Health care management is considered as a vital component in clinical settings. With the growing needs and demands of patients, appropriate strategies need implementation by the health care professionals. Patients who present severe life threatening conditions appear in need of great support. Here, the ultimate goal is to promote an improved patient outcome and quality of life (QOL). This task could rely on the skill and professional expertise of caregivers especially, nurses. Nurses have great potential in caring patients. They could incorporate special patient tailored strategies to improve outcomes. This description focuses on ‘nursing interventions to promote patient outcomes’.
Briefly, nursing interventions are reported to be actions performed by nurses to increase the patient’s treatment course .It could rely on assessment where nurses would determine the type of problem, formulate a specific plan, offer treatment and carry out evaluation (What are nursing interventions?, 2013).
So, the targeted people include those individuals with various types of cancer which may be in a progressive or fully developed state. This appears important to study because cancer individuals have a multitude of complications. When viewed from several perspectives, they appear complicated and need immediate assessment and management by care givers. They are at high risk of losing the life and their appropriate care could not only help in identifying their needs but also in providing an emotional support to their family members.
Nursing interventions could vary.
In a study, researchers have chosen nursing education as an intervention (Godino et al., 2006). This was chosen with the goal of lessening perception of fatigue in oncology patients. Here, researchers have employed a Functional Assessment of Cancer Therapy Fatigue (FACT-F) Scale as a tool to measure the fatigue levels in patients and controls who received nurse education. The outcome was a decreased fatigue level in the experimental group compared to increased fatigue level in control group. This tool was selected based on individual’s fatigue levels. So, the outcome, fatigue level was measured with the FACT- F scale following nursing education. It was learned that patients with cancer could better manage their fatigue through
nursing intervention with the personalized education and counseling(Godino et al., 2006).
The limitation of the study is that it has not properly considered the history of fatigue levels among cancer patients and also no data on consistent FACT-F scores.
For pursuing a quality improvement initiative, a precise history on fatigue levels and other parameters that help in predicting fatigue would be considered. This is because, these measures would provide a supporting information to the intervention and could have added much light on the sensitivity and specificity of the tool. The desired outcomes would be increased satisfaction among patients and consistent FACT-F scores that could help in further extending the tool usage to other cancer patients.
In another study, a nursing intervention was applied to enhance dignified dying and quality of life for cancer patients at the end of life situations (Jo et al., 2011). This is known as Palliative care nursing intervention. The outcomes were measured by conducting a survey on nurses who regularly attend the dying patients .The survey consisted of interventions from the International Classification for Nursing Practice (ICNP) catalogue on Palliative Care.Here, this survey has Likert response sets. No other tool was described rather than the survey.This survey was selected based on nurses’ palliative routine care service to cancer patients and their attitudes towards the guidelines(Jo et al., 2011).
It was learned that palliative nursing interventions are essential for nurses who attend to the dying cancer patients. It was also learnt that catalogue use in classifying the nursing interventions could promote better communication with other nurses about care delivery in their nation.
The limitations are that low sampling and confining the study to only one region.. So, to pursue quality improvement initiative, it is essential to carry out surveys by recruiting good number of nurse participants. This is because it helps in generalizing study, obtain and evaluate the enormous data to standardize the nurse care plan for cancer patients who encounter death (Jo et al., 2011). The desired outcome was increased agreement between standard ICNP catalogue and routine nurse care at oncology units that ensures better professional satisfaction and care delivery.
According to Dyar et al (2012), advanced cancer patients need to receive discussion-based palliative care interventions for improved outcome. In this study, the outcomes were measured by discussing about the advantages of hospice, living wills discussion, advanced directives and QoL. This is accompanied by measuring variations from baseline QoL and improvement in hospice awareness. The tools that were used for outcome measurement included QoL tools, Linear Analogue Self Assessment scale (LASA), Functional Assessment of Cancer Therapy-General [FACT-G] and hospice knowledge questionnaires (HKQ) (Dyar et al.,2012). The tools were selected based on patients’ willingness to participate to undertake visits by ARNP and capability to complete questionnaire.
It was learnt that a discussion based palliative nurse care intervention could improve patient outcome. Especially, early palliative care directed by ARNP along with QoL assesements and hospice education could enhance emotional well being of patients with metastatic cancer (Dyar et al.,2012)
The important limitation is reduced size of cohort (Dyar et al.,2012). In order to pursue quality improvement initiative, more widespread intervention application with controls, referrals by ARNP are needed. This is because it could ensure much coverage of patients with metastatic cancer who would be willing to express their psyco-social feelings in surveys, and control groups who with their baseline scores could help in better assessing the outcomes. It is important because by focusing on broad population, we could understand the feasibility or awareness of palliative care and hospice services in people who are minority and underserved subgroups.
The desired outcomes are that ARNP-directed intervention when applied early during course of metastatic cancer patients' therapy could be well adopted by patients and their families which might ensure improvement in patients’ mental and emotional QoL (Dyar et al.,2012).
Further, prostate cancer patients need a supportive nurse care intervention for improving their outcomes (Cockle et al., 2013). Here, the outcomes were measured with the help of questionnaire based survey tools like Supportive Care Needs Survey (SCNS), EuroQol EQ-5D-3L and a self-rating scale of Health State. They were selected based on unmet supportive care needs of cancer patients who require an evaluation in relation to nursing care. It was learnt that nurses supportive care could address the survivorship needs and lessens unmet needs of men with prostrate cancer. Failure to contact the nurses could increase the unmet needs of men. So, patient outcomes could be influenced by supportive nursing care (Cockle et al., 2013)
The limitations are that the study was carries out in a very brief period where symptoms and unmet needs were thoroughly focused. The researchers were unable to differentiate co-morbidities from the effects of prostate treatment. In addition, no association was observed between unmet needs and age, socio-economic status (Cockle et al., 2013).
So in order, to purse a quality improvement initiative, increased nurse provision with training must be consistently promoted to address any issues like psychological care and sexual dysfunction. These should be preferred for improving supportive care. Here, symptom management and long term side effects are the areas that need improvement apart from information provision. Care related to monitoring and management need to be increased as the
the population of men increases. So, a goal oriented supportive care for men after prostate cancer therapy is essential to meet ever growing men’s population (Cockle et al., 2013). The desired outcome is that unmet needs in cancer patients could be found or identified in association with illness, treatment factors and other parameters.
In another study, a trans institutional modular nursing intervention was used
Here, the outcomes were measured by using standard pain treatment, the Self Care Improvement through Oncology Nursing (SCION-PAIN) program. It has the modules like pharmacologic pain management, nonpharmacologic pain management and discharge management. So, no other tools were used.
This program was selected based on certain barriers that need to be overcome such has undertreated pain due patient, health care professional and institutional barriers. It was selected based patients’ perception, activities and pain management attitudes. It was learnt that this intervention is efficacious in enhancing cancer pain self-managing potential in patients. It was also learnt that patients misconceptions about a drug use, say opiods, that interfere in pain management could be overcome with the aid of program (Jahn et al., 2010).
However, this study did not mention about how it has minimized known or unknown biases that made strengthened the study. In order to pursue a qualitative initiative, research should clearly differentiate the patient’s attitudes like self care actions, knowledge from opinions. Here, researchers should identify any unknown confounding factors that interfere in pain management.
The desired outcome would be that the intervention would promote increased
adherence to medication, communication with health care professionals and reliance on complimentary strategies. It is also expected that nurse professionals integrate the intervention into their regular care service schedule in wards. This would make the SCION-PAIN program more applicable to real world case scenarios (Jahn et al., 2010).
Next, ovarian cancer patients who are more prone to psychological distress need intervention to improve their cancer management skills. To this end, advanced practice nurse (APN) interventions were applied to lessen psychological distress during ovarian cancer treatment (O'Sullivan et al., 2011).
In this study, the outcomes are measured by distress thermometer (DT), psychiatric APN serving in a consultation-liaison nursing role (PCLN) documentation Forms, and the Omaha System criteria that involves problem classification ccheme, intervention scheme, and a problem rating scale for outcomes. These were selected based on earlier data that describe patients’ medical history, demography, cancer –specific and psychiatry characteristics.
It was learnt that the intervention has provided information on spectrum of problems encountered by women during the treatment course. Further, this intervention has taught that women following surgical treatment for ovarian cancer could greatly require a guideline- oriented clinical plan for managing psychological distress.
The limitations of the study are that the researchers have used previously collected data and made a secondary analysis (O'Sullivan et al., 2011).
The use of DT was not validated on a cross-cultural basis and hence its potential in measuring distress in patients of different educational and ethical background is unknown.
Patients who experienced symptoms like fatigue were nor precisely identified as per the coding of Omaha System Problems. There was poor sampling with restricted diversity. Researchers need to rely only on a small subsample of subjects who were obtained from three sample as per DT scores and consent for PCLN intervention. The subsamples also represented only nonwhite subjects who had very low college education. The sample was derived from the large women population enrolled at a single cancer center who received cancer therapy. So, this study falls short in its potential to be generalized to other ovarian cancer women population (O'Sullivan et al., 2011).
The desired outcome is that women experiencing distress and unable to work psychologically could manage their rising cancer problems if they receive support from support from APNs.
Ultimately, it is possible to expect women with low distress who will be ready to openly convey their needs and issues to APNs and could become active health goal achievers (O'Sullivan et al., 2011).
APN intervention was also explored for women with gynecologic cancer (McCorkle.et al., 2009).. This intervention appears important because these women appeared deficient in and important for improving their poor quality of life QOL accompanied by psyco-social needs after surgery and during chemotherapy.
The outcomes were measured by using APN and PCLN, QOL scales like the short-form Health survey (SF-12), symptom distress Scale, center for epidemiological studies-depression scale. QOL assessments included the Center for Epidemiological Studies-Depression Scale , the ambiguity subscale of the Mishel Uncertainty in Illness Scale , the Symptom Distress Scale, and the Short-Form Health Survey (SF-12) (McCorkle.et al., 2009).
These scales served as tools in the study. They were selected based on patients’ distress and attitudes in providing responses to self-reported questionnaires administered at baseline. It was learnt that nurse oriented interventions targeting both physical and psychological aspects of QOL could provide outcomes in cancer patients post surgery instead of intervention that targets only one QOL parameter(McCorkle.et al., 2009). The limitations of the study are that the study did not carry out enough correlation analysis between the scales used for outcome measurement. This prevented in making a cross-confirmation about the scores obtained. The other limitation is that the short study duration.
So, to pursue a qualitative improvement initiative, there is need to enhance the duration of the project to another 6 months. This could be because, long term study could help in assessing the distress levels and other QOL needs that could get altered or return to abnormal once the short period intervention ceases.
The desired outcome is that improved psychological wellbeing and physical functions in women who encounter psycho-social distress and issues related to QOL post surgery and during chemotherapy. It is also reasonable to expect improved adherence to cancer based therapies among the affected population if the nursing interventions are generalized and applied on an evidence base approach.
References
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