Transition journey from hospital to home in patients with cancer and their caregivers: A qualitative study

Background The National Cancer Institute Singapore initiated the NUH2 Home program in January 2014, referred to as BCaring Across the Cancer Continuum,^ a nurse-led cancer transitional care service (CTCS) that provides home care to patients with cancer and their caregivers. The study aimed to explore the transition experiences of patients with cancer and their caregivers. Method Using a purposive sampling, 12 patients with cancer and 12 caregivers were recruited. Audiotape interviews were conducted until data saturation was achieved. Each interview was transcribed verbatim, and thematic analyses were performed to extract significant themes and subthemes. Results Four themes emerged from the data including (1) ongoing concerns, (2) needing timely help, (3) resuming control and normality of life, and (4) appreciating the transition care. The transition journey of patients and caregivers provided them with an ability to regain control and normality in their lives, be reassured and confident in being able to care for hemselves and manage the physiological and psychological strains associated with the multiple vicissitudes associated with having cancer and its treatment while at home. Conclusion Our study addressed the nature, patterns, conditions, and responses to transition care. Our findings provided relevant contextual knowledge to further improve the transition care service based on the recommendations of the patients with cancer and their caregivers who first experienced the new service

Light at the end of the tunnel: New graduate nurses' accounts of resilience: A qualitative study using Photovoice

Background: Resilience is the ability to overcome any stressful situation. The ability to bounce back is said to enable a person to emerge stronger, perform better, and become more confident and selfefficient. The new graduate nurses' journey is a stressful experience as they become immersed in the day-to-day work pressures. Objective: The study explored the new graduate nurses' accounts of resilience and the facilitating and impeding factors in building their resilience. Methods and Participants: A qualitative study using Photovoice was employed in this study and guided by the theory of Sense of Coherence. Nine new graduate nurses from one university and working for a year in one university-affiliated hospital in Singapore were interviewed and data was subjected to thematic analysis. Findings: Four themes emerged: (1) resilience is persevering and overcoming obstacles; (2) resilience is accepting one's responsibilities and fulfilling them; (3) resilience is adapting to new situations; and (4) resilience is taking control of own learning. The exhaustive account of their resilience is portrayed as “light at the end of the tunnel”. Conclusion: In spite of the stressful working environment and obstacles encountered as new graduate nurses, participants' resilience is built upon the comprehensibility, meaningfulness and management of any situation they face in their personal, spiritual and professional life. Future research is needed to objectively measure their level of Sense of Coherence and association with their level of resilience

Evaluation of psychometric properties of professional quality of life scale among nurses in Singapore

Background and Purpose: Nurses experience compassion fatigue (CF), depression, burnout (BO), and even signs of post-traumatic stress disorder. This study aimed to evaluate the psychometric properties of the Professional Quality of Life Scale (ProQOL) among nurses in the Southeast Asia context. Methods: Psychometric testing of interitem correlations and reliability, and both convergent and discriminant validity, as well as construct validity analyses was conducted among 1,338 nurses from two academic centers in Singapore. Results: Findings demonstrated significant interconstruct correlations among the three subscales of ProQOL, namely compassion satisfaction (CS), BO, and secondary traumatic stress (STS). ProQOL displayed satisfactory internal consistency and discriminant validity. Conclusions: Psychometric properties of the CS component were found to be satisfactory. ProQOL may be integrated into strategies in supporting and improving nurses' QoL which could focus to lessen BO and CF at work, as well as improving individual satisfaction in the care of patients

Understanding the influence of resilience on psychological outcomes — Comparing results from acute care nurses in Canada and Singapore

Background: Building resilience among nurses is one of the ways to support and retain nurses in the profession. Prior literature which evaluated influence of resilience on psychological outcomes, were conducted in relatively homogeneous populations. It is of interest to evaluate whether relationships between resilience and psychological outcomes remain consistent across nations and among different nursing populations. Aim: To evaluate a theoretical model of the impact of resilience on burnout (BO), secondary traumatic stress (STS) and compassion satisfaction (CS) by comparing results between nurses in Canada and Singapore. Method: A self-reported questionnaire consisting of questions on demographics, resilience (Connor-Davidson Resilience Scale), and psychological adjustment (Professional Quality of Life) was administered via an online survey. One thousand three hundred and thirty-eight nurses working in two Academic Medical Centres in Singapore responded to the online survey. Similar data was also collected from 329 nurses in Canada. Hypotheses were tested using structural equation modeling. Results: Resilience exerts a significant negative direct impact on STS, and a significant negative direct impact on BO. Additionally, resilience has a positive direct impact on compassion satisfaction. STS exerts a positive direct impact on BO while CS has a negative direct impact on BO. Conclusion: Current study affirmed significant associations between resilience and professional quality of life. Knowledge on resilience is key in informing design and implementation of resilience-building strategies that include professional development, and strengthening of interpersonal skills. A resilience-based approach will help reduce nurses' BO and STS while caring for their patients, and in turn reduce turnover

Minimal clinically important difference of the EORTC QLQ-CIPN20 for worsening peripheral neuropathy in patients receiving neurotoxic chemotherapy

Context/objectives This is the first study to determine the minimal clinically important difference (MCID) of the European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire-CIPN twenty-item scale (EORTC QLQCIPN20), a validated instrument designed to elicit cancer patients’ experience of symptoms and functional limitations related to chemotherapy-induced peripheral neuropathy. Methods Cancer patients receiving neurotoxic chemotherapy completed EORTC QLQ-CIPN20 and the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity [FACT/GOG-NTX] at baseline, second cycle of chemotherapy (T2, n = 287), and 12 months after chemotherapy (T3, n = 191). Anchor-based approach used the validated FACT/GOG-NTX neurotoxicity (Ntx) subscale to identify optimal MCID cutoff for deterioration. Distribution-based approach used one-third standard deviation (SD), half SD, and one standard error of measurement of the total EORTC QLQ-CIPN20 score. Results There was a moderate correlation between the change scores of the Ntx subscale and sensory and motor subscales of QLQ-CIPN20 (T2: r = − 0.722, p < 0.001 and r = − 0.518, p < 0.001, respectively; T3: r = − 0.699; p < 0.001 and r = − 0.523, p < 0.001, respectively). The correlation between the change scores of the Ntx subscale and the QLQ-CIPN20 autonomic subscale was poor (T2: r = − 0.354, p < 0.001; T3: r = 0.286, p < 0.001). Based on the MCID derived using distribution-based method, the MCID for the QLQ-CIPN20 sensory subscale was 2.5–5.9 (6.9% to 16.4% of the subdomain score) and for motor subscale was 2.6–5.0 (8.1%–15.6% of the subdomain score). Conclusion The MCID for the EORTC QLQ-CIPN20 established using distribution-based approaches was 2.5–5.9 for the sensory subscale and 2.6–5.0 for the motor subscale. When noted in assessments even with small change in scores, clinicians can be alerted for appropriate intervention