Did we do everything we could have? Nurses' contributions to medicines optimization: A mixed-methods study

The Role of Nurses in the Management of Adverse Events in Patients Receiving First-Line Axitinib Plus Immuno-Oncology Agents for Advanced Renal Cell Carcinoma

OBJECTIVES

The recent approval of first-line tyrosine kinase inhibitor plus immuno-oncology agent combination therapy for the treatment of advanced renal cell carcinoma offers substantially improved response rates and survival compared with the previous standard of care. This expansion of treatment options has also led to a greater range and complexity of potential treatment-related adverse events related to overlapping toxicities. The aim of this article is to discuss the management of common treatment-emergent adverse events (AEs) associated with axitinib plus immuno-oncology therapy, highlight the specific roles of oncology nurses in managing these events, and provide AE management resources to aid oncology nurses in their care of patients with advanced renal cell carcinoma.

DATA SOURCES

Author experience, journal articles, and treatment guidelines were used.

CONCLUSION

The use of oncology nurses and nurse-led innovations to monitor and assess treatments can have a positive impact on the management of AEs in cancer patients by identifying those who are most at risk, providing regular assessment, appropriate patient education, and supporting the monitoring of patient safety.

IMPLICATIONS FOR NURSING PRACTICE

Skilled oncology nurses should be a key part of a team that addresses the supportive care needs and management of AEs that are associated with novel cancer treatments. Early and ongoing communication between the patient and oncology nurses regarding the development of adverse events is a critical component of maximizing treatment outcomes and quality of life.

Perception of the professional self-image by nurses and midwives. Psychometric adaptation of the Belimage questionnaire

BACKGROUND

The aim of this paper is to present the research results on the perception of the professional self-image by Polish nurses and midwives as well as the psychometric adaptation of the Belimage scale.

METHODS

A cross-sectional survey was conducted from January to November 2018. The study group consisted of 670 clinical practice nurses and midwives. A diagnostic survey method was applied using the Belimage questionnaire after it obtained acceptable psychometric properties through an adaptation procedure.

RESULTS

In the group of respondents, the professional image of nurses and midwives is dominated by instrumental skills, documentation and organization of care, and communication skills. There is a statistically significant difference in the image of these two professions in terms of the ability to think and act creatively and critically, as well as innovation and evidence-based practice. The respondents' opinion regarding the perception of their image by themselves and society is statistically significant in each of the analyzed areas. In the professional image created by the public, nurses and midwives recognize that being a nurse/midwife is a vocation-277 (41.3%). However, in terms of their self-image, most nurses and midwives consider their work to be hard-442 (66%) and poorly paid-445 (66.4%). In the psychometric validation process, the Belimage questionnaire retained the original item structure, and the reliability of the subscales assessed with the Cronbach's alpha coefficient ranged from 0.845 to 0.730.

CONCLUSIONS

The professional image of nurses and midwives varies depending on the profession and the perspective of the assessment in relation to themselves and society. The study showed a particularly unfavorable social image of nurses and midwives, which significantly influences the outlook of nurses and midwives themselves on this issue.

Public Perceptions and Attitudes on the Image of Nursing in the Wake of COVID-19

BACKGROUND

The COVID-19 pandemic in recent years has given nursing teams a unique place in this war, and an opportunity to change public opinion. The perceptions have the power to affect the users of health services, the nurses' performance, health policy, and even the choice to become a nurse.

AIM

To examine the relationship between the public's perceptions and attitudes to the nursing profession compared with other healthcare professions, and to examine the relationship with the image of nursing in the wake of the COVID-19 pandemic.

DESIGN AND METHODS

This study is a cross-sectional study, with a descriptive correlational design. Specifically, 80 respondents, men and women aged 18-75, joined a survey consisting of an anonymous questionnaire.

RESULTS

A positive relationship was found between the public's perceptions and attitudes to nursing compared with other professions and the image of nursing in the wake of COVID-19, so the more positive public opinion was, the more positive the image of nursing would be.

CONCLUSION

In the wake of COVID-19, the public's opinion and perception of the nursing profession compared to other professions and their attitudes to nurses are more positive. It is important to continue to explore which factors most affected and changed the image of nursing during the pandemic, and to design strategies to preserve the improved image of nursing among the public on an ongoing basis.

[The role of nurses in pharmaceutical care in Germany: A qualitative analysis]

BACKGROUND

In 13 European countries, laws have been passed that allow nurses to prescribe medicines, but mostly within a limited framework and with a doctor involved. Germany is not among these countries. Only the prescription of medical aids has already been included into the development of extended nursing competencies. We investigated the views of the health care professions involved (doctors, pharmacists and nurses) regarding the role of nurses in pharmaceutical care.

METHOD

We conducted 22 semi-structured interviews with 23 members of the three professional groups involved in the European research project DeMoPhaC. These data collected in Germany were analysed using qualitative content analysis. Five main categories were developed.

RESULTS

Pharmaceutical care by nurses can be described within the following main categories: 1. Knowledge and competences, 2. Patient care, 3. Communication, 4. Multi-professional team and 5. System. The communication between the professional groups involved and with patients and caregivers is of particular importance. Interaction in the multi-professional team is just as crucial. Pharmaceutical care takes place within the health system which sets the framework and often boundaries as well. The current and ideally conceived roles of nurses are seen differently in the respondents' respective contexts. Between the professional groups there is both agreement and dissent on the topics addressed. However, the development of nursing roles requires collaborative and transparent processes in teams and organisations. Particularly in the hospital setting, the participants saw a great need for change in order to achieve cooperation at eye level.

DISCUSSION

The results show that nurses play their role in the complex field of pharmaceutical care under very heterogeneous circumstances. The empowerment of nurses, which was called for by some participants, cannot be achieved from within the professional group alone. Cooperation from all the players involved is needed. The development of nursing roles in the medication process with simultaneous expansion of qualifications and competences can contribute to making the nursing role more attractive. Clear role models promote the transparency of processes for all involved. If all players know what they can expect of nurses, tasks can be redistributed in the multiprofessional team.

CONCLUSION

The above-mentioned diversity of perspectives can be a resource for development and individual solutions. However, it can also be interpreted negatively as a sign of uncertainty and less standardised ways of working. In view of the data evaluated here, the prescription of medicines by non-medical professionals remains a distant goal for developments in the German health care system. First of all, structures and processes are required that permanently guarantee safe pharmaceutical care with equal participation of all relevant stakeholders.

Nurses and Pharmaceutical Care: Interprofessional, Evidence-Based Working to Improve Patient Care and Outcomes

Pharmaceutical care necessitates significant efforts from patients, informal caregivers, the interprofessional team of health care professionals and health care system administrators. Collaboration, mutual respect and agreement amongst all stakeholders regarding responsibilities throughout the complex process of pharmaceutical care is needed before patients can take full advantage of modern medicine. Based on the literature and policy documents, in this position paper, we reflect on opportunities for integrated evidence-based pharmaceutical care to improve care quality and patient outcomes from a nursing perspective. Despite the consensus that interprofessional collaboration is essential, in clinical practice, research, education and policy-making challenges are often not addressed interprofessionally. This paper concludes with specific advises to move towards the implementation of more interprofessional, evidence-based pharmaceutical care.