Problem-solving cancer care education for patients and caregivers.

PURPOSE: A program evaluation was conducted to explore the potential effects of a 90-minute problem-solving education session for persons with advanced cancer and their families. DESCRIPTION OF PROGRAM: Patients with advanced cancer and their families, who were visiting a tertiary-care outpatient setting, were invited to attend a 90-minute individualized educational session that taught basic problem-solving principles using a cognitive-behavioral framework. Pre-education and posteducation data were collected about the confidence of participants in providing care, their feelings about being informed about resources, and their perceptions of their problem-solving ability. RESULTS: At baseline, most participants reported low confidence about their ability to provide cancer care and felt uninformed about community resources, but they viewed themselves as moderate-to-good problem solvers. Forty-two educational sessions were delivered to 49 caregivers and 40 patients. Two months later, participants reported feeling more informed about community resources and achieved higher posteducation scores for problem-solving ability. More caregivers than patients reported that reading The Home Care Guide for Cancer made a great deal of difference in their approach to home care. CLINICAL IMPLICATIONS: Most educational sessions for families affected by cancer focus on delivering information, not on building skills. These findings suggest that a one-on-one educational session that teaches problem-solving skills can be successfully delivered in a busy clinic setting. Family caregivers are especially likely to benefit from this program.

Family reports of cancer pain, pain relief, and prescription access.

PURPOSE: The authors 1) describe family caregiver reports of degree of pain, pain relief, and prescription access in persons with advanced cancer during the last 4 weeks of life and 2) test for differences according to geographic location and care setting. DESCRIPTION OF STUDY: A randomized, stratified sample of 375 caregivers was produced from a list of all state residents who died of cancer in 1994. Written informed consent was received from 170 family caregivers (46%) who were then interviewed by telephone. Caregiver responses regarding pain intensity, pain relief, prescription access, and care setting were analyzed. RESULTS: Eighty-six percent (n = 147) of caregivers reported that pain was a problem, and 61% (n = 103) recalled a great deal to quite a bit of pain compared with 25% (n = 44) who recalled some or little pain. The mean degree of pain was 2.23 (SD +/- 1.32) on a scale of 1 (a great deal) to 5 (no pain). Of 140 caregivers reporting pain relief data, 46% (n = 64) reported that interventions either stopped the pain or that pain became much better, whereas 54% (n = 76) reported that interventions made the pain a little better, had no effect, or made it worse. The overall mean of pain relief was 2.62 (SD +/-.87) on a scale of 1 (usually stopped the pain) to 5 (made it worse). Greater degrees of pain were associated with reports of less pain relief (r = -19; P =.02). No differences in pain or pain relief were found across county type or patient care setting. Caregivers in the institution-only group (n = 18) recalled lower degrees of pain and the home-only group (n = 61) reported the most pain relief. Many in this latter group were served by hospice and home health nurses, and only 4% of the entire sample were served by physicians alone. Notably, 12% (n = 21) of the sample reported problems filling prescriptions. Of these, half had difficulty obtaining medicine because it was "not available." A total of 48 problems with prescription access were found that were distributed evenly across county types and patient care settings. CLINICAL IMPLICATIONS: Findings suggest that caregiver reports about the degree of pain or the effectiveness of pain interventions do not vary by residence or care setting at the end of life. Pain relief is moderate at best. Health professionals in all patient care settings should routinely address the issue of obtaining and paying for prescriptions, and local cancer pain task forces should be formed to advocate for better pain relief. An additional solution is to equip families with problem-solving skills specific to cancer pain.

Using pictographs to enhance recall of spoken medical instructions.

Pictographs have been used in nonliterate societies to help people remember spoken instructions and, today, they could be used to help nonliterate people remember spoken medical instructions. This study tested the hypothesis that pictographs can improve recall of spoken medical instructions. Twenty-one junior college subjects listened to lists of 38 actions for managing fever and 50 actions for managing sore mouth. One of the action lists was accompanied by pictographs during both listening and recall while the other was not. Subjects did not see any written words during the intervention and, therefore, relied entirely on memory of what they heard. Mean correct recall was 85% with pictographs and 14% without (P < 0.0001) indicating that pictographs can enhance memory of spoken medical instruction--often to a very high level. For this technique to be clinically useful, further research is needed on how to achieve accurate recall of large amounts of medical information for long periods of time by nonliterate patients. By viewing illiteracy as a memory problem, the large body of research on learning and memory can be utilized in designing education materials for this group.

The effects of community differences on health status, health stress, and helping networks in a sample of 900 elderly.

Documenting the social and environmental conditions that promote the health and well-being of individuals is an important step in the advancement of community health nursing knowledge. With the current growth of community-based health care, it would seem to be a prerequisite for planning community-level interventions. The purpose of this research was to link structural properties of communities to the functioning of individuals. We examined the link between levels of community education and percent population change as derived from census data from 18 randomly selected communities and individual measures of health, health stress, and network support in a sample of 900 elderly living in these communities. Results indicate that when community education levels are high, community growth does not affect the health of the elderly which results in less stress with health and the need for fewer helpers. If, however, community education levels are low, and the population is growing, elderly experience poorer health and more health stress and they need more help.

The prepared family caregiver: a problem-solving approach to family caregiver education.

Early hospital discharges, greater reliance on outpatient care, and the growing prevalence of chronic diseases has increased the demands on family members who care for patients at home. Family caregivers need information and training to insure that patients' needs are met and that home care is coordinated with that of health professionals. We propose a prescriptive problem-solving model for how care should be managed at home and for the kinds of information and training family caregivers should receive. The Prepared Family Caregiver model, which is summarized in the acronym COPE (Creativity, Optimism, Planning, and Expert information), teaches family caregivers how to develop and carry out orderly plans which address both medical and psychosocial problems and are coordinated with care plans of health professionals. The model is based on extensive research on problem-solving training and therapy. It empowers family members and patients for coping with illness and can help to moderate caregiver stress.

Scanning electron microscopic examination of ultrasonic and effervescent methods of surface contaminant removal from complete dentures.

Dentures were examined by scanning electron microscopy to evaluate removal of surface contaminants such as plaque, calculus, microflora, and cigarette smoke. Ten complete dentures were obtained during patient appointments and prepared for SEM examination. Samples from 10 control surfaces, 10 surfaces cleaned with effervescent cleansers, and 10 surfaces ultrasonically cleaned were photographed at x5000. One photograph of each sample was evaluated in random order by five judges for a total of 150 observations. Photographs were compared with one of a clean denture sample. Statistical analysis of the results validated the superiority of the ultrasonic method for cleaning dentures.

Quality assurance feedback as a nursing management strategy.

Quality assurance and effective nurse management can be viewed as intersecting goals. Objective feedback derived from quality assurance data is a potentially powerful means of enhancing nurses' performance and job satisfaction. The use of automated information systems to provide such direct feedback offers the additional advantage of recognizing nurses as self-monitoring, self-correcting professionals. The need, opportunity, and challenge involved in meshing quality assurance with human resource management through computer-generated feedback are discussed in the context of the home health care setting.

Preliminary observations on the effect of mantle field radiotherapy on salivary flow rates in patients with Hodgkin's disease.

Changes in stimulated and non-stimulated whole saliva flow rates were measured in 11 Hodgkin's disease patients who received therapeutic doses of radiation to a mantle field at the M. D. Anderson Hospital in Houston, Texas. Salivary flow rates were examined before, during, and after radiotherapy. Mean flow rate reductions of 54% for non-stimulated saliva and 55.7% for paraffin-stimulated saliva were observed post-radiotherapy. Flow rates had not returned to pre-irradiation levels in any of the patients who were observed for two to three months after completion of therapy. Results obtained from this preliminary study indicate that most patients who receive therapeutic doses of radiation to a mantle field experience a significant reduction in salivary output which is manifest during the period of treatment and persists for a period of at least two to three months post-radiotherapy.