Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Total knee arthroplasty (TKA) is a common surgical procedure for the treatment of patients with pain and immobility as a result of osteoarthritis or rheumatoid arthritis. Pain-related interference, pain and nausea are recovery-limiting in these patients in the immediate postoperative period. Preoperative educational interventions that include pain communication and management information have been shown to decrease pain in joint replacement patients (McDonald & Molony, 2004). This randomized controlled trial compared usual preoperative education to an individually delivered preoperative education program. Participants (N=143) were randomized to intervention or usual care groups during routine preadmission testing. The usual care group received the usual preoperative teaching. The treatment group received the usual care teaching, a booklet containing content specific to symptom management after TKA, an individual teaching session during the preadmission testing visit and a telephone follow-up support call during the week before surgery. The primary outcome for this study was pain-related interference with activity and was measured using the Brief Pain Inventory Interference subscale (BPI-I) (Cleeland et al., 1994) on postoperative day three. Secondary outcomes were pain, nausea and expected postoperative activity and were measured on postoperative days one, two and three. There were no differences between groups in any of the outcomes for this study. BPI-I total scores were 24.4±14.4 in the intervention group and 22.4±15.1 in the usual care group (P=0.5) on the third postoperative day. Overall results demonstrated that although TKA patients had severe postoperative pain and severe nausea, they received inadequate doses of analgesia and anti-emetics. Available evidenced based protocols and practices in the health care environment were not followed Individualizing education content was not sufficient to produce a change in postoperative symptoms for these patients. Further research involving the modification of environmental and system factors affecting the provision of symptom management interventions is warranted.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Thesis (M.A.)--Northern Kentucky University, 2008. / Made available through ProQuest. Publication number: AAT 1454014. ProQuest document ID: 1679682531. Includes bibliographical references (p. 34-36)

Diss. (sammanfattning) Göteborg : Univ. , 2010.

Este estudo trata-se de uma análise de conceito do diagnóstico de enfermagem Náusea no tratamento quimioterápico, de acordo com o modelo de Walker e Avant. Os objetivos foram: identificar e sintetizar o conceito náusea em pacientes durante o tratamento quimioterápico por meio de uma revisão integrativa; identificar os atributos, os antecedentes, as consequências e os referenciais empíricos da náusea relacionada à quimioterapia; elaborar um caso modelo, um caso-relacionado e um caso-contrário do conceito náusea em pacientes durante o tratamento quimioterápico; comparar a definição de náusea da NANDA-I, edição de 2012-2014 com as definições de náusea encontradas nos estudos da revisão integrativa; comparar os atributos definidores da náusea relacionada à quimioterapia na literatura com as características definidoras e os antecedentes com os fatores relacionados do diagnóstico de náusea da NANDA-I. Foram seguidas as oito etapas da análise de conceito de Walker e Avant: seleção do conceito, objetivos da análise conceitual, identificação dos possíveis usos do conceito, determinação dos atributos definidores, identificação do caso modelo, identificação de casos adicionais, identificação de antecedentes e consequências e definição de referenciais empíricos. Para este estudo foi selecionado o conceito de náusea em pacientes em tratamento quimioterápico e o objetivo da análise foi investigar se o diagnóstico de enfermagem náusea da NANDA-I contempla o tratamento quimioterápico como fatores relacionados. Posteriormente foi realizada uma revisão integrativa para identificar os possíveis usos do conceito, bem como os referenciais empíricos, os antecedentes e consequências. O atributo definidor mais frequente foi transpirar; os antecedentes mais encontrados foram idade menor que 50 anos, potencial emético do quimioterápico e ansiedade e a consequência foi redução na qualidade de vida. Quanto aos referenciais empíricos mais usados pelos autores dos estudos da revisão integrativa foram, diário do paciente, Escala Visual Analógica e entrevista. Não houve divergências entre a definição de náusea da NANDA-I e as dos estudos da revisão. Entre as características definidoras e os fatores relacionados da NANDA-I, edição de 2012-2014, foram identificados nos estudos da revisão integrativa: aversão à comida, relato de náusea, salivação aumentada, cinetose, ansiedade e medicamentos. Esta análise de conceito possibilitou a percepção de que tratamento quimioterápico ou a quimioterapia devem ser incluídos à relação dos fatores relacionados do diagnóstico de enfermagem Náusea da NANDA-I. Este trabalho poderá ser norteador para o desenvolvimento das outras etapas do processo de validação do diagnóstico de enfermagem Náusea, no tratamento quimioterápico / The present study is an concept analysis of nausea during chemotherapy treatment according to the model by Walker and Avant. The objectives of the study were to identify and synthesize the concept of nausea in patients during chemotherapy treatment by means of an integrative review; identify the attributes, antecedents, consequences, and empirical references on chemotherapy-related nausea; construct a model case, a borderline case, and a contrary case of the concept of nausea during chemotherapy treatment; compare the definition of nausea according to 2012-2014 issue of NANDA-I with definitions found in integrative review studies; compare the defining attributes of chemotherapy-related nausea found in the literature with the its defining characteristics, and the antecedents with the factors related to the diagnosis of nausea found in NANDA-I. The eight steps of concept analysis by Walker and Avant were followed: selecting a concept, aims of the analysis, identifying the possible uses of the concept, determining the defining attributes, identifying the model case, identifying the additional cases, identifying the antecedents, and consequences, and defining empirical references. For the present study, the concept of nausea in patients undergoing chemotherapy treatment was selected and the aim of the analysis was to investigate whether the diagnosis of nausea in nursing found in NANDA-I contemplates chemotherapy as a related factor. The, an integrated review was carried out so as to identify the possible uses of the concept as well as empirical references, antecedents and consequences. The most frequently found defining attribute was sweating; the antecedents most commonly found were age (under 50), emetic potential of the medication and anxiety, and the consequence found was lower quality of life. The empirical references most commonly used by authors of integrative review studies were the patients\' journal, Visual Analogue Scale, and interview. There were no disagreements between the definitions in the 2012-2014 issue of NANDA-I and the review studies. Among the defining characteristics and related factors in the 2012-2014 issue of NANDA- I, aversion to food, reports of nausea, increased salivation, cinetosis, anxiety, and medication. The present concept analysis has led to the perception that chemotherapy should be included in the list of related factors of the diagnosis of nausea in nursing in NANDA-I. The present study could be a roadmap for the development of other steps in the process of validation of the diagnosis of nausea in nursing

O objetivo deste estudo é avaliar a eficácia de duas técnicas de acupuntura no controle da náusea e vômito em pacientes portadoras de Carcinoma Invasivo de mama, submetidas à quimioterapia anti-neoplásica. Foram incluídas no estudo 64 pacientes no período de março de 2003 a fevereiro de 2007, do Hospital A.C. Camargo com diagnóstico anatomopatológico de carcinoma invasivo da mama, candidatas à quimioterapia adjuvante com esquemas que incluem doxorrubicina e ciclofosfamida. O estudo foi realizado no primeiro ciclo de quimioterapia. As pacientes foram randomizados em 3 grupos: As pacientes do grupo A, receberam tratamento antiemético convencional com medicamentos. As pacientes do grupo B, receberam o tratamento antiemético convencional e aplicação de acupuntura clássica. As pacientes do grupo C, receberam tratamento convencional e aplicação de acupuntura auricular. As pacientes foram submetidas à auto-avaliação nos primeiros 21 dias após o início da quimioterapia, e conforme os critérios da Common toxicity criteria of the National Cancer Institute (NCI CTC), preencheram a ficha de coleta de dados em relação à náusea e vômito neste período. Quanto à náusea do primeiro ao sétimo dia, encontramos pelo teste de Kruskal-Wallis diferença significativa (p=0.040), sugerindo que a acupuntura diminui a intensidade de náusea deste período, e quanto à duração de dias de pior intensidade também foi significativo (p=0,037) ou seja a acupuntura diminui os dias de pior intensidade.Quando utilizamos o teste de Mann-Whitney encontramos diferença significativa da intensidade de náusea somente entre os grupos A e B (p=0,013), significando que a acupuntura clássica diminui a intensidade de náusea em relação ao grupo controle. Em relação aos dias de pior intensidade de náusea encontramos diferença entre os grupos A e B (p=0,043) e entre grupos B e C (p=0,010) ou seja, a acupuntura clássica diminui os dias de pior intensidade de náusea em relação aos grupos controle e acupuntura auricular. Quanto à gravidade do vômito, do primeiro ao sétimo dia, encontramos pelo teste de Kruskal-Wallis diferença significativa (p=0,036) entre os grupos, sugerindo que a acupuntura diminui a gravidade de vômitos. Pelo teste de Mann-Whitney entre os grupos A e B encontrou-se diferença significativa (p=0,017), ou seja, a acupuntura clássica diminui a gravidade de vômitos comparado ao grupo controle. Quanto ao número de dias de vômito de pior grau entre o primeiro e o sétimo dia encontramos ao aplicar o teste ANOVA diferença significativa entre os grupos (p=0,029), sendo que a acupuntura diminui o número de dias com vômito. O teste t aplicado para os grupos em pares revelou entre grupos A e B (p=0,035), portanto, a acupuntura clássica diminui o número de dias de vômito comparado ao grupo controle. Ao estudarmos a intensidade de náusea entre oitavo e vigésimo primeiro dia encontramos pelo teste de Kruskal-Wallis entre os grupos diferença significativa (p=0,022), sendo que a acupuntura diminui a náusea entre oitavo e vigésimo primeiro dia. Pelo teste de Mann-Whitney entre grupos aos pares encontrou-se diferença significativa entre os grupos A e B (p=0,016), houve diferença entre grupos A e C (p=0,049). Portanto, há diferença significativa entre grupos B e C em relação ao grupo A, ou seja, a acupuntura clássica e auricular diminuem a náusea entre oitavo e vigésimo primeiro dias em relação ao grupo controle. Conclusão: A acupuntura clássica diminui a intensidade e duração de náusea e vômito do primeiro ao sétimo dia pós-quimioterapia. A acupuntura clássica e auricular diminuem a intensidade de náusea do oitavo ao vigésimo primeiro dia pós-quimioterapia. / The purpose of this study is to evaluate the efficacy of two acupuncture techniques in the control of the nausea and vomiting in patients diagnosed of Invasive Breast Carcinoma submitted to chemotherapy. Sixty four patients with pathological diagnosis of Invasive Breast Carcinoma were included in the study during the period of March 2003 to February 2007 at Hospital A.C. Camargo. The patients received adjuvant chemotherapy including doxorubicin and ciclophosphamide. The study was developed during the first chemotherapy cycle. The patients were randomized in 3 groups: Patients of the group A received conventional antiemetic treatment with drug administration. Patients of the group B received conventional antiemetic treatment with drug administration and application of classic acupuncture. Patients of the group C received conventional antiemetic treatment with drug administration and application of auricular acupuncture. During the first 21 days, the patients performed self-reports after receiving the chemotherapy shot, according to the Common toxicity criteria of the National Cancer Institute (NCI CTC). They filled out the data collection instrument related to the nausea and vomiting in this period. As for the nausea from the first to the seventh day, we found statistical significancy (p=0.040) using the Kruskal - Wallis test, suggesting that acupuncture reduces the intensity of nausea in this period. Regarding length of days having worse intensity of nausea in this period, results were statistically significant by ANOVA test (p=0.037) with acupuncture decreasing the number of days of worse intensity. Through the Mann Whitney test, we also found significant difference regarding the intensity of nausea among the groups A and B (p=0.013), showing that classic acupuncture reduces the intensity of nausea when compared to the control group. In relation to the days of worse intensity of nausea we found difference among the groups A and B (p=0.043) and among groups B and C (p=0.010) meaning that classic acupuncture decreases the days of worse intensity of nausea when compared to control group and auricular acupuncture group. As for the severity of the vomit, from the first to the seventh day, we found through Kruskal - Wallis test a significant difference (p=0.036) among the groups, suggesting that acupuncture reduces the severity of the vomits. Using the Mann - Whitney test among the groups A and B a significant difference was found (p=0.017) meaning that classic acupuncture reduces the severity of vomits compared to the control group. As for the number of days of vomit in worse degree between the first and the seventh day, we used the ANOVA test and found significant difference among the groups (p=0.029) with acupuncture reducing the number of days with vomit. The t test applied for the groups in pairs revealed statistical significance among groups A and B (p=0.035) and therefore, classic acupuncture reduces the number of days of vomit compared to the control group. We have analysed the intensity of nausea between eighth and twentieth first day. Through the Kruskal - Wallis test, we found significant difference among the groups (p=0.022) showing that acupuncture also reduces the nausea between eighth and twentieth first day. Analyzing the groups in pairs with the Mann - Whitney test, we found significant difference among the groups A and B (p=0.016) and among groups A and C (p=0.049). Therefore, there is significant difference among groups B and C in relation to the group A. Classic acupuncture and auricular acupuncture reduce the nausea between eighth and twentieth first days when compared to control group. Conclusion: Classic acupuncture reduces the intensity and duration of nausea and vomit from the first to the seventh day after chemotherapy. Classic acupuncture and auricular acupuncture reduce the intensity of nausea from the eighth to the twentieth first day after chemotherapy.

Background: Cannabis has been legalized in Canada since October 2018 and shown to be effective for chemotherapy-induced nausea (CIN). Purpose: Guided by the Ottawa Model of Research use, the aim was to determine factors influencing oncology nurses discussing cannabis use with patients experiencing CIN. Part I: A literature review to identify oncology nurses’ practices, knowledge, and attitude toward providing guidance on cannabis use for patients with CIN. Twelve articles were included. Results showed that health care professionals were hesitant to provide guidance for patients on using cannabis for medical purposes. But no studies specifically focus on nurses and CIN. Part II: A descriptive, cross-sectional study was conducted using survey methods. Twenty-five Canadian oncology nurses responded to the survey. Half (n=11) correctly answered the knowledge question about the effectiveness of cannabis. Most (n=18) did not feel confident providing guidance on use of cannabis for CIN. The top three barriers identified are social stigma, lack of knowledge, and lack of support in the workplace. Conclusion: Few Canadian oncology nurses discuss cannabis use for CIN. Identified barriers need to be addressed for oncology nurses to be prepared to discuss use of cannabis for CIN.

No description available.

Este estudo teve como objetivos analisar o conceito náusea em pacientes no período pósoperatório imediato; avaliar a validade de conteúdo e clínica do diagnóstico de enfermagem Náusea no período pós-operatório imediato, considerando-se o modelo de Fehring; identificar a incidência do referido diagnóstico em pacientes no período pós-operatório imediato; verificar possíveis associações entre os antecedentes de náusea obtidos na análise de conceito e os identificados nos pacientes com náusea no pós-operatório imediato e verificar a frequência de ocorrência das características definidoras principais e secundárias do diagnóstico Náusea. A pesquisa foi desenvolvida em três etapas: análise de conceito, validação de conteúdo e validação clínica. A análise de conceito seguiu as oito fases propostas por Walker a Avant: selecionar o conceito, definir o objetivo da análise, identificar a utilização do conceito, definir atributos definidores, desenvolver casos-modelos, desenvolver outros casos, identificar antecedentes e consequentes e verificar as referências empíricas. Essa etapa foi fundamental para a realização das etapas posteriores (validação de conteúdo e validação clínica), permitindo a construção de definições operacionais e a elaboração de instrumentos de coleta de dados mais direcionados ao cenário do paciente com náusea no período pós-operatório. Participaram da validação de conteúdo 52 expertos que responderam a um instrumento que continha dados de identificação profissional e de validação do diagnóstico de enfermagem Náusea (enunciado, definição, posição que ocupa na estrutura taxonômica e características definidoras, descritas em uma escala tipo Likert). A maioria dos expertos considerou o domínio 12 (Conforto), a classe 1 (conforto físico) e o enunciado (náusea) adequados ao diagnóstico. Foram sugeridas modificações na definição atual do referido diagnóstico de enfermagem. Quatro características definidoras foram consideradas principais (relato de náusea, salivação aumentada, aversão à comida e sensação de vômito) e oito foram denominadas secundárias (deglutição aumentada, gosto amargo na boca, palidez, taquicardia, diaforese, sensação de calor e frio, alterações da pressão arterial e dilatação pupilar). Na etapa de validação clínica, 106 pacientes foram incluídos na amostra. Para a coleta de dados, foram utilizados o questionário de avaliação pré, intra e pósoperatória e a Escala Hospitalar de Ansiedade e Depressão. A náusea foi avaliada em duas etapas: 1) análise das manifestações objetivas (dois enfermeiros simultaneamente) e 2) subjetivas (um enfermeiro). A incidência de náusea foi de 21,70% e, na maioria das vezes, de moderada intensidade. Os antecedentes associados à presença de náuseas no pós-operatório foram: sexo, idade, tipo de anestesia, presença de dor, movimentação e alimentação pósoperatória e odores nocivos. Na etapa 1, a característica definidora denominada principal foi relato de náusea, e as manifestações secundárias foram sensação de vômito, palidez e deglutição aumentada. O índice de concordância variou de 86,95% a 100,00%. Na etapa 2, as características consideradas principais foram relato de náusea e sensação de vômito, e as características definidoras secundárias identificadas foram salivação aumentada e sensação de calor e frio. Os escores totais do diagnóstico de enfermagem Náusea foram de 0,79 e 0,73 para as validações de conteúdo e clínica respectivamente, considerado válido para a Taxonomia da North American Nursing Diagnosis Association - International (NANDA-I). Concluiu-se que o relato de náusea, sensação de vômito, palidez, salivação aumentada, deglutição aumentada e sensação de calor e frio são fortes indicativos do diagnóstico de enfermagem Náusea. / The aims of this study were to analyze the nausea concept in patients during the immediate postoperative period; to assess the content and clinical validity of the nursing diagnosis nausea in the immediate postoperative period, considering Fehring\'s model; to identify the incidence of this diagnosis in patients during the immediate postoperative period; to check for possible associations between the nausea antecedents obtained in the concept analysis and those identified in patients with immediate postoperative nausea and to verify the frequency of the primary and secondary defining characteristics of the Nausea diagnosis. The research was developed in three phases: concept analysis, content validation and clinical validation. The concept analysis followed the eight phases proposed by Walker and Avant: select the concept, define the aim of the analysis, identify the use of the concept, define defining attributes, develop model cases, develop other cases, identify antecedents and consequences and check empirical references. This phase was fundamental to accomplish further phases (content validation and clinical validation), permitting the construction of operational definitions and the elaboration of data collection instruments that were better directed at the context of postoperative nausea patients. Fifty-two specialists participated in the content validation, who answered an instrument with professional identification data and the validation of the nursing diagnosis nausea (wording, definition, position in taxonomic structure and defining characteristics, described on a Likert scale). Most experts considered domain 12 (Comfort), class 1 (physical comfort) and the wording (nausea) adequate for the diagnosis. Modifications were suggested in the current definition of the referred nursing diagnosis. Four defining characteristics were considered primary (reported nausea, increased salivation, aversion toward food and gagging sensation), while eight were called secondary (increased swallowing, sour taste in the mouth, pallor, tachycardia, excessive sweating, feeling hot and cold, blood pressure alterations and pupil dilation). In the clinical validation phase, 106 patients were included in the sample. For data collection the pre, intra and post-operative assessment questionnaire and the Hospital Anxiety and Depression Scale were used. Nausea was assessed in two phases: 1) analysis of objective manifestations (two nurses simultaneously) and 2) subjective (one nurse). The incidence level of nausea corresponded to 21.70%, in most cases of moderate intensity. The following antecedents were associated with the presence of nausea and vomiting: gender, age, anesthesia type, presence of pain, postoperative movements and meals and harmful smells. In phase 1, the defining characteristic that was considered primary was reported nausea and the secondary manifestations were gagging sensation, pallor and increased swallowing. Agreement levels ranged between 86.95% and 100.00%. In phase 2, reported nausea and gagging sensation were considered primary characteristics, while increased salivation and feeling hot and cold were identified as secondary defining characteristics. The total scores of the nursing diagnosis Nausea corresponded to 0.79 and 0.73 for the content and clinical validations, respectively, which are considered valid for the Taxonomy of the North American Nursing Diagnosis Association - International (NANDA-I). In conclusion, reported nausea, gagging sensation, pallor, increased salivation, increased swallowing and feeling hot and cold are strong signs of the nursing diagnosis Nausea.