the effect of written information and counselling by an Advanced Practice Nurse on resilience in women with vulvar neoplasia six months after surgical treatment and the influence of social support recurrence and age a secondary analysis of a multicen

Women with vulvar neoplasia often complain about physical and psychological distress after surgical treatment. Lack of information and support can influence resilience. Whether an information-related intervention through an Advanced Practice Nurse supports resilience and which other factors affect resilience in women with vulvar neoplasia has never been investigated. The aims of this study were (a) to analyse whether counselling based on the WOMAN-PRO II program causes a significant improvement in the resilience scores of women with vulvar neoplasia compared to written information and (b) to identify the potential predictors of resilience. A randomized controlled trial was conducted in women with vulvar neoplasia (n = 49) 6 months after surgical treatment in four Swiss hospitals and one Austrian hospital. Analyses of resilience and its predictors were performed using a linear mixed model. Thirty-six women (intervention I, n = 8; intervention II, n = 28) completed the randomized controlled trial. In total, 13 women (26.5%) dropped out of the trial. The resilience score did not differ significantly between the two interventions three and six months after randomisation (p = 0.759). Age (b = .04, p = 0.001), social support (b = .28, p = 0.009), counselling time (b = .03, p = 0.018) and local recurrence (b = −.56, p = 0.009) were identified as significant predictors of resilience in the linear mixed model analyses. The results indicate that the WOMAN-PRO II program as single intervention does not cause a significant change in the resilience scores of women with vulvar neoplasia 6 months after surgery. Predictors that promote or minimise resilience have been identified and should be considered when developing resilience programs for women with vulvar neoplasia. A repetition of the study with a larger sample size is recommended. The WOMAN-PRO II program was registered in ClinicalTrials.gov NCT01986725 on 18 November 2013.

feeling someone is there for you experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse

AIMS AND OBJECTIVES To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. BACKGROUND Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients’ perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. DESIGN A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. METHODS Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. RESULTS Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. CONCLUSIONS Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as ‘feeling someone is there for you’. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. RELEVANCE TO CLINICAL Practice Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical Practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended.

‘Feeling someone is there for you’ – experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse

AIMS AND OBJECTIVES To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. BACKGROUND Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients’ perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. DESIGN A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. METHODS Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. RESULTS Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. CONCLUSIONS Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as ‘feeling someone is there for you’. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. RELEVANCE TO CLINICAL Practice Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical Practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended.

a qualitative analysis of an Advanced Practice Nurse directed transitional care model intervention

Close to 50% of adults over age 65 years have three or more chronic illnesses and over 20% live with more than five chronic conditions (G. Anderson & Horvath, 2002). Comorbidity is associated with numerous adverse effects including poor quality of life, polypharmacy and increased adverse drug events, increased use of health care resources, increased mortality, and caregiver (CG) burden (Boyd et al., 2007; Gijsen et al., 2001; McGlynn et al., 2003). The posthospitalization period is an extremely vulnerable time for these individuals.

Cognitive impairment (defined in this study as a diagnosis of dementia or delirium or as deficits in orientation, recall, or executive function) is one of the most common comorbidities seen in an older adult population, and its presence compounds the management as well as the complications associated with multiple illnesses, including a greater risk for morbidity, preventable rehospitalizations, and decreased survival (Feil, Marmon, & Unuizer, 2003; Zuccala et al., 2003). Research has also demonstrated that chronic cognitive impairment typically worsens during hospitalization for a variety of reasons, that delirium is also highly prevalent in hospitalized elderly individuals, and that preexisting cognitive impairment can increase hospitalized patients’ level of vulnerability to adverse events as well as CG burden and CG stress posthospitalization (Bell, Araki, & Neumann, 2001; Inouye, 2006).

To address the issues surrounding an increasingly elderly population and test strategies for reducing the adverse effects of hospitalization for cognitively impaired older adults, we conducted a study of an Advanced Practice Nurse (APN)-led Transitional Care Model (TCM; M. Naylor et al., 1994; M. D. Naylor et al., 1999, 2004) intervention. The TCM has been tested with cognitively intact older adults in previous research (M. Naylor et al., 1994; M. D. Naylor et al., 1999, 2004); in this article, we report the findings of an exploratory, qualitative descriptive content analysis focused on the barriers and facilitators associated with implementing this model in a population of cognitively impaired older adults and their family CGs.

Advanced Practice Nurse strategies to improve outcomes and reduce cost in elders with heart failure

The aim of this study was to investigate whether, in a randomized controlled trial (RCT) of vulnerable elders with heart failure (HF), Advanced Practice Nurses (APNs) who were coordinating care in the transition from hospital to home could improve outcomes, prevent rehospitalizations, and reduce costs when compared with usual care. The APN strategies focused on improving patient and family or caregiver effectiveness in managing their illnesses, strengthening the patient-provider relationship, and managing comorbid conditions while improving overall health. The results were positive. By capitalizing on the patient’s desire to achieve their identified goals, APNs successfully educated patients about the meaning of their symptoms and appropriate self-management strategies; improved patient-provider communication patterns; and marshaled caregiver and community resources to maximize patient adherence to the treatment plan and overall quality of life. While HF was the primary reason for enrollment in the study, optimal health outcomes demanded a strong focus on integrating management of comorbid conditions and other long-standing health problems. Specific strategies used by the APN to achieve these positive outcomes are addressed in this report. These strategies are compared with nursing interventions used in other RCTs of HF home management. Directions for future research are explored.

patient problems Advanced Practice Nurse apn interventions time and contacts among five patient groups

Efforts to provide high quality health care services while controlling health care costs have resulted in dramatic changes in health care systems, the delivery of health care services, and methods of reimbursement in the United States (American Medical Association, 2000; Baradell & Hanrahan, 2000; Goldfield, 2000; Lesser & Ginsburg, 2001; Oz et al., 2001). In these changed systems of care, providing high quality services while controlling costs remains an essential objective. Wellness programs and ambulatory care services including day surgery have shown cost savings while providing quality services (Drinkard et al., 2001). Care for people with major illnesses has raised more complex challenges for cost containment because of the need for costly procedures and drugs, adequate lengths of hospital stay, home care services, and continuity of care between health care settings and patients’ homes. Maintaining continuity of care through the use of home care services has been linked to improved patient and family outcomes (Kearney, York, & Deatrick, 2000). However, recent reductions in reimbursement for home care services have the potential for loss of health gains and increased use of hospital and acute care services (Goldfield, 2000).

Achieving high quality health care services and reasonable health care costs requires testing and evaluating types and levels of services capable of maintaining health at reasonable cost. Such testing requires knowledge of the problems of specific patients’ groups needing health care services, provider interventions, provider time and number of patient contacts associated with optimal patient outcomes, and whether provider interventions could be more efficient and cost effective (Daly, Maas, & Johnson, 1997; Delaney, Reed, & Clarke, 2000; O’Conner, Kershaw, & Hameister, 2001; Stange et al., 1998). These issues are critical when the contracted care involves high-risk, high-cost, high-volume groups. To achieve this end, data are needed to accurately and adequately document health care problems of specific patient groups, to examine the processes of care, and to establish links among process, desired health outcomes, and consumer satisfaction. This analysis was conducted to determine those linkages.

the effect of written information and counselling by an Advanced Practice Nurse on resilience in women with vulvar neoplasia six months after surgical treatment and the influence of social support recurrence and age a secondary analysis of a multicen

Women with vulvar neoplasia often complain about physical and psychological distress after surgical treatment. Lack of information and support can influence resilience. Whether an information-related intervention through an Advanced Practice Nurse supports resilience and which other factors affect resilience in women with vulvar neoplasia has never been investigated. The aims of this study were (a) to analyse whether counselling based on the WOMAN-PRO II program causes a significant improvement in the resilience scores of women with vulvar neoplasia compared to written information and (b) to identify the potential predictors of resilience. A randomized controlled trial was conducted in women with vulvar neoplasia (n = 49) 6 months after surgical treatment in four Swiss hospitals and one Austrian hospital. Analyses of resilience and its predictors were performed using a linear mixed model. Thirty-six women (intervention I, n = 8; intervention II, n = 28) completed the randomized controlled trial. In total, 13 women (26.5%) dropped out of the trial. The resilience score did not differ significantly between the two interventions three and six months after randomisation (p = 0.759). Age (b = .04, p = 0.001), social support (b = .28, p = 0.009), counselling time (b = .03, p = 0.018) and local recurrence (b = −.56, p = 0.009) were identified as significant predictors of resilience in the linear mixed model analyses. The results indicate that the WOMAN-PRO II program as single intervention does not cause a significant change in the resilience scores of women with vulvar neoplasia 6 months after surgery. Predictors that promote or minimise resilience have been identified and should be considered when developing resilience programs for women with vulvar neoplasia. A repetition of the study with a larger sample size is recommended. The WOMAN-PRO II program was registered in ClinicalTrials.gov NCT01986725 on 18 November 2013.

feeling someone is there for you experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse

AIMS AND OBJECTIVES To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. BACKGROUND Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients’ perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. DESIGN A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. METHODS Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. RESULTS Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. CONCLUSIONS Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as ‘feeling someone is there for you’. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. RELEVANCE TO CLINICAL Practice Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical Practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended.

‘Feeling someone is there for you’ – experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse

AIMS AND OBJECTIVES To explore the experiences of women with vulvar neoplasia with care delivered by an Advanced Practice Nurse. BACKGROUND Women with vulvar neoplasia suffer from a high number of symptoms and report a lack of information and support by health care professionals. Further, talking about their disease, which is still a social taboo, is difficult for them. From approaches for other patients, it can be suggested that support from an Advanced Practice Nurse can be helpful. For Advanced Practice Nurse development, implementation and evaluation, it is important to assess patients’ perceptions. But so far, little is known about how patients with vulvar neoplasia experience support of an Advanced Practice Nurse. DESIGN A qualitative interview study was chosen to gain understanding of the experience of women with vulvar neoplasia who received care delivered by an Advanced Practice Nurse. METHODS Narrative interviews were conducted with a purposive sample of 13 women with vulvar neoplasia after they received care from an Advanced Practice Nurse for six months. Thematic analysis was used to analyse the data from the interviews. RESULTS Four main themes could be identified: a trusting relationship; accessibility; feeling safe and secure; and feeling someone is there for you. Women felt more secure and less alone in the experience of their illness through having the possibility of contacting an Advanced Practice Nurse and getting sufficient information and psychosocial support. CONCLUSIONS Women with vulvar neoplasia experienced care delivered by an Advanced Practice Nurse as ‘feeling someone is there for you’. Due to the localisation of the disease and the associated social taboo, psychosocial support from the Advanced Practice Nurse beyond months after surgery was very important for them. RELEVANCE TO CLINICAL Practice Addressing psychosocial needs in caring for women with vulvar neoplasia must be given greater attention in clinical Practice. Further, continuous nursing support delivered by an Advanced Practice Nurse beyond the acute treatment phase can be recommended.