Section A: Problem Description
Cancer patients often have to face fatigue in the name of cancer treatments. The following evidence-based practice project aims to implement and evaluate exercise programs for adult cancer patients. The exercise programs are to be designed in such a way that they are patient-friendly while promoting healthy living and supporting the patients for their future treatments. The program is designed in order to be both sustainable for the health of the patients and their well being, while encourgaging long-term treatments for the patients. These exercise programs will be used for the promotion of physical health and activity in gastrointestinal cancers. Patients suffering from different cancers of the human body can benefit from the treatment that will be provided in the following project. The project aims to establish a set ground of basic exercise that will increase in frequency depending on the need of the patients. Patients in the cancer department will benefit from both the short-term and long-term benefits of the exercise, which will help them ease their fatigue. Different researches and data has been analyzed for the project to provide the optimum exercise routine for the project, while any funding requirements required will be fulfilled by the respective departments and the Cancer Center.
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The news of cancer and its effects on the human body already has a severe impact on the human body. Cancer takes a physical and mental toll on the human body, which is already stressful for the individual suffering. The fatigue and stress that follows the treatments also has a severe impact on the human body. The fatigue from these treatments is intense and can cause the individual to feel tired at all times. The cancer-related fatigue is quite different from the everyday fatigue. Patients have described cancer-related fatigue as a feeling of extreme weakness, drained energy, being too tired to eat or sleep, or perform any daily function. This distressing situation can cause a lot of anxiety, pain, nausea or vomiting for some patients, while others may experience it in other ways. Cancer related fatigue and its symptoms can be described by extended periods of tiredness, without any reason; feelings of low energy and weakness; staying in bed for more than twenty four hours; feelings of confusion or having a hard time concentrating; and the tiredness affects disrupts an individual’s persona, social and work life. The symptoms of cancer related fatigue can last from months and extend up to years. The fatigue is usually seen in patients after the end of their treatment. It can be seen in patients who undergo chemotherapy in cycles, the very first days are typically difficult. For patients that receive radiation therapy, cancer-related fatigue worsens with treatments. Cancer-related fatigue differs from therapy to therapy and from patient to patient. The fatigue can also affect a patient more one day, and a less the next day. Cancer-related therapy can induce a sense of guilt in the individual and hinder their recovery. Normal day activities take a toll on the individual and cause an emotional and mental toll on the individual.
The main reasons behind cancer related fatigue are not understood. However, reseacrhers and doctors state that any cancer related treatment can possibly alter the normal protein and hormone levels in the human body. These hormones are related with incendiary procedures that can cause or decline weakness. These medicines mean to execute ordinary and destructive cells, which can prompt a gathering of waste in the body. The body is as of now recuperated of the treatment and the treatment is as of now enduring a psychological and physical weight for the body. The human body is attempting to fix the harmed tissue and fix the harm. Disease of the human body is a poisonous substance that changes the manner in which typical cells act and treat. Fatigue can be caused by more than one factor. Other factors that contribute to or may lead to fatigue include anemia, emotional distress, sleep problems, the effects of medicines, including, but not limited to, analgesics, sleeping pills, antidepressants, anti-nausea medicines, anti-cramp medicines, certain types of antihistamines and certain medicines for the heart. Other health problems can also contribute to cancer-related fatigue. These include problems with other organs such as the heart, lungs, liver, kidneys, or brain; nervous system problems; digestive system problems; infections, such as pneumonia, urinary tract infections, or viral illnesses; dehydration; low adrenal gland function which can cause low blood pressure and dehydration, followed by fainting; low sex hormones; and a low thyroid function. Poor nutrition and the lack of exercise also contribute to the cancer related fatigue. A poor diet and nutrition can affect the human body in different ways; such factors include different changes in the metabolism of the body; the increased energy needed to repair damaged cells; uncontrolled tumor growth competing for nutrients; poor appetite; nausea and vomiting; and diarrhea. The minimized physical ability during cancer and its treatment can affect the health of an individual. Physical activity during cancer may seem counterintuitive but the physical activity can help decrease fatigue, while helping in building stamina. Resting on the other hand, can increase the fatigue. The consumption of alcohol and other non-prescribed drugs also contribute to the fatigue.
Section B: Literature Support
Different scholars and researches suggest that physical exercise during cancer and cancer treatment can help enhance the fatigue felt by the cancer patients. Different coping strategies and mechanisms have been defined that can help the individuals survive cancer related fatigue. Different medical and self-care treatments have been devised and they can help the patient feel slightly better. Various medical interventions can help the underlying cause of the fatigue. In the case of anemia related fatigue, certain medicines can be prescribed that can help simulate the individual’s bone marrow to produce more red blood cells. For depression, doctors can suggest different medications that can enhance the quality of life of the individual, help their depression and boost their appetite. Adequate pain management strategies can also help control the fatigue, while allowing the doctors to make the appropriate balance. Self care options such as taking it easy; conserving energy, maintaining the energy of the patient and moving around can greatly improve the quality of the cancer treatment. People heal in different ways than others. For some patients, speaking about their fatigue can help them cope with the stress and allow them to feel better.
Researches show that exercise affects the cancer related fatigue during cancer treatment. Professional health and support organizations make use of exercise for the prevention and treatment of cancer related fatigue. Home based programs that are focused on the health of a patient and their education regarding cancer related fatigue are more effective and have long term affects. A staff nurse in a cancer care center or the respective departments is needed to be assigned who can help the patients practice the evidence based practice changes. The director of the program will be responsible for creating and planning the program and the staff nurse will be assigned the duty to do so. Educational brochures and motivational initiatives will also be provided that can help enhance the life quality of the individuals. Physicians and nurses are to be encouraged in order to present a more effective and hands on training regarding the different cancer related fatigues. The different initiatives that have previously been devised include the following:
1. The introduction of an activity program during the patient’s clinic visits
2. Teaching and educating the patients in order to promote a healthier living and life style
3. Providing follow up treatment for the individuals
Section C: Solution Description
“The desired solution for this project is to present and identify the different needs of the patient that can help identify the physical needs of the patient. The requirement of patients suffering from cancer has been related to “energy through movement”, at the Holden Comprehensive Cancer Center. The process follows the Iowa pattern of informed practice. [26] The quota of patients who are being addressed in the project are those who have cancer of the gastrointestinal system. The patients have one of the following cancers: stomach, esophagus, pancreas, biliary tree, or colorectal. The project is dividing the patients into two different groups and the outcomes of the patients will be compared. One of the groups is the action group and the other one is the standard care group. The comparison will be drawn from their quality of life (QOL) and personal feedback. The oncologists or the coordinator are responsible for identifying the patients and they are required to encourage the patients to carry out movement while receiving treatment. The coordinator or medical assistant (MA) will present the details of the program at the start when patients are receiving treatment. Both groups will complete a questionnaire to assess the degree of fatigue, the effect of fatigue on their QOL and the perception of staying active during cancer treatment (Appendix 1). This questionnaire will be repeated in three months.”
“The standard care group receives information about cancer and treatment fatigue based on the current format of questions and answers, and resources. Patients in the action group receive additional instructions from the care coordinator on the value of effectiveness during their Cancer treatment and receive a signed Excellence recipe from their oncologist to participate in a low to moderate movement (annex 3). These brochures are available: energy per movement; Excellence calorie chart; step by step, towards better health: foot; Eat Smart, Food Security, and resistance. Tools to facilitate low to moderate movement are also made available to the patient at the time of teaching. The tools include a step counter, resistance band(s) and a weekly Excellence contract, is placed in a pocket gold energy through a patient-movement kit. The activity of the discusses”, including the benefits of exercising and standardized questions about your activity since your last appointment is completed by the doctor (oncologist, nurse and / or MA. All patients are asked about their level of fatigue and their effects on QOL at each scheduled visit throughout the three-month period. The funding is used for patient kits for the action group and for fast-tracking to other cancer patients in the hospital.”
“It’ s a team made up of a leader, year APN with advanced oncology certification and champions. The opinion leader and the AFN, education is obviously for the practice to change. To enrich the project team work is enhanced through the use of Physicians. The other members of the clinic team responsible for the care department, survivorship ARNPs and Nurse scientist with many EBP know-how. The team will focus on how to identify who-is-who-in-the-project, who will evaluate the materials that are part of the ETM-Kitts, and how to track Who and when to follow-up with these patients.”
“This group will also identify the tools used to measure the registration process and outcomes. Caregivers of media students will be recruited for Education and Encouragement of Patients. Fatigue has been shown to be an important problem in cancer patients. It affects more patient for more time than any other symptom and is considered by patients to be more than important bread gold nausea / vomiting. Research on the etiology and management of this symptom should be considered a priority.
“Fatigue and inconsistent physical performance are common and serious problems for cancer patients. We describe the effect of an aerobic excellence program designed for cancer patients suffering from these symptoms.
METHODS: 5 cancer patients are present with 4 women, 1 viral, Age 18-55. They participated in the training program. Overall, one can see that fatigue had been present for a time ranging between 5 weeks and 18 months. Moreover, it also presented as a hindrance to the patient from carrying out normal daily activities. The training program consisted of walking daily on a treadmill with an intensity corresponding to a lactate concentration of 3 +/- 0.5 mmol.L-1 and was carried out for 6 cr. Results: By the end of the exercise program we observed year improvement in Maximum physical performance (from 6.4 +/- 0.4 km.h – 1 tb 7.5 +/- 0.9 km.h-1, P < 0.05) and maximum walking distance (from 1640 +/- 724 m to 3300 +/- 953 m, p < 0.05). Heart rate and lactate concentration by an equivalent submaximal workload (5 km far.h-1) a significant reduction (of) 138 +/- 21 beats.min-1 tb 113 +/- 20 beats.min-1, P < 0.05, and from 2.6 +/- 1.4 mmol.L – 1 tb 1.3 +/- 0.6 mmol.L-1, P < 0.05); all patients experienced a clear reduction of fatigue and could carry out normal daily activities against without substantive limitations. Conclusion: henceforth, we can conclude that a program prescribed by the percentages of aerobic excellence is a success due to a determined intensity, frequency, duration and absorption capacity, as is the case for therapeutic purposes for primary fatigue in cancer patients.”
Section D: Implementation Plan
“Fatigue-related cancer (FRC) is a concern and disrupts normal functioning.[1] fatigue is the most commonly reported side effect of cancer treatment in patients with external or intestinal cancer.[2-4] CRF in patients with colon cancer is moderate to severe, affects quality of Life [2, 5] and changes in therapy.[6] many patients are seen at the Holden Comprehensive Cancer Center with gi cancer and are probably tired. Over the past two years, two participating oncologists have treated 124 patients with chemotherapy and / or radiation.”
“Research shows that CRF exercise can influence cancer treatment.[7, 8] many professional organizations support the practice of FRC prevention and treatment.[1, 9-13] research shows that home-based programs, patient education and patient materials can help promote movement.[14-17] a Personalkrankenschwester found that Fatigue is a necessity for adults, oncology, Patients and families, they could benefit from an exercise program. The team has experience, published prove it.[18-25], staff disease, the nurse acts as project leader and has established a team to plan and manage programs. The Energy through Motion Initiative was developed with nurses, doctors and physiotherapists who care for people with IM. For the “energy through movement” Initiative, an education brochure and DVD have been developed, other printed materials have been collected and a local household support service has financed energy through tickets. The kits contain a bag, a step counter, an activity, a contract, resistance bands and possibilities to use the recipe and printed material for use during the driver.”
“Staff began to prepare a local NSO program. Doctors or nurses have recommended patients with gastrointestinal Cancer with pflegestudenten Aspects: 1) run the activity program during the Patient’s second klinikbesuch, 2) teachings, such as the energy Motion kit, and 3) offer follow-up treatment days and calls. Students also have a “health salon” on the benefits of the active waiting room in the hospital for patients, families and visitors. If the patient ‘ s involvement in the movement was a problem or if the patients had functional disorders, a transfer to physiotherapy was performed to assess and individualise the activity. Twenty-two patients participated between September 2009 and May 2010 and provided feedback on changes to the content and program design of the kit.”
“Energy in motion began as an identified need of cancer patients Holden Comprehensive Cancer Center. The process follows Iowa model informed practice. The project includes two groups of Patients, both Cancers of the colon, Rectum, stomach, pancreas, esophagus, Bile, crossover, cholangiocarcinoma growth or Ampoule in two gastrointestinal (GI) krebskliniken treat. In order to compare fatigue, quality of life (QOL) and patient feedback to improve the project, an “action group” and a “standard care group”are identified. Patients are identified by their oncologist or care coordinator, as required, to participate in a low or moderate movement during their cancer treatment. The program is presented by the care coordinator or medical assistant (MA) on the first or second day of the patient ‘ s scheduled treatment. Both groups will complete a questionnaire to assess the degree of fatigue, the influence of fatigue on their QOL and the perception of staying active during cancer treatment. This questionnaire will be repeated in three months.”
Section E: Process Evaluation
“Preliminary data show that inpatients have found contacts with students, that the activity of the kit and the calls are useful. The results of this project are measured by feedback from patients during regular clinical visits on their fatigue and the impact of this project on their quality of life. Patients are also invited to comment on the implementation process. These assessments are performed on the basis of a patient questionnaire (annexes 1 and 2). In the first Section of the patientenfragebogens the intensity of Fatigue by means of a single Article by means of a validated evaluation method[27-29] and the impact of Fatigue on the basis of the relevant elements of the validated and generalized Kurzermüdungsinventars evaluated.[27, 30, 31] in the second section, the patient asks for feedback on the implementation process and whether patients feel that corrections are needed. Twenty-five patients from each of the standard care groups and activities are invited to speak. Because Cancer fatigue is variable during cancer treatment, fatigue and QOL values are compared within and between groups with basic descriptive statistics as part of the PBE assessment.”
“Frequency of ‘clinical activity interviews’ with the patient, and the feedback of clinical information on the implementation process will also be assessed through questionnaires. This questionnaire is based on a well-developed process evaluation, used in a series of evidence-based practical project evaluations. Clinicians ‘ feedback is used to assess and adapt the implementation process, where appropriate, to improve the sustainability of the project in ambulatory hospital services.”
“At the end of three months, pre-and post-evaluation surveys are compared within and between groups. Based on these findings, the director of the Center anticancer recommendations, how to help others, cancer treatment, energy through movement can offer. The results of the evaluation of projects in the quality and in the whole department and in the HCCC (for example, at committee meetings).”
“It is a team from a Guide, an APN with advanced oncology certification and Exchange champions. Of opinion Leaders and FFN, education is evident for the practice of change. To enrich the project, team work is enhanced through the use of Physicians. The other members of the klinikteams, for the department are responsible, are the nurses with a lot of EBP know-how. The team will focus on how to know who is in the project, who evaluates the materials that are part of the ETM kits, and how to track, Who and when to track these patients. This group will also identify the instruments to record processes and outcomes. Tutors of Secondary School pupils are recruited for the training and promotion of patients.”
“The family members of the patient / Family Advisory Committee are invited to participate in the role of this project and in the development and validation of the assessment instrument and to present the results to the patient /family advisory committee. The evaluation of the results is carried out by the nursing researcher of our medical centre in collaboration with the team and the centre of Clinical Excellence. No identifiable data are analysed – only Performance Improvement data are expressed in aggregate estimates and constant observation costs.
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