Abstracts 2004 Volume 22

ORL – Head and Neck Nursing

Table of Contents
Winter 2004 / Volume 22, Number 1

Features

The Impact of Tracheostomy or Laryngectomy on Spousal and Caregiver Relationships
Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN
Susan F. Rudy, MSN, CRNP, CORLN
April Hazard Vallerand, PhD, RN
Margaret M. Hickey, MS, MSN, RN, OCN®, CORLN
Mary Klein, MSN, RN
Sarah H. Kagan, PhD, RN, CS, AOCN
Elaine M. Walizer, LTC (ret.), AN, MSN

Departments
Editorial: Caregivers: Essential Elements
Linda K. Clarke, MS, RN, CORLN

Letters to the Editor:
Presidential Perspectives: Change: A Key to Opportunity
Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN

Spotlight on Research:
Assessing the Performance of Surgical Gloves
Feature Editor: Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN
Reviewer: Karen Baker, MSN, RN

Products of Interest: Tracheostomy and Laryngectomy Tubes
Feature Editor: Cynthia Tucker, BA, RN, RNFA, CNOR, CORLN

The Impact of Tracheostomy or Laryngectomy on Spousal and Caregiver Relationships
Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN
Susan F. Rudy, MSN, CRNP, CORLN
April Hazard Vallerand, PhD, RN
Margaret M. Hickey, MS, MSN, RN, OCN®, CORLN
Mary Klein, MSN, RN
Sarah H. Kagan, PhD, RN, CS, AOCN
Elaine M. Walizer, LTC (ret.), AN, MSN

Abstract
Care giving is an important component in the management of patients with a tracheostomy or laryngectomy. The purpose of this integrative research literature review was to gain a better understanding of the impact of care giving for adults and children with laryngectomy or tracheostomy on the patient, the family, and the caregiver. Patients who had undergone laryngectomy or tracheostomy included those with and without cancer. This integrated review of the literature on care giving in this population demonstrates the dearth of studies on this subject. Despite the significance of the care giving role, few studies have addressed care giving, and those that have are primarily descriptive. Studies are needed that develop and test interventions to assist caregivers in adaptation to their role, identification of methods of decreasing caregiver burden and strain, and coordination of resources to support patients and caregivers of patients with tracheostomies and laryngectomies.

Follow-up Quality of Life Assessment in Patients after Head and Neck Surgery as Evaluated by Lay Caregivers
Daniel G. Deschler, MD, FACS
Kathleen Walsh, MSN, RN
Richard E. Hayden, MD, FACS

Abstract

Objective/Hypothesis:
As rehabilitation after head and neck surgery is increasingly dependent upon caregivers with no formal training (lay caregivers), the lay caregiver's assessment of the patient's quality of life (QOL) status may be critical to successful rehabilitative efforts. This study evaluates lay caregiver QOL assessment at six and 12 months postoperatively and compares the findings to pre-operative assessments.

Materials and Methods:
Twenty-five patients undergoing head and neck surgery and their primary lay caregivers completed the Medical Outcomes Survey Short Form 36(SF–36) pre-operatively and were followed. Six and 12-month post-operative forms were completed and compared for available patient/lay caregiver pairs. Pair assessment was considered congruent if the lay caregiver’s assessment of each domain of the SF-
36 fell within the 90th % confidence interval of the patient’s score. High congruence was defined as congruence between the pairs for six or more of the eight domains. Results were also related to previously published preoperative data.

Results:
Fourteen and 6 patient/lay caregiver pairs completed the six and 12-month follow-up forms, respectively. Overall congruence was 55% and 45% at six and 12 months, respectively, down from 70% found pre-operatively. Forty-two percent and 17% of the patient/lay caregiver pairs were highly congruent at six and 12 months, respectively. Both values were below the 60% high congruence value noted pre-operatively. The trend toward lay caregivers underrating general health was maintained, while overrating of bodily pain leveled at six months and returned at 12 months. Same generation pairs demonstrated a steady decrease in high congruence levels at six and 12 months. Recurrent disease status no longer predicted high congruence at six or 12 months.

Conclusion:
Trends predicting high congruence in patient/lay caregiver QOL assessment identified preoperatively were not maintained in the post-operative evaluations, except the underrating of patients general health status. Lay caregiver ability to accurately assess patient QOL status did not improve and, in fact, appeared to worsen. Further study into lay caregiver assessment of patients’ quality of life status following head and neck surgery is warranted. Efforts should be directed toward the use of standardized assessment tools and anticipation of subject dropout with greater subject recruitment.

Departments

Editorial: The Hartford Award: An Exemplary Honor
Linda K. Clarke, MS, RN, CORLN

Presidential Perspectives: The Ethics of Privacy
Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN

Products of Interest: Sinus Care Systems
Feature Editor: Cynthia Tucker, BA, RN, RNFA, CNOR, CORLN

Practice Management: Unraveling Surgical Assistant Modifiers
Mary LeGrand, RN, MA

Spotlight on Research:
Decision Making in Advanced Cancer
Feature Editor: Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN
Reviewer: Mary Beth Happ, PhD, RN

The Nurse Educator Role in Otolaryngic
Margaret A. Kramper, RN, BC, FNP, M-S, CNS, CS, CORLN

Abstract
Otolaryngic allergy is a subspecialty demanding the standards of excellence for otolaryngic nursing described by the American Nurses Association (1994). This article provides a review of basic immunology, environmental control measures, pharmacotherapy, and immunotherapy and explores the nurse educator role in the care of otolaryngic allergy patients.

How I Do It: Using Walkie Talkies to Overcome the Fear of
Separation in Children Having Surgery
Barbara A. Mossman, RN

Abstract
Having surgery is an unnerving event for both patients and family members. But, when a child requires surgery, yet another fear is added to the stress equation, that is, the unwelcome fear of separation experienced by both the parent and child. This article describes an innovative protocol designed to alleviate this fear of separation experienced by children having surgery.

Departments

Editorial: Redesigned for the Times
Linda K. Clarke, MS, RN, CORLN

Presidential Perspectives:
Mentoring Relationships within a Professional Organization
Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN

Highlights From the Hill:
Communication: The Key to Government Relations Action
Ann T. McKennis, RN, CNOR, CORLN

Spotlight on Research: Nurse Practitioners Knowledge of
Tobacco Cessation and Screening for Lung Cancer
Feature Editor: Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN
Reviewer: Cindy J. Dawson, RN, BSN, CORLN

Products of Interest: Epistaxis Products
Cynthia Tucker, BA, RN, RNFA, CNOR, CORLN

Recurrent Epistaxis and Integrated Nursing Management: A Case Report
Pratima Poudel Acharya, MA, RN

Abstract
This is a case report of a 63-year old male with an acute presentation of recurrent epistaxis. The patient was seen in an after-hours ward assessment clinic. Mr. MK was marginally hypertensive, with a history of several past episodes of epistaxis. When manual pressure on the anterior nose failed to control the bleeding, bilateral anterior surgical packing was placed bilaterally when manual pressure on the anterior nose had failed to control the bleeding. In view of the patient’s medical and interview of the patient’s history of behavioral and medical problems, an integrated nursing approach was necessary to assist with in preventing future episodes recurrence of epistaxis and to maintaining an acceptable quality of life.

Practice Management: ABC’s: A Beginner’s Coding Lesson
Kim Pollock, RN, MBA, CPC

Abstract
Today, more nurses are asked to participate, or help, in coding for services rendered by facilities and/or physicians. Nurse Practitioners (NPs) and Clinical Nurse Specialists (CNSs) are oftentimes asked to code for the services they directly provide to patients. Yet, most nurses have not received formal coding education or training. It is important for nurses to understand the basics, or “ABCs,” of coding whether the workplace is a hospital, physician’s office, or ambulatory surgery center.

Departments

Editorial: Getting an “Armchair” Education
Linda K. Clarke, MS, RN, CORLN

Presidential Perspectives:
Multiple Lives, Multiple Roles or Mourning the Passing of Summers
Helene J. Krouse, PhD, APRN, BC, CORLN, FAAN

Highlights From the Hill:
The Medicare Prescription Drug Plan: How We Can Help Our Older Patients
Mary N. Klein, MSN, RN, LNFA

Products of Interest: Oral Care Products
Cynthia Tucker, BA, RN, RNFA, CNOR, CORLN

Emergency Ventilation of the Tracheostomy Patient, Part 1: Knowledge Assessment of Healthcare Professionals
Sheila Taylor Myers, PhD, RN
Deidra Sharp, BSN, RN, BC

Abstract
A nurse-driven investigation, using a convenience sample and comparative descriptive design, was conducted within a large medical center to identify healthcare professional’s (n=885) knowledge of emergency ventilation strategies for the tracheostomy patient. Registered nurses and physicians comprised the majority of survey responders (n=587) who answered a three-item questionnaire to assess specific knowledge. Findings focused primarily on differences in knowledge among subgroups of nurses, including those in critical care and non-critical acute care settings. Although increasing knowledge levels are documented since the mid 1980’s, concern for the knowledge available to manage the emergency ventilation of tracheostomy patients is voiced. Less than half of nurses and physicians in this sample were able to answer correctly all three questions asked regarding emergency strategies. Recommendations address this knowledge deficit.

Abstract
Saliva is an essential body fluid. It is important in maintaining oral health, taste acuity, mastication, deglutition and digestion, oral flora regulation, oral cleansing, voice acuity and speech articulation. Saliva is composed largely of water, but also contains minerals, electrolytes, buffers, enzymes, growth factors, cytokines, immunoglobulins, proteins, and metabolic waste products, with the concentrations and compositions of these components varying by individual. Many systemic disorders can affect salivary function, greatly compromising oral health. One such disorder is Sjögren's Syndrome (SS), an autoimmune exocrinopathy characterized by oral and ocular dryness with or without impairment of other organ systems. SS can cause substantial serologic autoimmune reactivity and in some instances is associated with other connective-tissue autoimmune disorders, such as rheumatoid arthritis, scleroderma, or systemic lupus erythematosus. SS increases the risk for developing malignant non-Hodgkin’s lymphoma. Treatment of this syndrome consists of a combination of multiple agents, depending on the degree of symptomatology: cholinergic agonists, artificial salivary substitutes, nonsteroidal anti-inflammatory agents, antirheumatic drugs, and biologic agents. This article describes saliva and salivary function, that pathogenesis of SS, the current treatment of xerostomia, and quality of life issues related to salivary dysfunction.