expectation and occurrence of postchemotherapy side effects: nausea and vomiting.

Although nausea and vomiting are among the most disruptive chemotherapy side effects, little is known about patients' expectations before therapy and their experience after chemotherapy. A stratified sample of 329 subjects on nine chemotherapy regimens were asked to list their expected symptoms and level of distress. The patients listed a total of 524 responses and 28 different symptoms. This paper focuses on the symptoms of nausea and vomiting. A statistically significant relationship (P = 0.015) was found between the patients' expectations of symptom experience and their expectations of symptom distress. No significant relationship was found between the expectation of the symptom and the actual symptom experience. These findings support the need for educational interventions that provide hopeful but realistic expectations of the unknown events for patients with cancer.

Sensory perceptions of women receiving tamoxifen for breast cancer.

Tamoxifen has been used as adjuvant treatment in advanced and early-stage breast cancer for the past decade. Recently this synthetic antiestrogen drug assumed a new role of chemoprevention for women at risk of developing breast cancer. The commonly occurring side effects associated with tamoxifen administration contribute to the acceptance of this antineoplastic drug for palliation and cure. However, there are no data about the sensory effects of women receiving tamoxifen. The purpose of this study was to elicit subjects' descriptions of sensory experiences while receiving tamoxifen. These descriptions are essential for developing nursing interventions to help patients use self-care behaviors and cope with the side effects of tamoxifen. Sensory data were collected from 20 women who had been receiving tamoxifen for at least 1 month and were not receiving any other chemotherapy. Subjects provided descriptors about all senses. The senses for which subjects most frequently provided descriptors were touch, taste, and sight.

Posters: innovative and cost-effective tools for staff development.

Nursing staff development educators can use the poster as a time- and cost-effective means to present essential information about policies and procedures as well as current, pertinent information about research findings. In this article, the authors present guidelines for preparation of successful poster presentations.

Sensory perception of patients on selected antineoplastic chemotherapy protocols.

Antineoplastic chemotherapy (ANCT) is a primary and adjuvant treatment modality for cancer. Although researchers have found that patients who are given preparatory sensory information before various health-care procedures experience less discomfort, literature describing subject's sensory experience before, during, and after ANCT is lacking. The purpose of this study was to elicit sensory responses from subjects before, during, and after one of six cycles of their initial course of treatment on one of two emetogenic ANCT protocols. These descriptions will be used to develop a preparatory sensory nursing intervention that may promote self-care and help cancer patients cope with the distress of chemotherapy. The Sensory Information Questionnaire was administered to a sample of 44 subjects who had just completed a cycle of ANCT. Subjects provided descriptors of all senses. The senses for which subjects most frequently provided descriptors were taste, touch, and smell. Descriptors varied for some sensations according to the chemotherapy drug protocols.

Quality of life in quadriplegic adults: a focus group study.

This article describes a study whose purpose was to provide additional information about the components of quality of life for quadriplegic individuals. A focus group technique was used to determine subjects' opinions about what constitutes an acceptable quality of life. Three focus groups with a total of 14 subjects met to discuss the topic. Transcripts of the interviews were analyzed to determine themes and to identify components of quality of life for these individuals. Findings indicate that the factors influencing quality of life for quadriplegics include inner strength/survival, finances, relationships, job/productivity, health, level of activity, assertiveness, and independence/dependence. These findings will provide health professionals and policymakers with information about what factors quadriplegics consider important to maintaining an acceptable quality of life. This knowledge is necessary for public policy development, resource allocation, and interventions that will enhance the quality of life for people affected by quadriplegia.

Nursing research. Making it easier.

Conducting nursing research, whether to fulfill a requirement for a graduate degree or to satisfy professional curiosity, often is frustrating for the novice researcher. This article presents strategies that can be used by staff development educators to assist nurse researchers in conducting research more efficiently.