What do cancer patients identify as supportive and unsupportive behaviour of nurses? A pilot study

What Nursing-Sensitive Outcomes Have Been Investigated to Date among Patients with Solid and Hematological Malignancies? A Scoping Review

Nursing-sensitive outcomes are those outcomes attributable to nursing care. To date three main reviews have summarized the evidence available regarding the nursing outcomes in onco-haematological care. Updating the existing reviews was the main intent of this study; specifically, the aim was to map the state of the art of the science in the field of oncology nursing-sensitive outcomes and to summarise outcomes and metrics documented as being influenced by nursing care. A scoping review was conducted in 2021. The MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and Scopus databases were examined. Qualitative and quantitative primary and secondary studies concerning patients with solid/haematological malignancies, cared for in any setting, published in English, and from any time were all included. Both inductive and deductive approaches were used to analyse the data extracted from the studies. Sixty studies have been included, mostly primary (n = 57, 95.0%) with a quasi- or experimental approach (n = 26, 55.3%), conducted among Europe (n = 27, 45.0%), in hospitals and clinical wards (n = 29, 48.3%), and including from 8 to 4615 patients. In the inductive analysis, there emerged 151 outcomes grouped into 38 categories, with the top category being 'Satisfaction and perception of nursing care received' (n = 32, 21.2%). Outcome measurement systems included mainly self-report questionnaires (n = 89, 66.9%). In the deductive analysis, according to the Oncology Nursing Society 2004 classification, the 'Symptom control and management' domain was the most investigated (n = 44, 29.1%); however, the majority (n = 50, 33.1%) of nursing-sensitive outcomes that emerged were not includible in the available framework. Continuing to map nursing outcomes may be useful for clinicians, managers, educators, and researchers in establishing the endpoints of their practice. The ample number of instruments and metrics that emerged suggests the need for more development of homogeneous assessment systems allowing comparison across health issues, settings, and countries.

Exploring Nursing Values in the Development of a Nurse-Led Service

This article considers the development of nurse-led services as a part of a pilot study and explores the therapeutic nature of the role of the nurse. In particular it suggests a need for reconsideration of the fundamental values of nurse-led care in the context of changing organizational culture. Within the UK there has been pressure from policy makers to extend the role of the specialist nurse and create new nursing roles, shifting the boundaries between professional health groups. The philosophy of nurse-led initiatives has therefore been driven mainly from a service redesign and clinical need standpoint rather than necessarily focusing on enhancing patients’ experience and the changes in organizational culture required to achieve this. While several studies have focused on the safety, comparative cost and comparative patient outcomes in nurse-led care in relation to traditional or doctor-led care, little attention has been given to the changing organizational values underlying the nursing role. Exploring this context is essential if new nursing roles are to provide more than relief for bottlenecks in the system and also meet their potential for providing patient centred and innovative models of care.

Factors influencing the development of end-of-life communication skills: A focus group study of nursing and medical students

BACKGROUND

Poor communication between health care professionals and dying patients and their families results in complaints about end-of-life care. End-of-life communication skills should be a core part of nursing and medical education but research suggests that qualified doctors and nurses find this a challenging area of practice.

AIMS

The aim of this study was to explore factors influencing the development of end-of-life communication skills by nursing and medical students.

DESIGN

A qualitative study comprising five focus groups.

PARTICIPANTS

Second year undergraduate nursing (n=9 across 2 focus groups) and fourth year undergraduate medical students (n=10 across 3 focus groups) from a London University.

FINDINGS

Barriers and facilitators influenced nursing and medical students' experience of communication with dying patients and their families in clinical practice. Extrinsic barriers included gatekeeping by qualified staff and lack of opportunity to make sense of experiences through discussion. Intrinsic barriers included not knowing what to say, dealing with emotional responses, wasting patients' time, and concerns about their own ability to cope with distressing experiences. Facilitating factors included good role models, previous experience, and classroom input.

CONCLUSION

In addition to clinical placements, formal opportunities for reflective discussion are necessary to facilitate the development of students' confidence and skills in end-of-life communication. For students and mentors to view end-of-life communication as a legitimate part of their learning it needs to be specified written practice-learning outcome. Mentors and supervisors may require training to enable them to facilitate students to develop end-of-life communication skills.

Nurse responsiveness to cancer patient expressions of emotion

OBJECTIVE

This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.

METHODS

This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.

RESULTS

Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.

CONCLUSION

Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.

PRACTICE IMPLICATIONS

Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.

Health literacy and the information needs and dilemmas of first-time mothers over 35 years

AIM AND OBJECTIVES

This paper aims to highlight the information-based dilemmas of a particular group of healthcare patients, first-time mothers over 35 years.

BACKGROUND

In recent years, there has been a proliferation of health-related information and a move towards greater public access to health information as an important step towards patient education and empowerment. Information technologies, such as the Internet, have added considerable momentum to this trend. Many health professionals now consider the provision of detailed health information to patients as requisite for informed decision making. Within the literature there is some emphasis on the importance of patient understanding of information received; however, to date, few studies have considered information over-consumption as problematic.

METHODS

Using in-depth interviews, a sample of 22 first-time mothers over 35 years was interviewed over three junctures: 35 weeks gestation, 10-14 days postpartum and six to eight months postpartum. Three focus group interviews of midwives and maternal and child health nurses were also conducted. This paper was undertaken as part of a larger project to evaluate the experience of first mothering over 35 years.

RESULTS

Mothers in this study were found to have access to large volumes of health information. This tendency was driven by both the women and the health professionals who cared for them. Midwives and maternal and child health nurses revealed a tendency to provide older first-time mothers with considerable health information of a medical orientation, understanding that this is what the women required. However, despite common perceptions of empowerment, the consumption of medical-type information proved frightening and many mothers described feeling overwhelmed by 'knowing too much'.

CONCLUSION

This study contributes to the limited understanding of the information needs of a growing group of childbearing women, first-time mothers over 35 years. By providing an insight into the 'downside' of extensive health information, nursing staff, in particular, may consider the amount and type of information they distribute. Some suggestions are offered to health professionals to ameliorate the information-based dilemmas of these women.

RELEVANCE TO CLINICAL PRACTICE

As the number of childbearing women over 35 years continues to grow, it is important for health professionals to understand the particular needs of this group. In doing so, doctors, midwives and maternal and child health nurses may be in a position to provide more meaningful maternal support.

The impact of oncology education on practice—A literature review

Cancer care currently enjoys a high national profile in the UK, with a growing emphasis on cancer education for nurses and allied health professionals, however, there is dearth of research into the effectiveness and impact of cancer education on practice. This paper explores the context of cancer care and education and reviews the literature regarding the relationship between the two. It explores the assumption that education positively influences practice and contributes to the health care agenda by supporting the need for further research in this area.

The clinical nurse specialist in gynaecological oncology-the role in vulval cancer

Gynaecological malignancy has an immense impact on the well-being of women. In order for these women clearly to understand their disease, investigations, treatment options and prognosis, it is essential that high-quality information be delivered in an appropriate environment. Effective communication is the essence of good relationships between the health professional and the patient. Patients' psychological, social and sexual rehabilitation following treatment for gynaecological cancer demand a holistic, pro-active approach by professionals who are skilled in the provision of this care. Within a multidisciplinary team (MDT), the clinical nurse specialist (CNS) is in a key position to be able to address these often complex and sensitive issues. This chapter explores the unique role of the CNS in the care of gynaecological cancer patients, and the care of vulval cancer patients in particular. The successful development of medical/nursing partnerships enables women with gynaecological cancer to gain proper access to essential expert knowledge and information and thereby to make informed decisions.

Care of women with breast cancer on a surgical ward: nurses' opinions of the need for support for women, relatives and themselves

BACKGROUND

In Sweden women with newly diagnosed breast cancer are admitted to surgical wards in order to undergo surgery and receive postoperative care. On these wards, nursing staff take care of women both with newly diagnosed breast cancer and those with cancer in advanced stages. Nurses have to meet the varying needs of patients and their relatives.

AIM

To describe nurses' opinions of the need for care and support for women and their relatives in connection with surgery for breast cancer, as well as their own need for support on a surgical ward.

METHODS

Thirty-one nurses from a surgical ward participated in semi-structured interviews. The interviews were tape-recorded and transcribed verbatim. Thereafter a step-by-step, qualitative content analysis was carried out.

RESULTS

The nurses described the need to talk and receive information as being the most important among women and their relatives, as well as among themselves. Only a few nurses mentioned the need for physical care among the women. Contact with relatives was described as being almost nonexistent. There was a discrepancy between what nurses described as important needs and how these needs were provided for.

CONCLUSION

This study shows that what the nurses described as being the most important needs, and the way how these needs were provided for, was more often seen from a theoretical point of view with few examples of self-experienced situations in the daily care. Needs among women and their relatives seemed to be not fully known to nurses and therefore, possibly, were not met. Nurses themselves had a pronounced need for support, which was sometimes unsatisfactorily met.

Ovarian cancer patients: are their informational and emotional needs being met?

A study was undertaken to assess if the informational and emotional needs of ovarian cancer patients were being met according to their individual requirements. In the study, a gynaecology oncology specialist nurse provided hospital nursing support through individual care and a patients' support group. A questionnaire was completed by 24 patients using an integrated qualitative and quantitative data collection. This study showed that respondents evaluated positively the care provided in these two ways. Further research into the needs of gynaecological cancer patients should be undertaken.

Communication between nurses and simulated patients with cancer: evaluation of a communication training programme

In this paper the effect of a communication training programme on the instrumental and affective communication skills employed by ward nurses during the admittance interview with recently diagnosed cancer patients was investigated. The training focused on teaching nurses skills to discuss and handle patient emotions. For this purpose, 46 nurses participated in 92 videotaped admittance interviews with simulated patients. The study had a randomized pre-test-post-test design. Multi-level analysis was used to measure the effects of the training. The results revealed that the trained nurses significantly increased asking open-ended psychosocial questions, which indicates that they were actively exploring patients' feelings. Furthermore, the patients showed a significant increase in affective communication. In conclusion, the results of this study demonstrate that, although limited, training can induce favourable changes in the communication skills of nurses, and can even affect patient communication. Future studies should focus on the further evaluation of educational programmes to enhance communication skills.

Communication skills of nurses during interactions with simulated cancer patients

AIM

In this paper the balance of affective and instrumental communication employed by nurses during the admission interview with recently diagnosed cancer patients was investigated.

RATIONALE

The balance of affective and instrumental communication employed by nurses appears to be important, especially during the admission interview with cancer patients.

METHODS

For this purpose, admission interviews between 53 ward nurses and simulated cancer patients were videotaped and analysed using the Roter Interaction Analysis system, in which a distinction is made between instrumental and affective communication.

RESULTS

The results reveal that more than 60% of nurses' utterances were of an instrumental nature. Affective communication occurred, but was more related to global affect ratings like giving agreements and paraphrases than to discussing and exploring actively patients feelings by showing empathy, showing concern and optimism.

CONCLUSION

In future, nurses should be systematically provided with (continuing) training programmes, in which they learn how to communicate effectively in relation to patients' emotions and feelings, and how to integrate emotional care with practical and medical tasks.

Quality of life in cancer care: patients' experiences and nurses' contribution

People with cancer experience great changes in their lives. Disease, treatment and prognosis affect their quality of life. The aim of this literature review was to ascertain how the illness affects patients' quality of life and to what extent nurses can influence or improve this experience. Twenty-two research articles were reviewed, the majority of which were qualitative in nature, studies that allow patients to portray their experiences in their own words. The concept of quality of life was defined as consisting of well-being in four core domains, psychological, social, physical and spiritual. It was found that patients' quality of life is affected in all four core domains and that these domains are overlapping and interdependent. The qualitative data also highlighted that each patient's experience is unique to that patient. Nurses have to be aware of this and remain sensitive to the individual patient's needs. Few of the articles reviewed examined nursing care from the patient's point of view. Tentative conclusions were that nurses can improve patients' quality of life by ensuring they are competent in daily practice, by giving patients a feeling of security and by treating them with respect as individuals and human beings.

Development of two instruments measuring social support for siblings of children with cancer

The literature on childhood cancer provides a very limited understanding of healthy siblings' perceptions of supportive interventions during the childhood cancer experience. The purpose of this article is to discuss the development of the Nurse-Sibling Social Support Questionnaire (NSSSQ). Instrument methodology for the study involved item development, face and content validation, and internal consistency reliability as described by Hockenberry-Eaton, Manteuffel, and Bottomley (1997). Item development for the research instrument evolved from an extensive review of the literature and clinical experience of the principal investigator. Content validity of the instrument was accomplished by five experienced pediatric oncology nurses according to the methodology described by Lynn (1986). Using the content validity index, each nurse rated each item as either 4 or 5, indicating 100% agreement among experts that these items measured the concept of social support. Readability for the instrument was determined by using a computerized program. Results showed that readability was concordant with the grade school level for all items. Twenty-five school-age siblings of children with cancer and their mothers were asked to complete the questionnaire. Instrument completion was accomplished in less than 1 hour. The NSSSQ showed high internal consistencies (alpha coefficients >.90). Results indicated that siblings' perceptions of social support differed from those of their mothers. Siblings perceive emotional and instrumental support as greater in importance, whereas mothers perceive emotional and informational support as more beneficial to siblings. Support issues for siblings of children with cancer have been difficult to assess because of the lack of appropriate instruments. This study finding provides exploratory evidence to suggest that the new instrument can help measure siblings' perceptions of social support during the childhood cancer experience.

A concept analysis of social support as experienced by siblings of children with cancer

Social support is a complex phenomenon. The concept is variably defined by multiple disciplines. This article analyzes the concept of social support by using the methods outlined in the nursing literature. The concept analysis focuses on psychosocial support of siblings of children with cancer. Each step in the concept analysis is presented to show the relevance of the concept with siblings of children with cancer.

Nurse-patient communication in cancer care. A review of the literature

Patients with cancer seem to experience distress particularly in the first period after diagnosis, and are likely to develop an affective disorder in the first 2 to 3 months. Communicative behaviors of nurses seem to play an important role in meeting the cognitive and affective needs of patients with cancer. This review of the literature examines the communicative behaviors of nurses during care activities with patients who have cancer. The studies show that emphasis is placed on the affective side, in which facilitating behaviors such as empathy, touch, comforting, and supporting are considered essential in caring for patients with cancer. Unfortunately, further studies in this review demonstrate that communication in oncologic care is complicated by such emotionally laden issues as the consequences associated with the life-threatening character of the disease and the far-reaching consequences of the medical treatment. This results in barriers to effective communication between patients with cancer and nurses. It is important, therefore, that nurses working with patients who have cancer are provided both structurally and repeatedly with continuing education programs in communication. Finally, most of the studies covered in this review have an explorative character. Future research in this area should pay attention to the use of controlled studies, large sample sizes, and observational instruments.