Social support as a buffer to the psychological impact of stressful life events in women with breast cancer.

BACKGROUND: Three theoretical models by which social support may influence the impact of stressful life events on cancer patients' psychological state were tested: 1) the additive model, in which social support and stressful life events each directly influence cancer patients' adjustment, irrespective of the magnitude of the other; 2) the buffering hypothesis, in which stressful events occurring in the presence of social support should produce less distress than if they occur in its absence; and 3) both additive and buffering models. METHODS: One hundred seventy-nine patients who had Stage II breast cancer (median age, 56 yrs; 68% disease free), treated a mean of 6.8 years since entry to Cancer and Leukemia Group B (CALGB) 8541, were interviewed by telephone concerning their psychosocial adjustment. The following measures were used: Medical Outcome Study Social Support Survey (MOS-SSS), Life Experience Survey (LES) a measure of stressful life events within the past 12 months, European Organization for Research on the Treatment of Cancer (EORTC QLQ-C30) a measure of quality of life, Mental Health Inventory (MHI), and the Systems of Belief Inventory (SBI) a measure of spiritual and religious involvement. RESULTS: Hierarchical regression analyses revealed that less than excellent levels of social support (P < 0.01), greater negative impact of LES fateful life events (e.g., death of family member) (P < 0.05), personal illness or injury (P < 0.05), and all other negative life events in the past year (< 4; P < 0.01) were significant predictors of greater MHI psychological distress, in addition to being divorced or separated (P < 0.001), and more recently treated for cancer on CALGB 8541 (P < 0.05). The interaction of LES scores with MOS-SSS or SBI social support, used to test the buffering hypothesis, did not significantly improve the prediction of MHI psychological distress. CONCLUSIONS: The results supported the additive model, with both stressful life events and social support independently and significantly affecting patients' emotional state. However, the level of social support needed to be very high to reduce the likelihood of severe psychological distress.

Weaning the long-term ventilator-dependent patient: common problems and management.

Weaning methods are an important ingredient in successful extubation. All too frequently, however, patient problems that thwart weaning are not identified or controlled. The pre-weaning assessment form in Table 2 should be used as an evaluation tool after the patient is intubated. Any "no" answers will indicate a common problem impeding weaning. Following problem identification, a plan of care can be developed using management strategies described in Table 3. Thus, a critical void in practice, impediments to weaning, is addressed. This article has addressed the need for the prevention or early identification of problems in mechanically ventilated patients. With this knowledge to guide our practice, we should be able to wean almost any patient.

Pulmonary nurse specialists: preparation for the advanced practice role.

A survey was done to determine the factors that influence nurses' decisions to prepare as specialists in pulmonary nursing. A questionnaire that included items concerned with biographic variables and perceptions toward pulmonary nursing was distributed on selected adult units of two medical centers and one community hospital in south central Connecticut. Data were collected from 113 medical-surgical nurses. Subjects were primarily women (96.5%) and in the 20-30 age range (mean = 30, SD = 7.06, median = 27.6). On the average, subjects had been employed for 7.5 years (7.03, median = 5.37). Thirty percent of the sample expressed a desire to work with pulmonary patients. This group had a positive score on the semantic differential (p = 0.0001). Nurses (N = 11) who had worked with a pulmonary clinical specialist rated their impression of caring for pulmonary patients more positively than those who had not (p = 0.044). Although only 13 subjects expressed an interest in preparing as a pulmonary nurse specialist, they had a positive score on the semantic differential (p = 0.0001). Limitations, recommendations for further study, and implications for nursing and nursing education are addressed.

Analysis of meal census patterns for forecasting menu item demand.

The purpose of this research was to identify functional relationships between the patient census and the official institutional census recorded at midnight for hospital inpatients and for mental health patients cared for in a satellite facility at the University of Missouri-Columbia Health Sciences Center. Investigation of these relationships was necessary to provide knowledge essential for the design of a statistical menu item forecasting system. Patient census for three meals (breakfast, lunch, and supper) was compared with the midnight census, using graphical analysis and analysis of variance. Reliable patterns were identified in the patient census data which required accommodation in a mathematical forecasting model. Three forecasting design options were identified and appraised. The simplest design option and the two more complex design options forecasted identical quantities.