Knowledge Of Symptom Management Research Articles

Changes in therapists’ knowledge of symptom management and stabilization following program co-participation with dissociative patients

Few professionals in the mental health field receive systematic training in treating trauma-related symptoms and disorders, including dissociative disorders (DD). Experts in the field of treating DDs recommend building stabilization skills early in treatment to improve emotion regulation and safety, yet research on DD therapists’ actual practices suggest that they are engaging in these practices less than recommended. DD patients may benefit from therapists learning more about emotion regulation and trauma symptom management towards stabilizing difficult experiences and risky, unhealthy, or unsafe behaviors. The current study considered whether an international group of therapists who participated alongside their DD patients in a 2-year Internet-based psychoeducational program demonstrated changes in knowledge related to symptom management and stabilization techniques. Therapists answered five free-form text questions related to DD symptom management and stabilization at baseline, mid-point, and end of the study. Results showed that significant changes in therapist knowledge were evident between baseline and mid-point, as well as between the baseline and the end of the study, with effect sizes ranging from small to large. Compared to when they began the study, therapists were better able to understand their DD patients’ reasons for self-injury, recognize warning signs of unsafe behaviors, identify coping skills, and identify skills to manage overwhelming feelings and intrusive traumatic content. Implications and opportunities for future research are discussed.

Knowledge and Attitude toward End-of-Life Care of Nursing Students after Completing the Multi-Methods Teaching and Learning Palliative Care Nursing Course

Introduction: This study aims to assess the palliative care nursing (PCN) knowledge and attitude of nursing students toward end-of-life care (EoLC) after completing the multi-methods PCN courses. Methods: A quasi-experimental study with a pre-and post-palliative survey was conducted. One hundred and sixty five nursing students from a faculty of nursing in Indonesia were enrolled, and knowledge and attitude were assessed using the palliative care quiz for nurses (PCQN) and the Frommelt Attitude Toward Care of the Dying and Death (FATCOD). Paired t-test and ANOVA were applied in this study. Results: After being involved in the PCN course, the mean score of PCN knowledge of the students increased significantly (p < 0.001). According to sub-domain analysis, the knowledge increased significantly in pain and symptom management (p < 0.001) and not significantly in the domains of theory and principle of the palliative, psychosocial, and spiritual care (p = 0.053; p = 0.080). Moreover, students’ attitude toward EoLC also increased significantly (p < 0.001), and positive attitudes increased from 75.6% to 91.5%. According to the ANOVA test, knowledge in two different groups (witnessed dying people and GPA) is not statistically meaningful (FWDP (1158) = 0.817, p = 0.367; FGPA (2.158) = 1.143, p = 0.322). Similarly, attitudes toward EoLC in two different groups are not statistically meaningful (FWD (1158) = 0.971. p = 0.326, FGPA (1157) = 1.278, p = 0.281). Conclusion: PCN courses with multi-method learning and teaching are effective to increase PCN knowledge, particularly in pain and symptom management knowledge, and also effective in increasing the positive attitudes toward EoLC.

Project ECHO in the Caribbean: Building a Virtual Community for Palliative Care Education Needs.

Despite a growing need, palliative care education tools tailored to providers in the Caribbean remain extremely limited. We conducted a mixed methods analysis of the first Project ECHO (Extension for Community Healthcare Outcomes) model adapted for palliative care providers in the Caribbean. These virtual, case-based sessions were held to enhance regional palliative care providers' knowledge of symptom management, communication, and psychosocial support. Participants reported strong satisfaction and significant impacts on their practices. They described significant improvements in their sense of community (1.23, P ≤ 0.01), confidence in palliative care skills (0.64, P ≤ 0.01), and knowledge for each monthly topic. Our findings suggest that the ECHO model has been successfully adapted to the needs of palliative care providers in the Caribbean, though further capacity building, public policy, and research are needed to broaden access to palliative care across the region.

Application of a nurse-led multidisciplinary health problem assessment tool on patients undergoing peritoneal dialysis at home: Across-sectional study.

To identify and analyze the most prominent problems of peritoneal dialysis (PD) patients by applying a nurse-led multidisciplinary health problem assessment tool. 170 PD patients were recruited from the PD center of the First Affiliated Hospital of GuangXi Medical University from January 2019 to June 2019, and their information was collected from July 2019 to June 2020 through telephone interviews, Wechat interviews, outpatient visits, and home visits; their health problems were classified and analyzed with regard to physiological, psychosocial, health-related behavior, and environment categories based on the Omaha Problem Classification System, and their knowledge, behavior, and status related to these problems were evaluated by the Omaha Knowledge-Behavior-Status Scale. 165 of the eligible patients completed the follow-up, and their ten most prominent health problems were "Income", "Social contact", "Pain", "Neuro-musculo-skeletal function", "Digestion-hydration" and "Edema", "Nutrition", "Physical activity", "Fluid and diet restriction", and "Symptom management". As for the Knowledge-Behavior-Status scale, they got the lowest scores in knowledge of "Symptom management", behavior of "Fluid and diet restriction" and Status of "Nutrition", while they scored the best in knowledge of "Nutrition" and "Edema", behavior of "Income" and "Pain", and Status of "Pain" and "Edema". The multidisciplinary problem assessment tool based on the Omaha Problem Classification System serves as an effective and instructive tool to identify the prominent health problems of PD patients and provides a basis for the development of subsequent targeted interventions.

Effects of a symptom management intervention based on group sessions combined with a mobile health application for persons living with HIV in China: A randomized controlled trial

ObjectiveThis study aims to evaluate the effects of a symptom management intervention (SMI) based on symptom management group sessions combined with a mobile health (mHealth) application (app) on the knowledge of symptom management, the certainty of symptom self-management, symptom severity, symptom distress, medication adherence, social support, and quality of life among persons living with HIV (PLWH) in China. MethodsA parallel randomized controlled trial with 61 PLWH was conducted in Shanghai, China. The participants in the control group (n = 30) downloaded the Symptom Management (SM) app according to their needs and preferences, and received routine follow-ups. The participants in the intervention group (n = 31) were guided to download and use the SM app, and received four tailored weekly group sessions at routine follow-ups. Each group session lasted for approximately 2 h and targeted one of the major modules of the SM app. All the outcomes were assessed at baseline and post-intervention. The study was registered with the Chinese Clinical Trial Registry (ChiCTR1900024821). ResultsThe symptom management knowledge and certainty of symptom self-management were significantly improved after the intervention (all P < 0.01). Compared with the control group, the scores of symptoms reasons knowledge score improved 11.47 points (95% CI: 3.41, 19.53) and scores of symptoms self-management knowledge score improved 12.80 points (95% CI: 4.55, 21.05) in the intervention group after controlling for covariates. However, other outcomes did not show statistically significant differences between the intervention group and the control group (P > 0.05). ConclusionThe SMI could improve PLWH’s symptom management knowledge and certainty of symptom self-management. Multi-center studies with larger sample sizes and longer follow-ups are needed to further understand the effects of SM app on ameliorating symptom severity and symptom distress. More innovative strategies are also needed to promote and maintain the sustainability of the SM app.

The Theory of Unpleasant Symptoms in Pediatric Oncology Nursing: A Conceptual and Empirical Fit?

Symptom management knowledge is a priority for pediatric oncology nursing research. Theories and models can frame the studies of symptoms experienced during childhood cancer. This article describes and analyzes the middle-range theory, theory of unpleasant symptoms (TOUS), for its conceptual and empirical fit with pediatric oncology nursing based on its current use in adult oncology research and its limited use to date in pediatric oncology. Searches in PubMed and CINAHL databases using the keywords theory of unpleasant symptoms and cancer and covering the time period 2000 to 2017 yielded 103 abstracts for review. Twenty published reports met eligibility criteria for review; only one included pediatric oncology patients. No study to date has tested all the components of the TOUS in pediatrics. The TOUS component of performance appears to be underaddressed across completed studies that instead include a focus on patient-reported quality of life rather than on perceived behavioral or performance indicators concurrent with the subjective symptom reports. Additionally, the influence of family, essential in pediatric oncology, is absent in the majority of studies guided by the TOUS. The TOUS is a structurally complicated framework that would be a conceptual fit for pediatric oncology if family influence and perceived function were included. Studies across this population and guided by the TOUS are needed, although testing all the theorized linkages in the TOUS would likely require a large sample size of patients and, thereby, multisite approaches given that cancer is a rare disease in childhood.

Factors influencing the use by radiation therapists of cancer symptom guides: a mixed-methods study

Background Radiation therapists play an important role in helping patients to safely manage and triage potentially life-threatening symptoms. The purpose of the present study was to assess factors influencing the use by radiation therapists of evidence-informed symptom practice guides for patients experiencing cancer treatment–related symptoms.Methods In a mixed-methods descriptive study guided by the Knowledge-to-Action framework, interviews and a barriers survey were conducted. Two independent reviewers conducted a content analysis of interview transcripts. Barriers survey data were analyzed using frequency distributions and univariate descriptive statistics. Open-ended data from the surveys underwent content analysis and were triangulated with interview findings.Results Of 90 radiation therapists approached, 58 completed the survey (64%), and 14 were interviewed. Of the 98% who reported providing symptom management to patients undergoing radiation treatment, 53% used evidence-informed practice guidelines. Radiation therapists had moderate moral norms (4.6 of 7) and beliefs about the consequences of using costars (pan Canadian Oncology Symptom Triage and Remote Support) practice guides (4.8), but neutral intention (3.4) and beliefs about their own capabilities (3.9). Environmental barriers included lack of time (2.0), lack of access (2.5), and neutral organizational support (3.0). Radiation therapists identified a need for training (5.5). Common unique barriers to practice guide use were lack of time during radiation treatments, unclear fit with scope of practice, disparate focus on site-specific symptoms, and lack of medication knowledge.Conclusions The symptom practice guides were perceived by the radiation therapists to benefit patients, enhance their own knowledge of symptom management, and promote consistent practice. Additional work is required to identify the scope of practice of radiation therapists within the interprofessional team.

Factors influencing the use by radiation therapists of cancer symptom guides: a mixed-methods study.

Radiation therapists play an important role in helping patients to safely manage and triage potentially life-threatening symptoms. The purpose of the present study was to assess factors influencing the use by radiation therapists of evidence-informed symptom practice guides for patients experiencing cancer treatment-related symptoms. In a mixed-methods descriptive study guided by the Knowledge-to-Action framework, interviews and a barriers survey were conducted. Two independent reviewers conducted a content analysis of interview transcripts. Barriers survey data were analyzed using frequency distributions and univariate descriptive statistics. Open-ended data from the surveys underwent content analysis and were triangulated with interview findings. Of 90 radiation therapists approached, 58 completed the survey (64%), and 14 were interviewed. Of the 98% who reported providing symptom management to patients undergoing radiation treatment, 53% used evidence-informed practice guidelines. Radiation therapists had moderate moral norms (4.6 of 7) and beliefs about the consequences of using costars (pan-Canadian Oncology Symptom Triage and Remote Support) practice guides (4.8), but neutral intention (3.4) and beliefs about their own capabilities (3.9). Environmental barriers included lack of time (2.0), lack of access (2.5), and neutral organizational support (3.0). Radiation therapists identified a need for training (5.5). Common unique barriers to practice guide use were lack of time during radiation treatments, unclear fit with scope of practice, disparate focus on site-specific symptoms, and lack of medication knowledge. The symptom practice guides were perceived by the radiation therapists to benefit patients, enhance their own knowledge of symptom management, and promote consistent practice. Additional work is required to identify the scope of practice of radiation therapists within the interprofessional team.

Factors and Structural Model Related to End-of-Life Nursing Care in General Ward in Japan

This study aimed to determine the factors related to the implementation of end-of-life nursing care in general wards and to examine the adequacy of the hypothetical care implementation model. A cross-sectional survey was conducted. As the results of multiple regression analysis, 8 factors were determined: subjective evaluation of nurses' own team, positive attitudes toward caring for dying persons, existence of a role model, death relief (Death Attitude Inventory), knowledge of symptom management knowledge of family assessment, abstract judgment skill, and participation in the seminar. The hypothetical model was constructed using these factors, and the adequacy of this model was confirmed by a structural equation modeling. These factors and the model would give suggestions of educational content and its method, which should be provided to general ward nurses.

Determinants of the Wiffingness to Endorse Assisted Suicide: A Survey of Physicians, Nurses, and Social Workers

The authors surveyed 1,137 physicians, nurses, and social workers (overall response = 48%) to characterize the willingness to endorse assisted suicide. Willingness to endorse varied among disciplines and was negatively correlated with level of religious belief (r = -0.35, P < 0.0001), knowledge of symptom management (r = -0.21, P < 0.0001), and time managing symptoms (r = -0.21, P < 0.0001). On multivariate analysis, the significant predictors were lesser religious belief (P < 0.0001), greater concern about analgesic toxicity (P = 0.001), diminished empathy (P = 0.03), lesser knowledge of symptom management (P < 0.04), and the interaction between religious belief and knowledge of symptom management (P = 0.04). Professionals' attitudes toward assisted suicide are influenced by diverse personal attributes, among which may be competence in symptom management and burnout.