Systematic review and meta-analysis of patient reported outcomes for nurse-led models of survivorship care for adult cancer patients

Purpose: This systematic review aimed to determine the effectiveness of nurse-led cancer survivorship care, compared with existing models of care, on patient reported outcomes for cancer survivors. Methods: Randomised and non-randomised controlled trials and controlled before-after studies published in English between 1 January 2007 and 28 July 2017 were identified in bibliographic databases including Medline, Pubmed and PsychINFO. Included studies described nurse-led cancer care after treatment to adults (age ≥18 years) \u3c2 years post treatment completion. Risk of bias was assessed using Joanna Briggs Institute’s tools and meta-analysis was undertaken. Results: Twenty one publications were included describing 15 tumour-specific trials involving 3278 survivors of breast (n = 5), gynecological (n = 3), head and neck (n = 2), colorectal (n = 2), upper gastrointestinal (n = 2) and prostate (n = 1) cancers. Seven trials reported quality of life (QoL) using the EORTC QLQ-C30; participants receiving nurse-led care (4–6 months) had better cognitive (4 trials, 463 participants; mean difference [MD] = 4.04 [95% CI, 0.59–7.50]; p = 0.02) and social functioning (4 trials, 463 participants; MD = 3.06 [0.14–5.97]; p = 0.04) but worse appetite loss (3 trials, 354 participants; MD = 4.43 [0.08–8.78]; p = 0.05). After intervention completion, intervention participants had reduced fatigue (4 trials, 647 participants; MD = −4.45 [−7.93 to −0.97]; p = 0.01). Conclusion: This systematic review synthesised outcomes of models of nurse-led survivorship care and contributes a meta-analysis of patient QoL to survivorship evidence. This review was limited by the risk of bias in many included studies for blinding of treatment personnel and outcome assessors. Nurse-led care appears beneficial for cancer survivors for some QoL domains

Patient perspectives on nurse-led consultations within a pilot structured transition program for young adults moving from an academic tertiary setting to community-based type 1 diabetes care

Purpose: We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. Design and Methods: A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction – short scale). HbA1c values were compared to guideline recommendations. Results: Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5 ± 0.5) while patients reported the lowest adherence to diet recommendations (2.9 ± 0.8). Overall satisfaction with nurse-led consultations was high (4 ± 0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. Conclusions: Young adults found the nurse-led consultations with therapeutic education to develop T1DM selfcare skills are an important complement to medical management during transition. Practice Implications: Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management

Visibility based hospital inpatient unit design.

Patient fall is one of the adverse events in an inpatient unit of a hospital that can lead to disability and/or mortality. Healthcare literature suggests that increased visibility of patients by unit nurses is essential to improve patient monitoring and, in turn, reduce falls. However, such research has been descriptive in nature and does not provide an understanding of the characteristics of an optimal inpatient unit layout from a visibility-standpoint. This dissertation fills significant voids in this domain and adds much-needed realism to develop insights that hospital decision-makers can use to design their inpatient unit layout. Our first contribution (Chapter 2) adopts an interdisciplinary approach that combines the human field of regard with facility layout design approaches. Specifically, we propose a bi-objective optimization model that jointly determines the optimal (i) location of a nurse in a nursing station and (ii) orientation of a patient\u27s bed in a room for a given layout. The two objectives are maximizing the total visibility of all patients across patient rooms and minimizing inequity in visibility among those patients. We consider three different layout types, L-, I-, and R-shaped; these shapes exhibit the section of an inpatient unit that a nurse oversees. To estimate visibility, we employ the ray casting algorithm to quantify the visibility of a target in a room when viewed by the nurse from the nursing station. This algorithm considers nurses\u27 horizontal visual field and their depth of vision. We also propose a Multi-Objective Particle Swarm Optimization (MOPSO) heuristic to find (near) optimal solutions to the bi-objective optimization model. Our findings suggest that the R-shaped layout outperforms the other two layouts on these visibility-based objectives. Further, the position of the patient\u27s bed plays a role in maximizing the visibility of the patient\u27s room. In our second contribution, we extend the model in the first contribution to now include position of the bed in patient rooms as a decision variable and consider various door positions. We consider four distinct layout types, L–shaped, U-shaped, R-shaped, and I-shaped, with eight patient rooms and a nurse-to-patient ratio of 1:4. We propose an ε-constrained approach to convert the corresponding bi-objective optimization model into a single objective optimization model, prioritizing equity as an objective function. We propose a progressive refinement algorithm to solve this optimization model within a reasonable time. Our findings suggest that a significant improvement in the equity score of a layout can be obtained through the joint determination of patient beds and nurse positions. We also perform a comparative analysis of equity offered by various layout types and observed that angular layout types are a promising output. We also observed that higher spatial distance between nurses is beneficial in achieving higher equity measures when obstruction is high in the case of angular layouts. There are several implications of our findings to practice. The insights from our study related to the impact of layout shapes, bed locations, and obstruction levels on patient visibility can help decision-makers in both greenfield and retrofitting of existing inpatient unit layout designs. Our models can quickly identify highly visible layouts, avoiding costly trial and error in layout changes. Improved decision-making in inpatient unit design will facilitate better patient experiences through equitable visibility distribution and enhanced quality of care

Managing Patient Care: A Substantive Theory of Clinical Decision Making in Home Health Care Nursing

This study investigates the phenomenon of clinical decision making, deriving a grounded substantive theory to explain how home health care nurses make patient care decisions. Despite the continuing shift of health care from acute care settings to the patient\u27s home, little is known about home health care nurses\u27 clinical decision making processes and the factors influencing them. The study employs a field research design using grounded theory based on symbolic interactionism. Data collection at two Visiting Nurse Associations includes participant observation and open-ended interviews of 21 nurses, and document analysis of patients\u27 records and home care nursing practice policies. The study uses the constant comparative technique for data analysis and incorporates measures to enhance its credibility, transferability, dependability, and confirmability. Managing patient care emerged as the basic social process that explains home health care nurses\u27 clinical decision making. This process has three components. First, it embodies the problem solving process with the phases of problem finding and problem management. Problem finding consists of the cognitive processes and decisions of cue searching and inferring patient problems, while problem management consists of planning, intervening, and evaluating. Second, to manage patient care, home care nurses use three styles based on their approach to gathering and evaluating information-- skimming, surveying, and sleuthing. Third, interacting clinical and non-clinical factors influence patient care management: the nurse\u27s education and experience, the patient\u27s health-related attributes, the nurse-patient interaction, and the organizational, legal, and economic factors. With these three components, the emergent theory of managing patient care integrates elements of three cognitive theories--information processing, cognitive continuum, and skills acquisition--thus bridging the traditionally dichotomous rational and phenomenological perspectives underpinning clinical decision making. The emergent theory raises issues critical to the teaching and improvement of clinical decision making among practicing and future home care nurses, in the context of the potential ethical dilemmas implied by the sometimes conflicting factors that influence patient care management. It serves as the springboard for extending the study to other clinical specialties, building a body of substantive theories that would lead to a formal theory of clinical decision making in nursing

The effect of a communication protocol implementation on nurse/physician collaboration and communication.

This study examined the effect on physician/nurse collaboration and communication of the implementation of the SBAR protocol, used as nurses reported patient changes to physicians, in a Midwestern community hospital ICU. The design was a two-phased descriptive design. Data were collected through two surveys, one of which addressed collaboration and the other which addressed communication factors. The surveys were administered to ICU nurses (n = 28) and physicians (n = 30) three times. The study also explored attitudes regarding the efficacy of SBAR and interdisciplinary collaboration through interviews with a representative sample of physicians (n = 10) and nurses (n = 10). The collaboration and communication scores analyses, which employed a significance level of (p = .05) and repeated measures ANOV A, established the following key findings: (a) Nurses perceived that nurse-physician collaboration had significantly improved between Time 1 and Time 3; (b) physicians did not perceive that nurse-physician collaboration had significantly improved; (c) at Time 1, the physicians scored significantly higher than the nurses on communication elements of openness and understanding; and (d) the nurses perceived that understanding had significantly improved between Time I and Time 2 and between Time I and Time 3. Interview data generally confirmed the survey findings. Nurses affirmed that SBAR should be taught to all new nurses, but both nurses and physicians perceived the Recommendation statement as overly assertive. Several implications arose from this study: (a) Nurses wanted more collaboration with physicians and perceived that SBAR increased collaboration and improved understanding; (b) physicians did not voice wanting improved collaboration and perceived that SBAR had not changed either collaboration or communication; and (c) authors of SBAR might study the effectiveness of the Recommendation statement

An examination of selected factors associated with nurses\u27 behaviour and intentions related to patient teaching

Patient teaching is integral in the provision of an effective health care service. Registered nurses in all settings, have a professional responsibility to contribute towards their clients’ health promotion and maintenance by providing those clients with the health education they require. This study investigated the patient teaching intentions and behaviours of 181 registered nurses employed in acute medical and surgical settings at three metropolitan hospitals in Perth Western Australia. Within the framework of Ajzen and Fishbein’s (1980) theory of reasoned action, the study examined the relationships between registered nurses’ intentions to teach patients, their patient teaching behaviours and selected factors that have been associated with enhancing or hindering nurses in carrying out their patient teaching. One of the aims of the study was to examine the relationship between registered nurses’ patient teaching behaviours and intentions and their attitudinal and normative beliefs about patient teachin

Empowerment counselling in nursing well-child visits for healthy family lifestyles

Background: Empowerment counselling has long been assumed to improve people’s health and is encouraged to be adopted in routine healthcare. However, the questions as to whether empowerment reliably benefits preschool children and families’ health and whether it is being addressed in nursing well-child visits for healthy family lifestyles are yet to be addressed. The overall purpose of this thesis is to contribute toward the clarification and advance of empowerment counselling in nursing well-child visits for healthy family lifestyles. This thesis consisted of three studies. Aims: To synthesize the existing evidence on health interventions using the empowerment concept with preschool-age children and families (sub-study 1). To develop a Portuguese translation and adaptation of the Empowering Speech Practices Scale and investigate its construct validity and reliability (sub-study 2). To describe and compare nurses’ and families’perceptions regarding the degree of empowerment counselling in well-child visits for healthy family lifestyles and explore its associations with nurses’ and families’ sociodemographic and nutritional characteristics (sub-study 3). Design and Methods: We conducted a systematic literature review (sub-study 1), and an observational cross-sectional survey study (sub-study 2 and 3) with 82 families attending a 5-year-old well-child visit and 25 nurses from 12 health functional units situated in Portugal’s Central Region and the Metropolitan Area of Lisbon. Results: In sub-study 1, only ten intervention studies met the criteria for inclusion, with 50% showing positive effects. Children’s participation was scarce. Overall, studies provided limited details on theory application. Sixteen promising behaviour change techniques were identified. Findings from sub-study 2 supported the Portuguese Empowering Speech Practices Scale internal reliability and construct validity, suggesting it has potential usefulness as a measure of empowerment counselling in 5-year-old well-child visits. Sub-study 3 showed that both nurses and families perceived empowerment had been practised to a high degree in the nursing well-child visits. Still, the domain of participatory practices of empowerment counselling can be expanded. The family’s limited familiarity with the health system, having children with overweight, and the well-child visits being conducted in Customized Health Care Units were associated with lower empowerment counselling scores. Conclusions: The findings of the studies give valuable insights to plan further work needed to prove the effectiveness and meaningfulness of using empowerment counselling in well-child visits