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   Table of Contents - Current issue
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October-December 2020
Volume 7 | Issue 4
Page Nos. 301-403

Online since Monday, September 14, 2020

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PERSPECTIVE  

Challenges in Teaching Palliative Care Module Virtually during COVID-19 Era Highly accessed article p. 301
Shanaz Cassum, Khairunnisa Mansoor, Amina Hirji, Amber David, Amina Aijaz
DOI:10.4103/apjon.apjon_42_20  
With the COVID-19 pandemic hitting the global community, routine activities of universities, offices, and industries have been hindered. People are being forced to rethink the ways of working virtually from home for providing education, business, and health services in this social distancing during the COVID era. This sudden shift also posed challenges of online teaching in a private university, in urban Karachi, Pakistan. The Aga Khan University, School of Nursing and Midwifery recently conducted an online palliative care module using a virtual learning environment and Microsoft Teams for Trainee Nurse Interns. Although the first experience of online teaching and learning was a successful venture for faculty and students, in a lockdown situation, numerous challenges were also encountered being a lower middle-income country. The issues of electricity shutdown, Internet connectivity, and quality assurance were anticipated on transition to online pedagogy, but backup plans were formed to make execution promising.
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EDITORIALS Top

Oncology Nursing Challenges during COVID-19 Outbreak: Precautions and Guidance p. 305
Abhishek Shankar, Tulika Seth, Deepak Saini, Sachidanand Jee Bharati, Shubham Roy
DOI:10.4103/apjon.apjon_39_20  
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Cancer Screening during COVID-19 Pandemic p. 308
Naveen Chandrahas Khargekar, Divya Khanna
DOI:10.4103/apjon.apjon_21_20  
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COVID-19 and Self-Care Measures by Chemotherapy Patients p. 310
Salima Shams, Khairunnisa Mansoor
DOI:10.4103/apjon.apjon_20_20  
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ORIGINAL ARTICLES Top

A Model for Building Research Capacity and Infrastructure in Oncology: A Nursing Research Fellowship p. 312
Ann M Mazzella Ebstein, Margaret Barton-Burke, Kristen L Fessele
DOI:10.4103/apjon.apjon_35_20  
Objective: This article describes how one comprehensive cancer center in the Northeast United States reorganized their nursing research fellowship (NRF) with the goals of engaging nurses in research processes, developing a culture of inquiry, building nursing research capacity, and sustaining infrastructures for facilitating high-quality, nurse-led oncology research studies. Methods: The basis for the curriculum, course work, and research practicum is derived from academic courses taught at the undergraduate, graduate, and doctoral levels. Evidence from the current literature, expertise of nurse-scientists, and feedback from former fellows provided the background for a fellowship model that included: (1) amending curriculum timeframes; (2) incorporating protected time; (3) improving access to resources; (4) enhancing the protection, data sharing, and accessibility of data; and (5) involving nurse-scientists as mentors and facilitators of research processes. These factors were incorporated over 3 years. Metrics included individual class and overall course evaluations and ongoing assessments. Results: In three cohorts from 2016 to 2019, a total of 21 nurses were accepted, and 18 (86%) nurses completed the NRF. In cohort 1 through cohort 3, 17 fellows presented their research findings internally, and a total of nine projects were presented at external forums. There were seven fellows whose manuscript submissions resulted in 21 journal publications. Of the 18 fellows, 15 (83%) conducted institutional review board-approved studies and three (17%) fellows developed studies involving one concept analysis and two systematic reviews. Conclusions: Utilizing technology, the fellowship improved access beyond the classroom setting. Improved application processes, the inclusion of protected time for nurses, and mentoring from nurse-scientists demonstrate a commitment to fostering a culture supporting new knowledge and innovation for improving patient care.
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Determining the Concerns of Breast Cancer Survivors to Inform Practice p. 319
Gek Phin Chua, Quan Sing Ng, Hiang Khoon Tan, Whee Sze Ong
DOI:10.4103/apjon.apjon_26_20  
Objective: Breast cancer is the most common cancer in women across all ethnicities, accounting for almost one in three incident cancers in female, and the leading cause of mortality in Singapore. Literature reveals that survivors of breast cancer have many concerns, and these concerns can linger on for decades. The primary aim of this secondary analysis was to establish the concerns of breast cancer survivors and use the data to inform practice. Methods: The present report was part of a bigger data designed to evaluate the concerns of cancer survivors (top six cancers) across the survivorship trajectory. Data of 438 breast cancer survivors were derived from a cross-sectional survey of the self-reported concerns of 1107 cancer survivors, using the questionnaire adopted from the Mayo Clinic Cancer Centre's Cancer Survivors Survey of Needs. Logistic regression models were fitted to estimate the odds ratios to assess the association of various variables with the presence of ≥1 concerned or very concerned issue among patients. Linear regression models were fitted to identify the variables associated with quality of life (QOL). Results: A total of 438 breast cancer survivors responded to this survey. The top five concerns were cancer treatment and recurrence risk (55.5%), followed by fear of recurrence (FOR) (54.6%), long-term effects of treatment (53.4%), osteoporosis/bone health (39.0%), and keeping primary care physicians informed (37.4%). Cancer treatment and recurrence risk, FOR, and long-term treatment effects were among the top concerns across the survivorship trajectory. The mean QOL was 7.5 on a scale of 0–10. Conclusions: Irrespective of the cancer trajectory, survivors of breast cancer have serious concerns that warrant attention. Designing patient care delivery that addresses these concerns identified is critical in assisting them in their coping process and enhancing their QOL.
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The Troubled Nurse: A Qualitative Study of Psychoemotional Effects of Cancer Care on Nurses in A Nigerian Cancer Care Setting p. 328
Chinomso Ugochukwu Nwozichi, Theresa A Guino-o, Amarachi Marie Madu, Raul Hormazabal-Salgado, Mutiu Alani Jimoh, Oluwatosin Taiwo Arungwa
DOI:10.4103/apjon.apjon_25_20  
Objective: Nurses who care for cancer patients are exposed to varying degrees of psychological pressure. These psychological issues among nurses are thought to have some consequences relating to professional satisfaction, quality of care, and patient outcome. This study aimed to explore the psychological and emotional impact of caring for persons among cancer care nurses. Methods: A qualitative, descriptive approach was employed, and a purposive sampling technique was used to select seven nurses who were interviewed one-on-one. Interview data were coded and analyzed using NVivo 12 to generate the final themes and patterns. The EQUATOR's COREQ guideline for qualitative studies was adhered to. Results: Data analysis yielded two major themes and four sub-themes. Participants expressed concerns about their frequent encounter with dying patients on the ward which affects their own mental well-being as persons. Sometimes, the health-care professionals used emotional distance to mitigate the emotional and psychological effects of the frequent deaths encountered on the ward. Professional dissatisfaction was also brought about by the increased amount of patients who died on the ward, the gloomy nature of the care environment, and the feeling of incapacitation to help. Conclusions: The findings indicate that nurses who care for cancer patients need to be supported to enhance their psychological and emotional well-being. The findings of this study could help nurse managers to understand the level of psychological pressure cancer care impose on nurses and the importance of improving the mental health of nurses in cancer care.
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Childhood Cancer Survivors: Self-Reported Quality of Life during and after the Cancer Trajectory p. 336
Margaretha Stenmarker, Karin Enskär, Maria Björk, Mirka Pinkava, Bo Rolander, Marie Golsäter
DOI:10.4103/apjon.apjon_22_20  
Objective: This cross-sectional study aimed to present how the unique cancer experience in childhood influences young adults' quality of life (QOL). Methods: Qualitative and quantitative methods were used to code and analyze a study-specific questionnaire (133 items). These data are presented in accordance with a conceptual QOL/health-related QOL model. Results: The participants included 34 women and 28 men (n = 62) diagnosed with solid tumors/lymphoma in the period 1983–2003, who had been treated at the same childhood cancer center in Sweden. The current mean age was 28.7 years (range: 18–45, standard deviation [SD]: 6.3, median value: 28.5), the mean age at diagnosis was 12.9 years (range: 8–17, SD: 2.3, median value: 13), and the mean time elapsed since treatment was 15.7 years (range: 4–28, SD: 2.4, median value: 15). The response rate was 65%. Higher levels of psychological maturity were reported by women versus men (P = 0.01) and by survivors diagnosed with cancer during adolescence versus school age (P = 0.04). Male participants reported lower levels of physical limitations (P = 0.03) and emotional distress when being of treatment and in contact with health care services (P = 0.04). The strongest factor influencing QOL during therapy was parental support (97%), while the strongest factors after therapy were to live a life similar to peers (82%) and to be satisfied with one's life situation (81%). During treatment, limitations influencing QOL were related to lack of school support (2%), and after treatment, to deteriorated relationships with siblings (5%). Conclusions: Life-threatening diseases at young ages have long-term psychosocial effects with ambiguous results at multiple levels. To capture these experiences, we recommend clinical studies that are based on conceptual clarifying frameworks and adopt a quantitative and qualitative research approach.
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Effect of Workplace Spirituality on Quality of Work Life of Nurse Cancer Survivors in South Korea p. 346
Juhyun Jin, Eunju Lee
DOI:10.4103/apjon.apjon_36_20  
Objective: Return to work is known to have a positive effect on the quality of work life of cancer survivors, including the nurse cancer survivors, along with other factors, such as workplace spirituality. The aim of this study was to identify the effect of workplace spirituality and its constituent concepts on the quality of work life of nurse cancer survivors. Methods: A cross-sectional survey comprising the nursing workplace spirituality (NWS) and quality of nursing work life (QNWL) scales was completed by 130 cancer survivor nurses between October 15, 2018, and May 15, 2019, in two general hospitals in metropolitan areas, and snowball sampling was used in parallel. The data were analyzed using SPSS 22 software, determining descriptive statistics, and conducting an independent t-test, one-way ANOVA, Pearson's correlation coefficient, and hierarchical multiple regression. Results: The average scores for all NWS and QNWL subdomains were medium. Age, nursing tenure, and the factors of NWS were positively correlated with QNWL, especially the harmony between the workplace and the individual (r = 0.65, P < 0. 001). In the second hierarchical regression, controlling general characteristics, harmony between the workplace and the individual (β = 0.38, P ≤ 0.001), and relationship with colleagues (β = 0.19, P = 0.031) were significant predictors of QNWL explaining 59.0% of the variance. This model was found to be suitable (F = 16.29, P ≤ 0.001). Conclusions: Effective and practical organizational systems and intervention programs based on organizational support, including colleagues' support for increasing the quality of work life for nurse cancer survivors, are required.
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Developing Adult Sepsis Protocol to Reduce the Time to Initial Antibiotic Dose and Improve Outcomes among Patients with Cancer in Emergency Department p. 355
Mustafa Z Bader, Abdullah T Obaid, Hisham M Al-Khateb, Yazeed T Eldos, Moath M Elaya
DOI:10.4103/apjon.apjon_32_20  
Objective: Sepsis is a common cause of noncancer-related deaths among oncology patients. Delay in the initiation of efficient antimicrobial therapy will decrease the survival rate. This study aims to develop a sepsis protocol for adult oncology patients to decrease the time needed to receive the initial dose of antibiotic in an emergency department (ED), improve the early recognition of sepsis, and decrease the in-hospital mortality rate due to sepsis. Methods: A quasi-experimental research design was used. A total of 168 participants were assigned into pre- and post-intervention groups (n = 85) and (n = 83), respectively. The quick Sequential Organ Failure Assessment screening tool was used to screen patients in the triage room. Results: There was a significant difference in the proportions of receiving the initial antibiotic dose whether ≤1 h or >1 h between pre- and post-intervention groups. The results also showed that 89.4% of the postintervention group received their initial antibiotic dose in <1 h compared with 10.8% of the preintervention group. The median time needed for administering the initial antibiotic dose was decreased from 95 min to 45 min. The results of the changes in mortality rates are promising as it decreased 11.7% after applying the adult sepsis protocol. Conclusions: Applying an adult sepsis protocol in the ED significantly decreased the time needed to initiate antibiotic treatment. It is recommended to utilize a multidisciplinary and systematic approach in screening and treating sepsis.
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Evaluating Preoperative Anxiety Levels in Patients Undergoing Breast Cancer Surgery p. 361
Maria Katsohiraki, Sofia Poulopoulou, Nikolaos Fyrfiris, Ioannis Koutelekos, Polyxeni Tsiotinou, Olga Adam, Eleni Vasilopoulou, Maria Kapritsou
DOI:10.4103/apjon.apjon_31_20  
Objective: Patients' anxiety and stress levels are increased after the surgery. High levels of anxiety and stress could increase postoperative complications, as well as to prolong postoperative hospitalization and postoperative morbidity. This prospective, cross-sectional study was to evaluate the preoperative stress levels in patients undergoing breast cancer surgery. Methods: In the study participated 165 female patients who underwent breast cancer surgery, in a major oncological hospital in Greece. Demographic and clinical data were collected, and anxiety and stress levels assessed using the State-Trait Anxiety Inventory (STAI) Scale, which was a self-report questionnaire consisting of 40, 4 Likert Scale questions. The first 20 questions, STAI-X-1, were concerned to how the patient felt while answering the questionnaire (anxiety as a condition) and the remaining 20 questions, STAI-X-2, based on how the patient felt overall (stress as a personality trait). Descriptive statistics and nonparametric tests were performed at a significance level alpha = 0.05. Results: In the present study, 165 females were enrolled who underwent breast cancer surgery. The mean age of the participants was 55.86 years, whereas the mean body mass index was 26.85. The 60.6% of patients underwent a lumpectomy and 28.5% had mastectomy. The 35.8% experienced moderate levels of anxiety, and the 17.6% experienced high levels. The two scales were positively correlated (rho = 0.643, P < 0.001), at the significance level P = 0.01. Furthermore, the Stai-X-2 Scale was negatively correlated with body height (rho = −0.1188, P = 0.016). Conclusions: The present study showed that patients' personality influenced their anxiety levels. Thus, the role of the nurse is a cornerstone in their psychological support preoperatively, to reduce the anxiety and stress levels.
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Relationship between Health Literacy and Medication Adherence of Turkish Cancer Patients Receiving Oral Chemotherapy p. 365
Huri Seval Gonderen Cakmak, Doğan Uncu
DOI:10.4103/apjon.apjon_30_20  
Objective: The aim of this study was to explore the relationship between health literacy and self-report medication adherence of Turkish cancer patients receiving oral chemotherapy. Methods: The present research was a descriptive and cross-sectional study and conducted with 100 voluntary cancer patients who were admitted to the medical oncology outpatient clinic and received oral chemotherapy. The data were collected through a questionnaire form consisting of the Oral Chemotherapy Adherence Scale and the Turkish Health Literacy Scale (TSOY-32). The collected data were analyzed using descriptive statistics, one-way ANOVA, and Pearson's correlation coefficient.Results: The results revealed that 57% of the patients were female, 35% were primary school graduates, 51% were breast cancer, and 36% took capecitabine. The mean index scores of the participants on both scales were calculated as 12.39 ± 1.51 and 73.25 ± 6.18, respectively. Overall, a positive and strong correlation was found between oral chemotherapy adherence and health literacy of the participants (r = 0.707, P = 0.000). Conclusions: Medication adherence and health literacy levels among the cancer patients in Turkey are alarming so that patient-centered interventions and training are required to overcome the barriers to medication adherence.
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Effectiveness of Structured Education on Patient's Knowledge and Practice Regarding Colostomy Care p. 370
Sahar A Abdelmohsen
DOI:10.4103/apjon.apjon_24_20  
Objective: Evaluating the effectiveness of structured education on patient's knowledge and practice regarding colostomy care. Methods: A quasi-experimental study design (pre–posttest) was utilized to fulfill the aim of the study. The study was carried out in the outpatient surgery clinic at South Egypt Cancer Institute; a nonprobability convenient sample of 60 adult male and female colostomy patients was included in the study. Two tools were utilized; Tool I: A structured interviewing questionnaire sheet, including three parts: Part I: Demographic characteristics of the studied patients, Part II: Assessment of colostomy, and Part III: Patients' knowledge regarding colostomy (pre–post); Tool II: A colostomy care observation checklist (pre/post). Results: A highly statistically significant difference was found regarding total knowledge and practice scores of the studied sample pre- and post-application of the structured patient education. Conclusions: On light of the present study results, it can be concluded that structured patient education was found to be effective in enhancing patient's knowledge and practices, regarding stoma and peristomal skin care.
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Assessment of Information Needs of Patients with Breast Cancer: A Hospital-Based Study in Sri Lanka p. 375
Daya Chandrani Kuruppu, Chandrika Neelakanthi Wijeyaratne, Nalika Gunawardane, Indrani Amarasinghe
DOI:10.4103/apjon.apjon_23_20  
Objective: This study assessed the information needs of breast cancer (BC) patients who presented themselves to the outpatient clinics or wards of the National Cancer Institute, Maharagama, Sri Lanka. Methods: Information needs were measured using the validated questionnaire in the vernacular (Sri Lankan Information Needs Assessment Questionnaire – BC). Results: All affected women indicated a strong need for information related to the disease, treatment, and psychosocial service while the need for information on procedures for diagnosis and physical care was not strong. Younger women (age ≤37) (P < 0.0001) and women with higher education (P < 0.0001) had significantly higher information needs. Conclusions: The results indicated that information needs to be addressed in educational packages require that younger women and those with higher education have specific needs.
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Effectiveness of Education Program on Nursing Knowledge and Attitude toward Pain Management p. 382
Aqel El-Aqoul, Abdullah Obaid, Ihsan Jarrah, Khaled Al-Rawashdeh, Ahmad Al Hroub
DOI:10.4103/apjon.apjon_17_20  
Objective: Nurses have an integral role in pain assessment and management. Adequate knowledge and positive attitudes toward pain management are essential to provide high-quality nursing care for cancer pain. The purposes of this study are to evaluate nurses' knowledge and attitude toward cancer-related pain and to assess the effectiveness of a pain management education program on nurses' knowledge and attitude toward pain. Methods: A quantitative, experimental design was used. Results: The total number of participants who were surveyed at three measurement points was 131, with a completion rate of 87.3%. Findings revealed that the score of knowledge and attitude toward cancer-related pain ranged from 14 to 35, with a mean of 23.6 (standard deviation [SD] = 4.38). The mean scores of the intervention group and the control group at two measurement points regarding knowledge and attitude toward cancer-related pain were 32.7 (SD = 2.8) and 32.8 (SD = 4.3) and 23 (SD = 5.5) and 22.2 (SD = 3.8), respectively. There were significant differences at three measurement points among the intervention group (F = 114.3, P < 0.0005). There were no differences in the three measurement points among the control group (F = 3.4, P = 0.055). Conclusions: Nurses have essential roles in cancer pain. A pain management education program can improve nurses' knowledge and attitude toward cancer-related pain.
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Improving the Management of Terminal Delirium at the End of Life p. 389
Megan Sutherland, Aakriti Pyakurel, Amy E Nolen, Kalliopi (Kalli) Stilos
DOI:10.4103/apjon.apjon_29_20  
Objective: Terminal delirium is a distressing process that occurs in the dying phase, often misdiagnosed and undertreated. A hospital developed the “comfort measures order set” for dying patients receiving comfort care in the final 72 h of life. A chart review of patients experiencing terminal delirium revealed that the current medication option initially included in the order set was suboptimally effective and patients with terminal delirium were consistently undertreated. The purpose of this pilot study was to highlight an in-service intervention educating nurses on the management of terminal delirium at the end of life and to assess its effect on their knowledge of the management of patients with terminal delirium. Methods: A before-and-after survey design was used to assess the effect of the in-service training on nurses' knowledge of terminal delirium. Results: We describe the results from a small sample of nurses at a large urban tertiary care center in Canada. Of the twenty nurses who attended the in-services, 60% had cared for a patient with terminal delirium; however, 50% felt that their knowledge of the topic was inadequate. Despite no statistical significance between the pre- and posttest scores for both the oncology and the medicine unit nurses, all participants who completed posttest survey found the in-services useful. Conclusions: The findings from this study provide initial insights into the importance of in-service trainings to improve the end-of-life care and nursing practice. Future research will include expanding this pilot project with sufficient power to assess the significance of these types of interventions.
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Effectiveness of Telenursing for Postoperative Complications in Patients with Prostate Cancer p. 396
Daisuke Sato
DOI:10.4103/apjon.apjon_28_20  
Objective: This study is addressing the question of whether a telenursing system using information and communication technology is effective for improving postoperative complications and quality of life (QOL) in patients with prostate cancer. Methods: Using a tablet computer, the participants were asked to provide information on various items, including urinary frequency, number of incontinence pads used, and presence of sexual desire and erections. Both the participants and researchers monitored automatically graphed time-dependent changes in symptoms, and the researchers could propose concrete measures to reduce patients' complications. The primary endpoint was an improved score on the expanded prostate cancer index composite (EPIC) and improved urinary incontinence based on a positive stress test. The secondary endpoint was an evaluation of self-care responses to the Functional Assessment of Cancer Therapy-General (FACT-G) instrument. Results: This study asked 33 patients who met all inclusion criteria to participate in the study, 30 of whom agreed. We compared the scores of EPIC, FACT-G, and stress test for prostate cancer patients 1 month and 3 months after surgery. The scores of urinary incontinence and urinary bother for both groups were significantly higher in 3 months after surgery than in 1 month after surgery, showing improvement in symptoms. The amount of urine left in the bladder after stress test increased showing the improvement in urinary incontinence (P = 0.001). Conclusions: The relationship between prostate cancer patients' complications after surgery and QOL showed that their physical well-being improved as they found relief from their symptoms. Telenursing was shown to be effective for symptom management of patients with chronic diseases including cancer.
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