The purpose of this report is to describe variables associated with fatigue for disease-free survivors of breast cancer. On the basis of Mishel's theory of illness uncertainty and the antecedents of uncertainty, a cross-sectional, descriptive, correlational design was used to examine (a) the relationship of fatigue with cancer-related variables and the presence of concurrent illness and (b) whether fatigue and educational level explained a significant proportion of the variation in illness uncertainty. The Mishel Uncertainty in Illness Scale (MUIS) and a single fatigue item on the McCorkle & Young Symptom Distress Scale were used as variable measures. Data were collected from 109 women 1 to 6 years after treatment for Stage I to III breast cancer with no known metastasis. Findings showed that low to moderate fatigue persisted for women, which was related significantly to the presence of concurrent illness. When concurrent illness was taken into account, fatigue was significantly related to treatment with chemotherapy, irrespective of length of time since treatment, age, disease stage, or tamoxifen use. Finally, fatigue and education level explained a significant level of the variation in illness uncertainty. Nurses can identify and assist women who are at risk for fatigue and illness uncertainty after treatment for breast cancer ends.

Many family caregivers of frail older adults postpone or decline accessible and affordable services such as respite, despite their acknowledgement of unmet needs for support and time away from the burdens and stress of caregiving. How caregivers perceive their need for services, and the factors that influence their decisions to use or not to use services, remain poorly understood. This article reviews the literature on family caregiving and the complex interrelated factors that influence caregivers' choices regarding support services. It organizes these factors into four areas: (a) service characteristics, (b) personal predisposing factors that affect perceived need, (c) experiential coping and decision-making patterns, and (d) relational factors. It also examines the implications of this evidence for nursing assessments and interventions with frail older adults and their family caregivers.

When new-graduate nurses enter practice, they are expected to provide clear, effective handoff reports during care transitions. However, few nursing programs offer systematic instruction or opportunities to practice this important form of communication. This article describes a teaching intervention designed to prepare students with handoff skills they will need in practice. Data gathered to evaluate its effectiveness indicated that skill repetition improved student performance and perceived self-efficacy of handoff reporting. Lessons learned and recommendations for incorporating this instruction into nursing curricula are discussed.

No abstract