ABSTRACT
BACKGROUND:: Dyspnea is distressing in palliative patients with end-stage heart failure and many are hospitalized to optimize this symptom. We hoped to conduct a pilot study to determine whether the administration of intranasal fentanyl would decrease activity-induced dyspnea in this patient population. METHODS:: Patients performed two 6-minute walk tests with and without the administration of 50 µg of intranasal fentanyl. Vital signs were recorded before and after each walk, as were participant reported dyspnea and adverse events scores. RESULTS:: Twenty-four patients were screened, 13 were deemed eligible, and 6 completed the study. Dyspnea scores changed from a mean of 6.00 immediately after the walk without fentanyl to a mean of 3.83 after the walk with fentanyl ( P = .048). Mean respiratory rate decreased from 21.0 to 18.7 ( P = .034) breaths per minute and was considered a favorable outcome by the participants. Distance walked did not significantly increase with the fentanyl pretreatment (136.0-144.2 m; P = .283), although the participants reported feeling better while walking a similar distance. CONCLUSIONS:: In this pilot study, the preadministration of intranasal fentanyl prior to activity in palliative, end-stage hospitalized heart failure patients, safely reduced tachypnea, and the feeling of shortness of breath. This approach may help palliate advanced heart failure patients by alleviating symptoms brought on by exertional activities.
Subject(s)
Analgesics, Opioid/therapeutic use , Dyspnea/drug therapy , Dyspnea/etiology , Fentanyl/therapeutic use , Heart Failure/complications , Administration, Intranasal , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pilot ProjectsABSTRACT
PURPOSE/OBJECTIVES: To delineate the role of the oncology patient navigator, drawing from the experiences and descriptions of younger women with breast cancer. RESEARCH APPROACH: Interpretive, descriptive, qualitative research design. SETTING: Participants' homes, researcher's home, and via telephone, all in Winnipeg, Manitoba, Canada. PARTICIPANTS: 12 women aged 50 years or younger who were diagnosed with breast cancer within the last three years. METHODOLOGIC APPROACH: Face-to-face semistructured interviews explored patient experiences with the cancer care system, including problems encountered, unmet needs, and opinions about the functions of the patient navigator role. The audio-recorded interviews were transcribed and data were broken down and inductively coded into four categories. Constant comparative techniques also were used during analysis. FINDINGS: The role of the oncology patient navigator included two facets: "Processual facets," with the subthemes assigned to me at diagnosis, managing the connection, mapping the process, practical support, and quarterbacking my entire journey; and "Personal qualities: The essentials," with the subthemes empathetic care tenor, knowing the cancer system, and understanding the medical side of breast cancer. CONCLUSIONS: Despite the tremendous effort directed toward enhancing care for younger women undergoing treatment for breast cancer, gaps continue to exist. Younger women with breast cancer require a care approach providing ongoing dialogue, teaching, and emotional support from the point of diagnosis through treatment, including transitions of care within the oncology setting and back to their primary care practitioner. INTERPRETATION: Oncology nurse navigators are well positioned to provide patients with anticipatory guidance from diagnosis to the end of treatment.
Subject(s)
Breast Neoplasms/psychology , Patient Navigation , Professional-Patient Relations , Adaptation, Psychological , Adult , Age Factors , Anxiety/etiology , Breast Neoplasms/nursing , Female , Humans , Interview, Psychological , Manitoba , Middle Aged , Needs Assessment , Oncology Nursing , Patient Acceptance of Health Care , Patient Education as Topic , Patient Participation , Patient-Centered Care/organization & administration , Qualitative Research , Role , Social Support , Social Work , Uncertainty , Young AdultABSTRACT
PURPOSE/OBJECTIVES: To provide a critical analysis of a patient navigation model using the Synthesized Method of Theory Evaluation and the Criterion-Based Critique as frameworks for the analysis. DATA SOURCES: English-language research and clinical articles and Internet sources (CINAHL®, PubMed, and Google™ Scholar) on patient navigation up to April 2009. DATA SYNTHESIS: The British Columbia Patient Navigation Model (BCPNM) is a practical model developed from a psychosocial perspective. The BCPNM highlights the functions of the navigator for patients with cancer and is patient and family centered. CONCLUSIONS: The BCPNM provides a comprehensive framework for current patient navigation programs and can facilitate the development of future models. IMPLICATIONS FOR NURSING: The BCPNM is a useful model for nursing practice because it identifies and clearly highlights numerous functions that nurses provide. The model can serve as a guide for nurses who provide psychosocial interventions in a variety of oncology environments.
Subject(s)
Models, Nursing , Neoplasms/nursing , Neoplasms/psychology , Oncology Nursing/methods , Social Support , British Columbia , Culture , Humans , Nurse's Role , Philosophy, NursingABSTRACT
PURPOSE/OBJECTIVES: To provide a critical review of the empirical literature on anxiety in women with breast cancer using the physiologic, pathophysiologic, behavior, and experiential perspectives of the Human Response to Illness (HRTI) Model. DATA SOURCES: Research articles, clinical articles, and Internet sources on breast cancer and anxiety. Literature sources included CINAHL, PubMed, and PsycINFO, incorporating English language reports through March 2009. DATA SYNTHESIS: Patients with breast cancer experience fluctuating levels of anxiety throughout their diagnosis and treatment trajectory. Anxiety may influence an individual's response to treatment, treatment decision making, and overall quality of life. CONCLUSIONS: Research consistently demonstrates that anxiety in patients with breast cancer can have a negative effect on patient outcomes. IMPLICATIONS FOR NURSING: The insight gained from exploring anxiety within the context of the four interrelated perspectives of the HRTI model fosters the provision of optimal care for patients suffering with anxiety throughout their breast cancer illness trajectory.
Subject(s)
Anxiety/nursing , Anxiety/psychology , Breast Neoplasms/nursing , Breast Neoplasms/psychology , Models, Psychological , Female , Humans , Oncology NursingABSTRACT
PURPOSE/OBJECTIVES: To summarize the current scientific literature pertaining to the role of the patient navigator in oncology using the concept analysis framework developed by Walker and Avant. DATA SOURCES: Published research articles, clinical articles, and Internet sources on patient navigator roles and programs. Literature was obtained from CINAHL, PubMed, PsycINFO, the Cochrane Library, and Google Scholar, incorporating reports in English from 1990-2008. DATA SYNTHESIS: Patient navigation has received a plethora of attention as healthcare programs strive to streamline care and address current gaps in service delivery. The literature revealed that the role of the patient navigator remains context-specific and has been filled by a variety of individuals, including nurses, social workers, peer supporters, and lay individuals. CONCLUSIONS: The role of a patient navigator includes removing barriers to care, improving patient outcomes, and ameliorating the overall quality of healthcare delivery. IMPLICATIONS FOR NURSING: By examining the role of the patient navigator depicted in the scientific literature, nurses can gain insight into not only the features of navigation but also the current systematic gaps that call for navigation services. This article examines the numerous functions of a patient navigator and exemplifies the significance of the role in various domains.
