In response to a long history of problems with defining and measuring fatigue, the University of Kansas School of Nursing established a Center for Biobehavioral Studies of Fatigue Management to facilitate the study of fatigue in diverse populations. The purpose of this article is to review past efforts to define and measure fatigue and the conceptual problems relevant to currently used measures of fatigue. Several distinct characteristics and corresponding measures of fatigue are identified and a definition and framework for the study of fatigue are discussed. Future research on fatigue must attend to the conceptual distinctions among various measures and the measures of fatigue most appropriate to the goals of a study.

When diagnosis of dementia occurs earlier in the disease process, more time is available for treatment aimed at maintaining patient function and delaying decline, and for family education about the disease and its management. Primary care providers often, however, face challenges in making timely diagnoses. Nineteen practitioners in mostly rural areas of a mid-western state were interviewed about their experiences in diagnosis and treatment, to develop a more comprehensive understanding of barriers encountered by providers in non-metropolitan areas. Participants estimated that the time from symptom onset to diagnosis ranged from several months to one year, largely dependant upon family recognition. Limitations in access to consultants and limited or non-existent community support and education resources were major impediments to diagnosis and treatment, respectively. Like their colleagues in more urban communities, denial among family members, or families who were absent or uncooperative, created additional challenges for providers in making and communicating diagnoses and in supporting home-based or institutional care. Conversely, supportive and motivated families played a central role in positive patient care experiences. Participants agreed that support and education services were important for family caregivers, but generally had few resources to offer families, which constrained their ability to provide optimal care. Identifying challenges faced by rural practitioners is essential to planning appropriate interventions for consultative support and educational outreach.

Families caring for loved ones with dementia encounter multiple challenges.This study aimed to describe experiences of families seeking diagnosis and subsequent care and treatment for relatives with dementia. Using a descriptive qualitative approach, 14 family caregivers living in diverse areas of Kansas were interviewed regarding their experiences with dementia diagnosis and treatment. Initially uncertain about symptom interpretation, caregivers encountered marked delays in getting a diagnosis once they sought medical care. The diagnostic process often took several years and visits to numerous physicians, required considerable diligence, and ultimately resulted in feelings of mistrust toward the medical community. Caregivers described the physical and emotional strain of providing care, although support groups facilitated access to some educational and community resources. Nurses are in an opportune position to educate families about dementia and caregiving and to ease the considerable challenges they face by providing more active support during the diagnosis and care process.The population structure in the United States is shifting to include a greater percentage of older adults than ever before.

Symptom familiarity reinforces patterns about symptom management. SIM enriches understanding of symptom experiences. Comprehensive assessment, including the intraindividual perspective, is essential to successful symptom management.

No abstract