Isolation in blood and marrow transplantation.

This phenomenological study explored the perceptions of 20 patients who had undergone an autologous bone marrow transplantation (ABMT). Transcripts from interviews were analyzed for themes. Three themes emerged related to the experience of isolation during and after ABMT: physical isolation (protecting self and others), emotional isolation (protecting self and others), and physical and emotional isolation (supporting self and others). During physical isolation, participants were protected from infection and tried to protect family and friends from emotional burden. However, physical isolation often led to emotional isolation, which the physical presence of others ameliorated, particularly when an emotional presence was coexistent. Emotional presence was a main source of social support. Participants felt family and friends needed more guidance on ways to provide effective support. An important implication for health care professionals is that emotional support in the form of positive presencing should accompany providing information to both patients and family members.

Anxiety and depression: incidence and patterns in patients after coronary artery bypass graft surgery.

The purpose of this longitudinal study was to describe the incidence and patterns of anxiety and depression in older patients who undergo coronary bypass graft surgery and to determine the influence of gender and age on psychological recovery. A sample of 31 patients was assessed pre- and postoperatively at 2 to 3 days and at 2, 4, 8, and 12 weeks. Younger subjects experienced higher anxiety, reaching statistical significance at 2 and 4 weeks. Women had significantly higher trait and state anxiety and a higher, nonsignificant incidence of depression at all times. Younger subjects were more depressed at 2 to 3 days and at weeks 2 and 4. Because women and younger patients are at higher risk for psychological distress, they should be targeted for interventions.

African American women's experiences with breast cancer screening.

PURPOSE: To describe the experience and meaning of breast cancer screening for African American women. Breast cancer screening offers the greatest hope of reducing breast cancer mortality and improving breast cancer outcomes. Despite the proliferation of initiatives targeting African American women, they continue to be first diagnosed only when they have late-stage disease. DESIGN AND METHODS: Using hermeneutic phenomenological research methods, 23 low- and middle-income African American women were interviewed to gain an understanding of their experiences with breast cancer screening. FINDINGS: Participants varied in their experiences with breast cancer screening. Women spoke of a desire for a holistic approach to health that did not separate the breast from the rest of the body. This desire is indicated in the theme of minding the body, self, and spirit, along with themes of relationships and spreading the word about breast health issues. CONCLUSIONS: Interventions for African American women should include a focus on minding the body, self, and spirit to promote breast cancer screening, and should indicate the importance of relationships and spreading the word about breast cancer screening.

Are ethics committee members competent to consult?

The authors describe research conducted to assess the skills and knowledge base of individuals who perform ethics consultations in Maryland hospitals. The findings indicate a lack of formal educational preparation on the part of those who perform consults, and a general lack of institutional support for ethics committees.

Caring for dying patients who have air hunger.

PURPOSE: To understand nurses' experiences of caring for dying patients who have "air hunger." When air hunger occurs in people who are close to death, it often triggers increasing panic and breathlessness. Describing this phenomenon is an initial step toward a more informed and consistent response to air-hungry patients. DESIGN AND METHODS: Phenomenological study of 10 hospice, long-term care, oncology, or emergency medicine nurses who cared for air-hungry dying patients. Analysis was based on van Manen's guidelines for interpretive phenomenology. Interviews with two family members who witnessed their dying spouses suffer from air hunger were used to complement the nurses' accounts. FINDINGS: Themes of (a) the patient's look-panic beckons, (b) surrendering and sharing control, and (c) fine-tuning dying indicated ways nurses responded to relieve a patient's air hunger, including being prepared before air hunger occurs, calming patients and families, medicating patients, improvising care, attending to family members' needs, and drawing a distinction between palliating and killing. CONCLUSIONS: The three themes provide a framework for a new vision of "doing everything" for a dying person who suffers from air hunger. Care encompasses knowing what to do as well as how to stay present during suffering.

Autologous bone marrow transplantation: the patient's perspective of information needs.

Phenomenologic inquiry was used to explore patients' experiences with autologous bone marrow transplantation (ABMT). Interviews were conducted before and after implementation of a clinical pathway that included a teaching protocol for ABMT. Texts were analyzed individually, compared for pre- and postpathway patients to determine if different themes emerged from these two groups, and then combined. Themes common to both groups included (a) a range of needs for information, (b) everybody's different: a fine balance (the challenge of finding a balance when giving information to patients who vary in the amount of information they desire), (c) someone who has been there (the value of talking to someone who has survived an ABMT), (d) and the burden of ABMT patients teaching family. One theme that reflected different experiences of pre- and postpathway patients was that of the need to know detailed information about the ABMT and the fear of knowing too much. Whereas postpathway patients reflected more on the burden of knowing too much, prepathway patients expressed more dissatisfaction about not being told enough about procedures and symptoms to be expected. Suggestions for teaching patients about ABMT include being generally realistic while focusing on the positive, and viewing patient education as a process individualized according to each patient's needs.

Healthcare reform. Its effects on nurses.

Healthcare reform has been a major economic and political focus throughout the 1990s. In a national survey of registered nurses about work life and health, many narrative comments addressed changes in the healthcare system. This qualitative study an analysis of these comments, identified themes related to nurses' perceptions of changes and the effect of healthcare reform on the practice of nursing.

Parental smoking behavior and passive smoke exposure in children with asthma.

BACKGROUND: Smoking parents of children with asthma frequently report modifying their smoking behavior to reduce their child's smoke exposure. Research has not analyzed the association between parental efforts and the child's smoke exposure. OBJECTIVE: To determine passive smoke exposure and the relationship of self-reported parental modifications in smoking behavior to smoke exposure in children with asthma. METHODS: Parents of children seen in an inner-city Asthma and Allergy Outpatient Clinic completed questionnaires to evaluate their smoking behavior and modifications they made to decrease their child's exposure to cigarette smoke. Urine specimens were collected from the children to determine smoke exposure as measured by urinary cotinine/creatinine ratios. RESULTS: Children from homes with smokers had higher mean urinary cotinine/ creatine ratios than children from smoke free homes (30 versus 4 ng/mg; P = .0005). Cotinine/creatinine ratios increased with the number of smokers in the home. When the parent was the only smoker in the home, the mean urinary cotinine/creatine ratio of children whose parent smoked outside the house was lower than the mean of children whose parent smoked inside (21 versus 51 ng/mg; P = .038). With only one smoker in the home, there was no difference in mean cotinine/creatinine ratios when the primary caregiver was not the smoker versus when the primary caregiver was not the smoker (27 versus 15 ng/mg; P = .10). CONCLUSION: Smoking outside the house was associated with lower urinary cotinine/creatinine ratio only when the parent was the only smoker in the home.

Motivation, social support, and knowledge of parents who smoke and who have children with asthma.

Motivation to quit smoking, social support and knowledge of asthma were investigated in a group of parents (n = 39) who smoked and whose children had asthma. Parents who reported smoking only outside the house had higher rankings on a motivation to quit smoking measure than parents who reported smoking inside the house. Parents who smoked had less knowledge of asthma when compared to parents who did not smoke. Parents who smoked and reported joining a smoking cessation program had more knowledge of asthma than parents who smoked but did not join cessation programs. Analysis of urinary cotinine in the children revealed no associations between urinary cotinine and motivation to quit smoking, social support and/or knowledge of asthma.