Chemotherapy at home: keeping patients in their "natural habitat".

Escalating cancer rates and an increase in the complexity and duration of chemotherapy regimens have brought the issue of cancer treatment at home to the forefront. For the participants of this study, home chemotherapy was offered as a potential treatment choice. Ten patients who accepted home chemotherapy were interviewed using the methodology of interpretive description. They shared their experiences of receiving chemotherapy at home, and identified home as being a "natural habitat" in which they were better able to adapt to their circumstances. Patients were able to redistribute their resources including time, energy, and finances in ways that were meaningful to them. They felt the care provided was enhanced and they were more receptive to teaching. Lastly, participants viewed themselves as being less ill and better able to cope with their treatments. Given the results of this study and other research available, chemotherapy at home should be considered an option for patients with cancer.

Influences shaping nurses' use of distraction for children's procedural pain.

PURPOSE: This study explored pediatric nurses' choices to use distraction for managing painful procedures. DESIGN AND METHODS: Using interpretive description approaches, interviews with pediatric nurses provided descriptions of choices to manage procedural pain. RESULTS: Nurses' distress influenced distraction use to mitigate the suffering of children and themselves. Newer nurses described task mastery as influencing distraction choices. Nurses' accounts of performing painful procedures on children mirrored children's descriptions of pain from the literature. PRACTICE IMPLICATIONS: Nurses' distress and competency performing painful procedures on children influenced practice. Future qualitative studies could extend understanding of pain management choices by pediatric nurses and the impact on undermanaged pain.

Patient and family caregiver decision making in the context of advanced cancer.

BACKGROUND: A basic tenet of palliative care is to maintain an individual's control over the dying process. However, when decline occurs quickly, as may be the case in advanced cancer, transition of responsibility for illness management to a family caregiver may become necessary when care takes place in the home. OBJECTIVE: The aim of this study was to understand the decision-making process that occurs between a dying individual and his or her family caregiver. METHODS: Participants in this grounded theory study were selected by purposive and theoretical sampling methods. Data were collected and analyzed using a constant comparison approach. RESULTS: The core category covering captured the inordinate efforts taken by informal caregivers to ensure that their family member would be able to die in the manner of his or her choosing. The basic social process, dancing on the stairs, chronicled the families' decision-making process as they navigated through this delicate and precarious end stage of life. CONCLUSIONS: Dancing on the stairs required a close relationship between 2 people who were willing to remain engaged with each other, despite the difficulties they faced. This decision-making process may be applicable to other health care transitions in people's lives that need to be managed with another person. IMPLICATIONS FOR PRACTICE: Palliative care education for nurses in all care health settings may ease transitions for end-stage patients. Health promotion initiatives designed to educate the lay public about advance directives and end-stage illness management in a home setting may help to prepare family caregivers for their future responsibilities.

Family caregivers and transition to long-term care.

This study's purpose was to explore family caregivers' experiences while they waited placement of family members with dementia in long-term care and how they coped during this period of waiting and transition. In this exploratory descriptive qualitative study, interviews were conducted with 29 caregivers at entry to the placement wait-list and at 3 to 4-month intervals thereafter. Final interviews, with 15 caregivers, were conducted shortly after admission to long-term care. When "the waiting begins," the themes of crisis as initiator, synchronicity, control, and reciprocity emerged. "After placement" included the themes of deeply bonded relationships, attempting continuity, and sorting out the change. The findings provide new insight into family caregiver experiences during and after placement of a family member with dementia in long-term care. Clinicians must recognize that wherever services are provided, at home before placement or in institutions after placement, family caregivers must be incorporated as full partners in care.

Finding and evaluating potential research instruments.

In this column, I have outlined some of the basic strategies for finding appropriate research instruments and for evaluating them so that you can determine the best one to use for your own research. These strategies, as basic as they are, will help to guide you as you make decisions. Of course, there are complex issues surrounding the development and refinement of research instruments and you would do well to review reliability, validity, and sensitivity in research texts before choosing an instrument.

Factors which influence coping: home-based family caregiving of persons with advanced cancer.

The findings from a qualitative study of how caregivers coped while they cared for a dying family member at home are presented. Fifteen family caregivers were interviewed twice following the death of their family member. Although it was not one of the original objectives of the research, coping emerged as a category needing further analysis. There were factors that either facilitated or interfered with caregiver coping. Those factors that facilitated their coping included characteristics of the caregivers themselves; contributions made by the dying person; and supportive networks, both formal and informal, available to the caregivers. Interfering factors related to caregiver experiences with informal and formal systems. From the more distant perspective of post-death reflections, the caregivers provided insight into how their coping was grounded in the meaning associated with their experiences.

The bereavement experience following home-based family caregiving for persons with advanced cancer.

The purpose of this qualitative interpretive study was to explore the experience of bereavement following home-based family caregiving for persons with advanced cancer. The research question addressed by this research was: How do family caregivers of patients with advanced cancer perceive the effects of home-based caregiving on their bereavement? Fifteen caregivers were retrospectively interviewed twice after the death of their family member. Caregivers reported both positive (e.g., feelings of accomplishment, improved family relationships) and negative (e.g., haunting images, feelings of failure) outcomes that they attributed to having cared for their family member. Overall positive outcomes predominated and bereaved family members reported satisfaction with having provided care for their loved one who had died.

Prospective and retrospective research: considerations and questions.

We have outlined some of the reasons why retrospective research is generally considered inferior to prospective research and have explained some of the rationale for this view. Despite the problems, there are ethical and practical reasons for conducting retrospective research. Indeed, we have argued that there are times when retrospective research may produce more valid data. We hope that these ideas will contribute to ongoing discussions about oncology research designs.

The experience of respite during home-based family caregiving for persons with advanced cancer.

The purpose of this qualitative interpretive study was to explore the experience of respite during home-based family caregiving for persons with advanced cancer. Fifteen caregivers were interviewed twice after the death of their family member. Three main themes emerged from the data analysis. First, caring for a dying family member at home is an emotionally intense, exhausting, and singular experience, set in a world apart from everyday life patterns. Second, the caregivers differentiated between cognitive breaks and physical (getting away from) breaks of respite. To achieve a cognitive break and yet remain within the caregiving environment was viewed as important, whereas the physical separation from it was significant only if it contributed in some meaningful way to the caregiving. Third, the meaning of respite is rooted in the desire to bring a measure of quality and normalcy to the life of the dying person. Respite means staying engaged in living life with the dying family member.

Evidence-based practice: implications for the practising oncology nurse.

While the premises of EBP seem highly appropriate on the surface, disquieting questions are raised when one examines the implications for the practising oncology nurse of attempting to implement EBP. There are clinical situations for which no empirical evidence exists on which to base nursing decisions. In some cases, empirical evidence is sparse and based on a mix of small, descriptive studies. Although guidelines exist for examining purely quantitative literature and are being developed for examining purely qualitative literature, no guidelines exist for evaluating a mixture. The process of operationalizing EBP is time-consuming and requires expertise which many oncology nurses lack. Does this mean that EBP is a laudable but impossible enterprise? I don't think so. Nurses will need to incorporate the empirical literature as well as other sources of knowledge to inform their clinical decision-making. In addition, oncology nurses need to apply and adapt models, such as Howell and Pelton's (2001), to make the best use of all sources of knowledge to facilitate excellent patient care.