The relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among Israeli inpatients with cancer.

PURPOSE/OBJECTIVES: To examine the relationship of sleep disturbance and symptom severity, symptom interference, and hospitalization among inpatients with cancer. DESIGN: A descriptive, correlational, comparative design. SETTING: The oncology inpatient unit of a teaching hospital. SAMPLE: A convenience sample of 82 hospitalized patients. METHODS: Patients completed the Pittsburgh Sleep Quality Index (PSQI)-Home questionnaire, the MD Anderson Symptom Inventory (MDASI), and a demographic data information instrument within 72 hours of admission. Patients hospitalized for 10 days or more completed the PSQI-Hospitalization questionnaire and the MDASI. MAIN RESEARCH VARIABLES: Sleep disturbance, symptom severity, symptom interference, and hospitalization. FINDINGS: Although sleep disturbance scores were high at home and during hospitalization, the use of sleeping medication received the lowest score in the PSQI. Patients who were hospitalized for 10 days or more had significantly higher global PSQI scores at home than after being hospitalized for 10 days or more. A significant relationship was noted between global PSQI scores at home and symptom severity total mean scores, with the symptoms of numbness and tingling demonstrating the greatest correlation with sleep disturbance. A tendency existed for a significant relationship between global PSQI scores at hospital and symptom severity total mean scores. The symptom with the greatest correlation with global PSQI scores at hospital was sadness, followed closely by remembering. The interference items with the greatest correlation to global PSQI scores at hospital were patient's enjoyment of life, mood, and relations with others. CONCLUSIONS: Sleep disturbance was less of a problem for patients during their hospitalization than at home. Unlike other studies, numbness was found to be the symptom most closely correlated to sleep disturbance. IMPLICATIONS FOR NURSING: Additional investigation should be conducted to identify the factors that influence sleep disturbances in patients with cancer at home and the relationship between sleep disturbance and numbness and tingling.

Pain severity, satisfaction with pain management, and patient-related barriers to pain management in patients with cancer in Israel.

PURPOSE/OBJECTIVES: To examine pain severity, satisfaction with pain management, and patient-related barriers to pain management among patients with cancer in oncology units at a teaching hospital in Israel. DESIGN: Descriptive, cross-sectional, correlational design. SETTING: Oncology, hematology, and bone marrow trans-plantation (BMT) departments; oncology, hematology, and BMT daycare units; and a radiation department in an Israeli hospital. SAMPLE: Nonprobability convenience sample (N=144) of ambulatory (n=76) and hospitalized (n=68) patients experiencing pain in the past 24 hours. METHODS: Patients who had experienced pain in the past 24 hours completed the Revised American Pain Society-Patient Outcome Questionnaire, the Barriers Questionnaire-Short Form, and a demographic data questionnaire. MAIN RESEARCH VARIABLES: Pain severity, satisfaction with pain management, and patient-related barriers to pain management. FINDINGS: A significant inverse relationship was observed between patients' pain severity and their expectation of pain relief. Less-educated patients had significantly higher pain severity scores. Ambulatory patients waited longer for their pain medication than hospitalized patients. The greatest barriers to pain control were fear of addiction and the notion that medication should be saved in case the pain gets worse. In addition, ambulatory patients had higher pain barrier scores than hospitalized patients. CONCLUSIONS: The relationship between pain severity and the expectations of patients with cancer regarding pain relief indicate that patients' expected outcomes and barriers may impede optimal pain relief. This study also identified areas of possible weakness within the hospital's pain palliation program. IMPLICATIONS FOR NURSING: Nurses should assess for patients' expectations and barriers that could impede pain relief and provide appropriate interventions.

The relationship between symptom severity and symptom interference, education, age, marital status, and type of chemotherapy treatment in Israeli women with early-stage breast cancer.

PURPOSE/OBJECTIVES: To examine symptom severity's relationship to symptom interference, education, age, marital status, and type of chemotherapy treatment in Israeli women with stage I or II breast cancer. DESIGN: Cross-sectional, descriptive, correlational design. SETTING: Hadassah University Hospital's oncology daytime care unit in Israel. SAMPLE: 51 women with stage I or II breast cancer who were receiving an adjuvant chemotherapy protocol that included doxorubicin. METHODS: Women receiving adjuvant chemotherapy were given the M.D. Anderson Symptom Inventory (MDASI), a modified version of the Breast Cancer Prevention Trial Hot Flashes Subscale (BCPT-HFS), and a demographic and treatment questionnaire to assess their symptoms toward the end of their chemotherapy treatment. MAIN RESEARCH VARIABLES: Symptom severity, symptom interference, education, age, marital status, and type of chemotherapy treatment. FINDINGS: The most frequent and severe symptoms were fatigue, sleep disturbance, and drowsiness. The MDASI symptom severity total scores were positively correlated with total scores of interference with activities of daily life, with most individual symptoms being significantly related to the total interference scores. The strongest relationships were found with fatigue, distress, and sadness. Education was inversely related to the MDASI general symptom severity total scores; age was inversely related to the BCPT-HFS total scores. Patients who received treatment with doxorubicin plus cyclophosphamide or doxorubicin, cyclophosphamide, plus fluorouracil had greater symptom severity than those who received doxorubicin plus cyclophosphamide followed by paclitaxel and had their symptoms evaluated after receiving paclitaxel. CONCLUSIONS: Increased symptom severity disrupts daily function and life in women with breast cancer. IMPLICATIONS FOR NURSING: Evidence-based symptom profiles for different chemotherapy protocols are needed.

Israeli critical care nurses' attitudes toward physician-assisted dying.

BACKGROUND: Within critical care, end-of life decisions are common, including hastening of the dying process. One type of hastening the dying process is physician-assisted dying (PAD). OBJECTIVES: The purpose of this study was to determine Israeli critical care nurses' attitudes and practices toward PAD. METHODS: A convenience sample of 71 intensive care unit nurses were asked to fill out a modified critical care, Hebrew version of the Nurse's Attitudes Regarding Physician-Assisted Dying Questionnaire. Subjects were also asked whether they were requested or whether they performed actions to hasten the dying process. RESULTS: The majority of nurses supported PAD. However, only 10% of the respondents agreed to participate when PAD was to be administered by the nurse. Some nurses were asked by patients (12.7%) and/or by families (7.0%) to hasten the dying process. No nurse reported administering any lethal treatment. No significant differences in responses to the vignettes were found based on gender, marital status, place of birth or parents' place of birth, religion, age, type of education, having taken a post-basic course, years of general or intensive care unit nursing experience, or type of intensive care unit. However, significant differences were found in four vignettes based on level of self-perceived religiosity. CONCLUSION: The findings demonstrated that the Israeli critical care nurses sampled tended to agree with the concept of PAD but were unlikely to agree to having a more active role in hastening the dying process. This particular finding was true especially among those nurses who considered themselves more religious.

The cancer pain experience of Israeli and American patients 65 years and older.

With the aging of the world's population, cancer pain will become an increasingly important health issue. The purpose of this study was to describe the cancer pain experience of Americans (n = 60) and Israelis (n = 39) 65 years and older. Outpatients in teaching hospitals in the U.S. and in Israel completed study questionnaires. Thirty percent of the total variance of worst pain was explained by age, symptom severity, and cancer stage, and 40% of the total variance of pain interference was explained by whether they were American or Israeli, symptom severity, and sense of coherence. Israeli patients had significantly higher scores on worst pain and pain interference, and significantly lower pain management index (PMI) and knowledge and attitudes toward pain and pain control scores. Studies with larger samples and across different cultures are needed to confirm these findings in order to develop culturally appropriate interventions.

The cancer pain experience of Israeli adults 65 years and older: the influence of pain interference, symptom severity, and knowledge and attitudes on pain and pain control.

GOALS: Little is known about Israeli elders' cancer pain experience. The purpose of this study was to explore the cancer pain experience, including pain intensity, pain management index, pain interference, symptom severity, and knowledge and attitudes toward pain and pain control. PATIENTS AND METHODS: Descriptive cross-sectional methods were used to obtain data with four instruments. The patients were 39 Israelis 65 years and older who were receiving outpatient treatment for cancer in a major hospital center in Israel. RESULTS: Results showed that over half (56.7%) reported severe worst pain and had negative pain management indexes (56.4%). In addition, knowledge and attitudes toward pain and pain control were poor (54.55%). There were no significant relationships between pain intensity and other variables. However, pain interference demonstrated a significant positive relationship with symptom severity. Post hoc analysis revealed that Ashkenazi Jewish and more educated patients reported significantly less pain interference than Sephardic Jewish patients. CONCLUSION: Larger samples representative of the cultural differences in Israel are needed to more definitively identify elements of the cancer pain experience in Israeli elders that can be addressed to improve pain management.

Intrinsic and extrinsic religiosity, spiritual well-being, and attitudes toward spiritual care: a comparison of israeli jewish oncology nurses' scores.

PURPOSE/OBJECTIVES: To examine the differences among secular, traditional, and religious Israeli oncology nurses' intrinsic religiosity, extrinsic religiosity, spiritual well-being, and attitudes toward spiritual care. DESIGN: A comparative, descriptive study. SAMPLE: 148 Israeli Jewish nurses drawn from the membership of the Israeli Oncology Nursing Association. METHODS: Nurses completed mailed questionnaires. The four scales used were intrinsic and extrinsic religiosity portions of the Revised Age Universal Intrinsic-Extrinsic Scale, the Spiritual Well-Being Scale, and the Spiritual Care Perspective Scale. FINDINGS: Secular, traditional, and religious Jewish respondents differed significantly in intrinsic religiosity, extrinsic religiosity, spiritual well-being, and religious well-being. No significant differences were found in existential well-being and attitudes toward spiritual care. Although not significant, an interesting trend was that secular nurses demonstrated more positive attitudes toward spiritual care than religious nurses. CONCLUSIONS: Jewish nurses' religiosity, spiritual well-being, and perhaps their attitudes toward spiritual care may be influenced by whether they are secular, traditional, or religious nurses. IMPLICATIONS FOR NURSING: Israeli Jewish oncology nurses need self-awareness of their intrinsic religiosity, extrinsic religiosity, spiritual well-being, and attitudes toward spiritual care when they are administering holistic care to their patients.

Israeli oncology nurses' religiosity, spiritual well-being, and attitudes toward spiritual care: a path analysis.

PURPOSE/OBJECTIVES: To investigate the relationship among the antecedent factors of age, ethnicity, and education and the mediating variables of intrinsic religiosity, extrinsic religiosity, and spiritual well-being on Israeli oncology nurses' attitudes toward spiritual care. DESIGN: A correlational, explanatory study. SAMPLE: Members (N = 155) of the Israeli Oncology Nursing Society. METHOD: Subjects completed a mailed research package. A path model guided the testing of the hypotheses. MAIN RESEARCH VARIABLES: Spiritual well-being, intrinsic religiosity, extrinsic religiosity, age, ethnicity, and education. RESULTS: Variables of interest accounted for a small but significant amount of the total variance in attitudes toward spiritual care. However, only spiritual well-being, extrinsic religiosity, and education demonstrated direct relationships with these attitudes. In addition, intrinsic and extrinsic religiosity, mediated through spiritual well-being, demonstrated indirect relationships with attitudes. CONCLUSION: Nurses' attitudes toward spiritual care are influenced by their education, intrinsic and extrinsic religiosity, and spiritual well-being. IMPLICATIONS FOR NURSING: Because spiritual well-being is a good predictor of nurses' positive attitudes toward spiritual care, nurses' spiritual well-being should be supported. In addition, nursing education needs to examine ways that may support more positive attitudes toward spiritual care. Future research also should be conducted on other nursing populations and across cultures and religious affiliations.

Oncology and nononcology nurses' spiritual well-being and attitudes toward spiritual care: a literature review.

PURPOSE/OBJECTIVES: To review literature about oncology and nononcology nurses' attitudes toward spiritual care and the way that their spiritual well-being influences those attitudes. DATA SOURCES: Published research and literature review articles, books, master's theses, and doctoral dissertations. DATA SYNTHESIS: Spiritual considerations play an important part in the lives of patients with cancer. Therefore, nurses must not only examine their attitudes toward spiritual care but also identify variables that influence those attitudes. One of the major variables that may influence their attitudes is their own spiritual well-being. CONCLUSIONS: A significant association exists between attitudes toward spiritual care and spiritual well-being in nurses who care for nononcology populations. However, little research examines oncology nurses' attitudes toward spiritual care and the way that their spiritual well-being affects those attitudes. IMPLICATIONS FOR NURSING: Nurse researchers need to examine the spiritual dimension of oncology nurses and the way that this influences attitudes toward spiritual caregiving.

Spirituality and health for women of color.

Spirituality among African American and Hispanic women has been associated with a variety of positive health outcomes. The purposes of this commentary are (1) to define spirituality, comparing it with religiosity, and briefly examine the historical, cultural, and contextual roots of spirituality among women of color; (2) to explore research data that support a relationship between spirituality and health, particularly among women of color; and (3) to present several examples of how spirituality may enhance public health interventions designed to promote health and prevention.