Journal of Pediatric Hematology/Oncology Nursing

The purpose of this descriptive study was to measure the rated intensity of work-related stressors experienced by pediatric oncology nurses and to examine the reliability of a new instrument. The Stressor Scale for Pediatric Oncology Nurses (SSPON), a 50-item visual analogue instrument, was used to measure the intensity of those work-related stressors. A national sample (n = 92) of randomly selected members of the Association of Pediatric Oncology Nurses participated. Although most subjects had 2 or more years of pediatric oncology nursing experience (92%), the majority had greater than 5 years of experience (52%). Median scores on the SSPON indicated that the nurses sampled experienced a moderately high level of work stress. Scale items rated most stressful were "watching a patient suffer and not be able to do anything about it," "when a favorite patient dies," and "making mistakes:' Scale items rated least stressful were "when patients die at home rather than here at the hospital with us," "not feeling comfortable with my skills," and "when I can't answer a question about my patient." A comparison of total scale scores, using a t-test for independent samples, indicated that nurses with less than 5 years of pediatric oncology experience (n = 44) did not differ significantly from nurses with greater than 5 years of pediatric oncology experience (n = 48; t = 1.30, P = .199), in relation to intensity of work-related stress. Reliability was estimated using coefficient alpha. The total scale SSPON was found to be internally consistent (coefficient α = 0.93). However, the SSPON's six clusters need to be further refined, modified, and developed because of low coefficient alphas.

Preschool-age children undergoing radiation treatment for malignancies often require daily sedation or general anesthesia to assure adequate motion control. A few older children with severe anxiety reactions, a history of behavior problems, or developmental handicaps have similar problems with radiotherapy. The use of sedation or anesthesia adds risk and expense to a procedure that does not require their administration for pain management. This report describes an altemative approach using behavior analysis to teach cooperation and motion control to preschoolers and older children with special needs. Outcome data are presented for 10 children between the ages of 3 and 7. Eight of the 10 appeared to benefit from the behavioral program. These eight cooperated with radiation treatments without the need for repeated sedation or anesthesia. The benefits and limitations of this approach are discussed along with the need for additional research.

Thirty patients (ages 5 to 13) hospitalized In a pediatric oncology intensive care unit (ICU) rated the presence and severity of their pain on the Faces Pain Scale (FPS) and the Poker Chip Tool (PCT). Parents independently rated the child's pain on these scales and each patient's nurse completed the Objective Pain Scale (OPS). Patients' ratings on the FPS correlated significantly with parents' ratings on this scale (τ = .48, P = .002) but not on the PCT (τ = .23, P = .16). Nurses' ratings on the OPS were moderately correlated with patients' FPS ratings (τ = .37, P = .02) but were only weakly associated with PCT ratings (τ = .27, P = .09). The majority of patients, parents, and nurses eacpressed a preference for the FPS over the PCT. The FPS appears to be a clinically useful and accurate approach for measuring the pain of pediatric oncology patients in an ICU but is limited to those who can participate in a self-report measurement. © 1994 by Association of Pediatric Oncology Nurses.

When a child is diagnosed with cancer, parents try to understand why the cancer developed. Although usually it is not possible to explain what caused an individual child's cancer, clinical experience has shown that parents do form theories about the origins of their child's illness although, or perhaps because, no one knows the actual cause. A parent-completed epidemiology questionnaire (EQ), designed to provide a comprehensive and general epidemiology data base for studies conducted by the Childrens Cancer Group, included an open-ended item ("Do you have any additional comments or concerns about anything that could have caused or contributed to your child's illness?"). A convenience sample of 500 EQs containing responses to the open-ended question was reviewed independently by two experienced pediatric oncology nurses. Statements contained in the responses were categorized into 12 major themes according to content: concern about environmental exposures (n = 303), concern about family health history (n = 270), specific causality attribution (n = 39), puzzlement (n = 24), concern with cancer "clusters" (n = 23), concern with stress (n = 22), altruism (n = 15), specific feedback requests (n = 11), myths/misconceptions (n = 5), advocation of preventive education/screening (n = 4), active information-seeking (n = 6), and parental self-blame (n = 4). These themes or concerns provide useful information that can be applied in planning educational and supportive clinical interventions, as well as further research.