Outcomes/Effectiveness Research

Oncology nurses tend to follow guidelines to alleviate post-prostatectomy symptoms

Men who have undergone surgical removal of the prostate (prostatectomy) due to prostate cancer can suffer from pain, incontinence, impotence, and depression. Oncology advanced practice nurses (APNs) appear to follow clinical guidelines aimed at alleviating their pain, incontinence, and depression, concludes a new study. APNs consistently followed clinical guidelines for treating pain a mean of 91 percent of the time, incontinence 80 percent of the time, and depression 69 percent of the time. APNs may be a valuable resource to generalist nurses, helping them interpret and implement guidelines and influencing the overall quality of care delivery, suggests Regina S. Cunningham, Ph.D., R.N., A.O.C.N., of the Yale University School of Nursing.

In the study, 12,317 nursing interventions documented in nursing logs were coded as consistent or not consistent with clinical guidelines. Most of the interventions were related to managing urinary incontinence (60 percent), followed by pain interventions (33 percent), and interventions focused on depressive symptoms (7 percent). Nurses were described as consistently following clinical guidelines if they performed 75 percent or more interventions that followed the guidelines.

Yet consistency did not predict patient outcomes. This may have been due to the small sample of 59 men who underwent prostatectomy. Also, nurses varied little in their consistency of following guidelines, making it more difficult to determine differences in outcomes of patients for whom guidelines were not followed. Finally, nurse interventions that were not consistent with clinical guidelines were, in many respects, congruent with good clinical practice. The study was supported in part by the Agency for Healthcare Research and Quality (HS13124).

See "Clinical practice guideline use by oncology advanced practice nurses," by Dr. Cunningham, in the August 2006 Applied Nursing Research 19, pp. 126-133.

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