Date of Award

2008-04-01

Degree Name

PhD Nursing

Dissertation Committee

Jane M. Georges, PhD, RN, Chairperson; Patricia A. Roth, EdD, RN; Betty Ferrell, PhD, RN

Keywords

Auricular Acupressure, Dyspnea, end of life care, hospice, Lung Cancer, nursing, patients

Abstract

Introduction: Dyspnea is a debilitating symptom, common in advanced lung cancer patients, and poorly controlled. The National Institutes of Health has promoted the need for research regarding end of life care symptom control. Purpose: Conduct a feasibility study evaluating auricular acupressure effects on dyspnea in hospice lung cancer patients. Theoretical framework: The UCSF School of Nursing Symptom Management Faculty Group's Model for Symptom Management was used for the conceptual framework. The model includes three dimensions: symptom experience, symptom management strategies, and symptom outcomes. The Human Energy Field Theory provided context for using auricular acupressure. Aim: Conduct a pilot study evaluating feasibility and effects of auricular acupressure on dyspnea. Hypotheses: auricular-acupressure seed adhesive use on appropriate points plus standard care (SC) would be more effective than usual care or usual care plus placebo in (1) reducing dyspnea and (2) increasing oxygen saturation. Methods: Both quantitative and qualitative methods. Sample - 11 hospice patients with lung cancer and dyspnea. Procedure - 8 times (Day 1 baseline and post intervention, Days 2 early-late, 3 early-late, 4 early-late follow-ups) dyspnea was measured by the Cancer Dyspnea Scale and oxygen saturation was measured by pulse-oximeter. Qualitative questions were asked on Days 1 and 4. A trained professional administered the acupressure intervention after baseline assessments. Design -The experimental design included 3 conditions with eight measurement points in time. Patients were randomly assigned to one of three treatment conditions: (1) Standard Care; (2) Standard Care with seed adhesive on inappropriate points (placebo); (3) Standard Care with seed adhesive Auricular acupressure on appropriate points. The results were analyzed using analysis of variance (ANOVA). Results: Both quantitative and qualitative analyses supported the presence of acupressure effects with medium to large effects and a significant effect for dyspnea effort. Conclusions: Although difficult to recruit patients to a trial of alternative therapy in advanced disease, it is possible to test such treatments that potentially can improve symptoms in palliative care. Auricular acupressure may help ameliorate dyspnea. There is a continued need for symptom control at end of the life. The role of nursing is central to end of life care.

Document Type

Dissertation: Open Access

Department

Nursing

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