meetings are held to develop unit goals, to work on projects, and to discuss inconsistencies in clinical practice on the unit and make recommendations to resolve them. As part of the program the remain-

ing staff nurses were assigned to one of the committee members who was identified as resource leader for the group. The role of resource leader included meeting regularly with group members to identify individual goals and growth needs, facilitate learning experiences, track mandatory hospital program attendance, and maintain certification and competency skill check-offs. The staff development program has given resource nurses the autonomy and responsibility needed to meet criteria for advancement on the clinical ladder. More importantly, it has provided personalized, consistent support to the entire staff. Key factors in the success of this program were discussed with the intention of enabling others to institute similar mechanisms for staff support and development.

in Adolescents With Cancer: Do Friends Make a Difference?

Fostering Hope

Donna Saba, RN, MN In addition to the normal demands of adolescence, the adolescent with cancer must deal with to illness and death. Accompanying this vulnerability is the potential for loss of hope. Hopefulness has been widely recognized as a protecting mechanism in helping persons in crisis effectively cope. Previous research has neglected the potential influence and support peers might provide in illness. The purpose of this pilot study was to explore the importance of peer relationships to adolescent cancer patients by addressing the question: What influences do peers have on the adolescent with cancer’s level of hope during the first year after diagnosis? Six adolescents with varying diagnoses of cancer participated in a combined quantitative-qualitative study. Subjects completed two questionnaires, The Hopefulness Scale for Adolescents (HSA)L and The Inventory of Parent and Peer Attachment Revised (IPPA-r) 2 to provide a quantitative measure of hope and identify possible alterations in support systems, respectively. Each teenager also participated in an audiotaped interview focusing on peer involvement since diagnosis. Interview data were analyzed for consistent themes using grounded theory methodology. Themes emerging from individual interviews were compared with the quantitative measures for consistency and contrasting results. Reliability and validity testing was addressed through the grounded theory process of theme verification. Internal consistency for the HSA, as estimated by Cronbach’s alpha, ranged from .91 to .93. For the IPPA-r, internal consistency was .87 for Mother Attachment, .89 for Father Attachment, and .92 for Peer Attachment. Only descriptive statistics was used due to the limited number of subjects.. Results included four subjects showing a similar pattern between hopefulness and peer attachment scores (ie, subjects with higher peer attachment scores had higher levels of hope and subjects with lower peer attachment scores had lower levels of hope). A Friendship Sharing model has been proposed including antecedents to sharing, indicators of a shared life, and outcomes of sharing or not sharing. Four subjects experienced positive outcomes of being befriended (feeling encouraged, supported, hopeful, and accepted). Two subjects appeared isolated from friends, which resulted in isolation and boredom and perceived restricted friendships.


From Children’s Hospital, Oakland CA. © 1991

by Association of Pediatric Oncology Nurses.

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Quantitative data supported the proposed qualitative model demonstrating lower peer attachment and hopefulness scores for more isolated adolescents. Future recommendations included study replication and verification of the proposed Friendship Sharing model.

References 1. Hinds PS: An investigation of the relationship between adolescent hopefulness, caring behaviors of nurses, and adolescent healthcare outcomes. Diss Abstr Int 46:2623-B (University Microfilms No. 8522813), 1985 2. Armsden GC, Greenberg MT: The inventory of parent and peer attachment Individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc 16:427-453, 1987

Intravenous Midazolam Versus Fentanyl as Premedication for Painful Procedures in Pediatric Oncology Patients Kathy Conner, RN, MN, CPN, OCN, Eric Sandler, MD, Christine Weyman, MD, Kathleen Reilly, PharmD, Nancy Dickson, RN, OCN, and Jan Luzins, RN Many children with cancer must undergo frequent painful procedures, such as bone marrow aspirations and lumbar punctures, for the diagnosis and treatment of their disease. These repeated procedures usually result in anxiety and pain for patients and their families. In an attempt to decrease the anxiety and pain experienced with procedures, many institutions have tried various medications for sedation and/or pain relief purposes before procedures. Patients have experienced various degrees of relief and are often sedated for hours postprocedure. To help resolve these problems, two short-acting drugs were compared in a double-blinded crossover study. The study drugs included fentanyl, a narcotic analgesic, and midazolam, a benzodiazepine. The purpose of the study was to determine the efficacy and safety of these two drugs as premedications for painful procedures in pediatric oncology patients. . Patients between the ages of 3 and 21 years with a diagnosis of leukemia or lymphoma participated in the study. Safety measures were followed as mandated by the American Academy of Pediatrics for conscious sedation. All patients randomly received either fentanyl or midazolam for their first procedure on study with the other drug given at the next procedure. After two procedures on study, patients could select their drug of choice for subsequent procedures. Fentanyi was given at a maximum dose of 4 J.1g1kg and midazolam was given at 0.2 mg/kg to a maximum of 8 mg. Drugs were administered over 10 minutes and titrated to level of sedation and/or slurring of speech. Assessment of procedures was done using a visual analog scale, parent questionnaire, vital signs, and the Observational Scale of Behavioral Distress. For the 25 evaluable patients on study, 100% preferred study drugs to any previous sedation. The drug of choice for 18 patients (72% ) was midazolam while 7 patients (28% ) preferred fentanyl Minimal From Division of Pediatric Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL © 1991 by Association of Pediatric Oncology Nurses.

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Fostering hope in adolescents with cancer: do friends make a difference?

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