Caregiver responses and needs. An ambulatory bone marrow transplant model.

PURPOSE: This longitudinal, descriptive outcomes study was conducted to compare the emotional responses and needs of the caregivers of patients who undergo bone marrow transplantation (BMT) for hematologic malignancies, as observed in an inpatient/outpatient (IPOP) setting with those in an inpatient setting. DESCRIPTION OF STUDY: A convenience sample of 43 caregivers for patients undergoing either autologous or allogeneic BMT was selected from both the inpatient unit (n = 26) and the IPOP ambulatory setting (n = 17). Emotional responses were measured by the Profile of Mood States. The importance and satisfaction of informational, patient-care, and psychological needs were assessed with the Caregiver Needs Survey, a modified version of the Home Cancer Caregiver Needs Survey. Data were collected at six points across the BMT trajectory, from before the procedure to 12 months after. Descriptive statistics were used to report sample characteristics, emotional responses, and needs. Nonparametric statistics were used to compare the IPOP and inpatient caregiver groups, and to identify relationships between emotional responses and needs within groups. RESULTS: IPOP caregivers were found to have significantly less mood disturbance at points before discharge. Both groups showed a decrease in mood disturbance 6 and 12 months after BMT. IPOP caregivers had higher levels of satisfaction of their informational and psychological needs at day 21. Significant correlations between total mood disturbance and satisfaction of informational, psychological, and patient-care needs were found for inpatient caregivers across treatment time points. CLINICAL IMPLICATIONS: These findings support the IPOP model of care as being less emotionally distressing for and better meeting the needs of family caregivers. Specific implications for practice include the importance of caregiver education in the area of patient-care information and of assessment and intervention to meet caregiver psychological needs. Continued evaluation of the impact of changes in care delivery on family caregivers is essential for the provision of comprehensive cancer care.

Scanner technology for data-based decision making.

Scanner systems offer several benefits to nurse executives. Clinical, educational, and administrative data can guide the nurse executive's decisions providing greater control over patient care outcomes. Information from large patient care data sets provides a powerful tool for persuading executives in other departments. Additionally, the nurse executive who can eliminate the need for personnel to conduct time consuming and costly manual data entry, may be able to justify financial support for continued development of the nursing department's information system and technological training for the staff. In this way, scanner technology meets the immediate need for information and serves as an entry to more advanced communications systems.

Randomized clinical trials: issues for researchers.

The clinical trial is a randomized prospective study of human subjects in which the effectiveness of an intervention is compared against a control. Such a trial is considered to be a critical test of an innovative therapy. Trials require careful design and planning to be scientifically valid and clinically pertinent. In this review the clinical trial and its role in research are defined, and major ethical, methodological, and feasibility issues associated with trial design and organization are described.