Paediatric palliative home care with Internet-based video-phones: lessons learnt

We have designed and tested an Internet-based video-phone suitable for use in the homes of families in need of paediatric palliative care services. The equipment uses an ordinary telephone line and includes a PC, Web camera and modem housed in a custom-made box. In initial field testing, six clinical consultations were conducted in a one-month trial of the videophone with a family in receipt of palliative care services who were living in the outer suburbs of Brisbane. Problems with variability in call quality-namely audio and video freezing, and audio break-up-prompted further laboratory testing. We completed a programme of over 250 test calls. Fixing modem connection parameters to use the V.34 modulation protocol at a set bandwidth of 24 kbit/s improved connection stability and the reliability of the video-phone. In subsequent field testing 47 of 50 calls (94%) connected without problems. The freezes that did occur were brief (with greatly reduced packet loss) and had little effect on the ability to communicate, unlike the problems arising in the home testing. The low-bandwidth Internet-based video-phone we have developed provides a feasible means of doing telemedicine in the home.

Impact of an intensive nursing education course on nurses' knowledge, confidence, attitudes, and perceived skills in the care of patients with cancer

Purpose/Objectives: To evaluate the impact of a cancer nursing education course on RNs. Design: Quasi-experimental, longitudinal, pretest/post-test design, with a follow-up assessment six weeks after the completion of the nursing education course. Setting: Urban, nongovernment, cancer control agency in Australia. Sample: 53 RNs, of whom 93% were female, with a mean age of 44.6 years and a mean of 16.8 years of experience in nursing; 86% of the nurses resided and worked in regional areas outside of the state capital. Methods: Scales included the Intervention With Psychosocial Needs: Perceived Importance and Skill Level Scale, Palliative Care Quiz for Nurses, Breast Cancer Knowledge, Preparedness for Cancer Nursing, and Satisfaction With Learning. Data were analyzed using multiple analysis of variance and paired t tests. Main Research Variables: Cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Findings: Compared to nurses in the control group, nurses who attended the nursing education course improved in their cancer nursing-related knowledge, preparedness for cancer nursing, and attitudes toward and perceived skills in the psychosocial care of patients with cancer and their families. Improvements were evident at course completion and were maintained at the six-week follow-up assessment. Conclusions: The nursing education course was effective in improving nurses' scores on all outcome variables. Implications for Nursing: Continuing nursing education courses that use intensive mode timetabling, small group learning, and a mix of teaching methods, including didactic and interactive approaches and clinical placements, are effective and have the potential to improve nursing practice in oncology.

A review of peer support in the context of cancer

Peer support interventions for people with cancer, their families, and friends have been widely used throughout the world. The present study reviewed the research literature on psychosocial oncology over the past decade to assess the prevalence and contribution of articles on peer support. Using CD-Rom databases, 25 articles were retrieved for review. In each article, patients or their family members were the target group for supportive interventions, which were primarily for the delivery of peer support and included either a qualitative or quantitative evaluation of the program. A definitional taxonomy for peer support interventions, which identified eight discrete settings, was derived from three key dimensions: style of supervision, interpersonal context, and mode of delivery. The studies suggested that peer support programs help by providing emotional and informational support from the perspective of shared personal experience. However, a paucity of research-particularly randomized controlled trials-was noted. The reasons may include inherent difficulties in isolating for study what is essentially a naturalistically occurring interpersonal dynamic from the complex social and community contexts from which it emanates. The authors discuss the gap between practice and theory in this area and recommend a broader and more inclusive view of supportive care for people with cancer. (C) 2003 by The Haworth Press, Inc. All rights reserved.

Investigation of the benefits of HIV/AIDS caregiving and relations among caregiving adjustment, benefit finding, and stress and coping variables

The present study explored the nature of benefit finding in HIV/AIDS caregiving, and examined relations among caregiver adjustment, benefit finding, and stress and coping variables. A total of 64 HIV/AIDS caregivers and 46 care recipients completed interviews and questionnaires. First, the study aimed to explore the types of benefits associated with HIV/AIDS caregiving. Content analyses of caregiver responses to an interview question inquiring about gains from caregiving revealed eight benefit themes. Second, the study aimed to examine relations between caregiver adjustment and both benefit finding and stress and coping variables. We hypothesized that number of caregiver reported benefits, social support, challenge and control appraisals, and problem focused coping would be inversely related to poorer adjustment, whereas care recipient reported global distress and illness, caregiver threat appraisal and passive-avoidant emotion-focused coping would be positively associated with poorer adjustment. Correlations indicated that poorer adjustment (measured by global distress, depression, caregiving impact, social adjustment and health status) was positively correlated with care-recipient distress, threat appraisals and passive avoidant coping and inversely correlated with social support, and number of reported benefits. Unexpectedly, problem-focused coping, controllability and challenge appraisals, and care recipient illness were unrelated to adjustment. Third, the study aimed to examine relations between benefit finding and stress and coping variables. Correlations indicated that benefit finding was related to social support use, seeking social support coping and problem-solving coping. Findings indicate that the benefit finding and stress/coping frameworks have utility in guiding research into adaptation to HIV/AIDS caregiving. Results also indicate targets for intervention in the provision of services for HIV/AIDS caregivers.

Evaluating curriculum changes in undergraduate cancer education

Background. Previous studies have indicated that Australian medical schools have not adequately prepared our graduating doctors to care for patients with cancer. The University of Western Australia (UWA) introduced a two-week clinical attachment in cancer medicine for fifth-year students in 2000 and a four-day clinical attachment in palliative care for sixth-year students in 2001. This article evaluates the introduction of these dedicated clinical attachments in cancer and palliative care. Method. The Australian Cancer Society's Cancer Education Survey was administered to the UWA graduates starting their intern year in teaching hospitals in Perth, Western Australia, in 2002. Their responses were compared with data collected in a similar national survey of Australian and New Zealand interns in 2001. Results. The response rate was 56% (n = 70). When compared with the national data for 2001, more UWA interns (2002) would refer a newly diagnosed breast cancer patient to a multidisciplinary breast clinic (97% vs. 74%, P<.001). Fewer UWA 2002 interns rated their training as poor or very poor in the management of patients with incurable cancer (19% vs. 35%, P=.008) and the management of symptoms in patients dying from cancer (10% vs. 37%, P<.001), but they were more likely to rate their training in assisting a patient to stop smoking as poor or very poor (54% vs. 21%, P<.001). Only a quarter of the UWA 2002 interns had examined a patient with a cancer of the mouth or tongue (25% vs. 49%, P<.001), and only two thirds had examined a patient with lymphoma (64% vs. 83%, P<.001). Conclusions. Our data reflect changes in the final two years of the medical course at UWA and suggest that the introduction of dedicated attachments in cancer and palliative care has better prepared graduating doctors to care for patients with cancer.

A Delphi study of district nursing research priorities in Australia

This study, using a Delphi approach, sought the opinion of a self-selected panel of 320 district nurses regarding research priorities for district nursing in Australia. Over three rounds of questionnaires, the 419 research clinical problem areas requiring research as suggested by the panel were each rated in importance by the panel and then ranked through analysis from high to low average rating scores, thereby, whittling down the list to the top 15% (68) research questions and to a final list of the top 10 research priorities overall. Research questions focusing on discharge planning are dominant in these top 10 priorities, with documentation issues the second most common focus. Other foci in the top 10 priorities are staffing, aged care, palliative care, and assessment. The organization-specific top 10 research priorities focus on wound care, funding, education, and communication issues. Additionally, the top 68 priorities, which are either finitely practice-based or contextual-issues research questions, were categorized into 20 themes. The results will hopefully lead to scarce human and financial resources being directed to practice-relevant research programs that will facilitate improved health for district nursing (primarily home-nursing) clients in Australia and elsewhere. (c) 2005 Elsevier Inc. All rights reserved.