Perceived Symptom Experience in Head and Neck Cancer Patients with Lymphedema.

BACKGROUND: Lymphedema frequently develops as a long-term effect from cancer and/or its treatment, including head and neck cancer (HNC). There is a substantial lack of understanding regarding the symptoms and experiences related to head and neck lymphedema. OBJECTIVE: The objective of this study was to explore HNC patients' experiences of lymphedema, with emphasis on physical findings and associated symptom burden. DESIGN: This was a qualitative, descriptive study. A purposive sample of 20 HNC patients who completed lymphedema therapy participated in semistructured, face-to-face interviews. Thematic content analysis was utilized to assess data. RESULTS: Participants delineated the time when lymphedema onset presented and the sites of involvement. Most participants first noticed external or internal lymphedema/swelling within three months following either surgery or radiation therapy. Participants described a broad array of concurrent symptoms and functional deficits, including altered sensations, altered functions, neck-shoulder musculoskeletal/skin impairments, and psychosocial symptoms. DISCUSSION: HNC patients experienced multiple physical and psychosocial symptoms during the time they experienced lymphedema. CONCLUSIONS: Clinicians need to inquire about tissue swelling and associated symptoms early in the post-treatment period to initiate lymphedema management strategies in a timely manner and facilitate reduction of long-term symptom burden and functional deficits.

Guideposts to the future--an agenda for nursing informatics.

As new directions and priorities emerge in health care, nursing informatics leaders must prepare to guide the profession appropriately. To use an analogy, where a road bends or changes directions, guideposts indicate how drivers can stay on course. The AMIA Nursing Informatics Working Group (NIWG) produced this white paper as the product of a meeting convened: 1) to describe anticipated nationwide changes in demographics, health care quality, and health care informatics; 2) to assess the potential impact of genomic medicine and of new threats to society; 3) to align AMIA NIWG resources with emerging priorities; and 4) to identify guideposts in the form of an agenda to keep the NIWG on course in light of new opportunities. The anticipated societal changes provide opportunities for nursing informatics. Resources described below within the Department of Health and Human Services (HHS) and the National Committee for Health and Vital Statistics (NCVHS) can help to align AMIA NIWG with emerging priorities. The guideposts consist of priority areas for action in informatics, nursing education, and research. Nursing informatics professionals will collaborate as full participants in local, national, and international efforts related to the guideposts in order to make significant contributions that empower patients and providers for safer health care.

Integrated decision-making in response to weapons of mass destruction incidents: development and initial evaluation of a course for healthcare professionals.

INTRODUCTION: Standardized, validated training programs for teaching administrative decision-making to healthcare professionals responding to weapons of mass destruction (WMD) incidents have not been available. Therefore, a multidisciplinary team designed, developed, and offered a four-day, functional exercise, competency-based course at a national training center. OBJECTIVE: This report provides a description of the development and initial evaluation of the course in changing participants' perceptions of their capabilities to respond to WMD events. METHODS: Course participants were healthcare professionals, including physicians, nurses, emergency medical services administrators, hospital administrators, and public health officials. Each course included three modified tabletop and/or real-time functional exercises. A total of 441 participants attended one of the eight course offerings between March and August 2003. An intervention group only, pre-post design was used to evaluate change in perceived capabilities related to administrative decision-making for WMD incidents. Paired evaluation data were available on 339 participants (81.9%). Self-ratings for each of 21 capability statements were compared before and after the course. A 19-item total scale score for each participant was calculated from the pre-course and post-course evaluations. Paired t-tests on pre- and post-course total scores were conducted separately for each course. RESULTS: There was consistent improvement in self-rated capabilities after course completion for all 21 capability statements. Paired t-tests of pre- and post-course total scale scores indicated a significant increase in mean ratings for each course (all p < 0.001). CONCLUSION: The tabletop/real-time-exercise format was effective in increasing healthcare administrators' self-rated capabilities related to WMD disaster management and response. Integrating the competencies into training interventions designed for a specific target audience and deploying them into an interactive learning environment allowed the competency-based training objectives to be accomplished.