Uncertainty, symptom distress, and information needs after surgery for cancer of the colon.

The purpose of this study was to determine the relationships between uncertainty, symptom distress, and discharge information needs in individuals after a colon resection for cancer. The theoretical framework for the study was derived from Lazarus and Folkman's stress, appraisal, and coping model, and Mishel's theory of uncertainty in illness. Uncertainty was measured by the Mishel Uncertainty Illness Scale (MUIS); symptom distress of pain, fatigue, constipation, diarrhea and loss of appetite by visual analogue scales; and discharge information needs by the Patient Learning Need Scale (PLNS). Forty individuals with a first diagnosis of cancer were interviewed after surgical resection of colon cancer. The study results indicated that they had moderate levels of uncertainty, low levels of symptom distress, and a moderate number of discharge information needs. Information related to treatment, complications, and activities of living were identified as highly important. An increase in uncertainty was significantly associated with an increase in discharge information needs. Increased attention to information needs at discharge may decrease an individual's level of uncertainty and facilitate the transition from hospital to home.

An educational program to improve quality of life for individuals with acoustic neuroma.

Nursing management of the patient with an acoustic neuroma begins during the preoperative period and continues into the rehabilitative phase following hospital discharge. This article describes the process of developing and implementing an acoustic neuroma educational program. Program content was determined by a survey which identified the type of information acoustic neuroma patients wanted before and after surgery. The survey also described the problems patients encountered once home. Included in the program is a preoperative informational video, a discharge booklet, a multidisciplinary rehabilitation group for outpatients and educational sessions for nurses from the hospital and community.

Young adults' reactions to the death of a parent.

Reactions to the death of a parent were explored in a sample of 19 adults, who were 20-39 years at the time of their parents' deaths. The majority of the young adults' parents died of cancer or heart disease in a hospital setting. Young adults' grief was often profound and accompanied by varying degrees of somatic and psychological disruption. The adults expressed a need for support and recognition of the fact that their loss was significant. Dealing with personal grief frequently was complicated by the restructuring of relationships within the family of origin. The young adults experiencing the death of a parent reported expanded perceptions of life, altered sensitivity to the passage of time, and increased importance of family ties. Nurses can assist young adults at the time of a parent's death by providing anticipatory guidance and interpersonal support.

Nursing care of a patient with a subphrenic abscess.

A subphrenic abscess is an abscess which forms below the diaphragm and above the transverse colon. Patients in the postoperative period following gastric, esophageal or hepatic surgery are at risk of developing a subphrenic abscess especially if they are older, if they develop a leak at an anastomosis site or if there was a high operative blood loss. Nurses who are aware of high-risk patients should increase their observations of the signs and symptoms of early subphrenic abscess. Subphrenic abscesses are often managed on the general nursing units but signs of impending respiratory failure or circulatory collapse may warrant transfer of the patient to an intensive care unit. Nursing interventions are then focused on maintaining the body systems, evaluating the effects of the medical and nursing interventions and supporting the patient and family who may be very anxious at the severity of the unanticipated complication.

Informational needs of patients who undergo excision of an acoustic neuroma.

Individuals who undergo removal of an acoustic neuroma are usually apprehensive in spite of the intrinsically benign nature of the disease. Fears surrounding the experience are related to the real risks involved in surgery near the brain and the complications which can ensue. The intensity of the patients' feelings of anxiety and uncertainty might be decreased if nurses were aware of and attended to the informational needs of these patients. In order to describe the informational needs of acoustic neuroma patients, a retrospective survey of 21 subjects who had had removal of such a tumor six to eighteen months previously was carried out. The survey determined: (1) the type of information patients received preoperatively and postoperatively (2) the type of information patients wanted (3) the type of problems experienced postoperatively and (4) the length and severity of the problems if they occurred. Content analysis indicated that the majority of subjects experienced tiredness, depression, headache, and dryness of eyes and mouth in the postoperative and convalescent phases. The actual illness experience persisted much longer than the subjects had expected. Subjects expressed explicit informational needs related to self-management after the surgery. The implications for nursing care will be discussed and the recommendations for an interdisciplinary patient education programme will be outlined.