Effects and feasibility of a multi-disciplinary orientation program for newly registered cancer patients: design of a randomised controlled trial

Background Diagnosis and treatment of cancer can contribute to psychological distress and anxiety amongst patients. Evidence indicates that information giving can be beneficial in reducing patient anxiety, so oncology specific information may have a major impact on this patient group. This study investigates the effects of an orientation program on levels of anxiety and self-efficacy amongst newly registered cancer patients who are about to undergo chemotherapy and/or radiation therapy in the cancer care centre of a large tertiary Australian hospital. Methods The concept of interventions for orienting new cancer patients needs revisiting due to the dynamic health care system. Historically, most orientation programs at this cancer centre were conducted by one nurse. A randomised controlled trial has been designed to test the effectiveness of an orientation program with bundled interventions; a face-to-face program which includes introduction to the hospital facilities, introduction to the multi-disciplinary team and an overview of treatment side effects and self care strategies. The aim is to orientate patients to the cancer centre and to meet the health care team. We hypothesize that patients who receive this orientation will experience lower levels of anxiety and distress, and a higher level of self-efficacy. Discussion An orientation program is a common health care service provided by cancer care centres for new cancer patients. Such programs aim to give information to patients at the beginning of their encounter at a cancer care centre. It is clear in the literature that interventions that aim to improve self-efficacy in patients may demonstrate potential improvement in health outcomes. Yet, evidence on the effects of orientation programs for cancer patients on self-efficacy remains scarce, particularly with respect to the use of multidisciplinary team members. This paper presents the design of a randomised controlled trial that will evaluate the effects and feasibility of a multidisciplinary orientation program for new cancer patients

Cervical collar-related pressure ulcers in trauma patients in intensive care unit

Introduction: The application of a cervical collar (C-collar) in trauma patients can be life-saving. Previous studies, however, describe development of pressure ulcers related to C-collars.Objective: To retrospectively compare collar-related pressure ulcers (CRPUs) occurring in trauma patients admitted to the intensive care unit wearing a C-collar before and after implementation of preventive interventions and to identify risk factors for CRPU development.Methods: Retrospective chart review of 88 trauma patients admitted to the intensive care unit before (2006) and after (2008) implementation of preventive interventions; early C-collar removal (<24 hours) and an occipital foam ring. Data were collected in the first 14 days of admission on pressure ulcer incidence, risk factors, and preventive interventions.Results: The incidence of CRPUs was 1.1%. Although risk factors were present in the sample, it was impossible to identify significant risk factors for CRPU development and explore the effect of preventive interventions.Conclusion: The incidence of CRPUs in this study was low. CRPUs, however, should never be accepted as an inevitable complication of cervical immobilization. To identify trauma patients at risk and to apply effective preventive interventions for CRPU development, further research is needed

Validation of the Australian/English Version of the Diabetes Management Self-efficacy Scale.

Australians' use of the English language is influenced by a British educational curriculum, exposure to international television programmes and cultural backgrounds. Hence, adapting research instruments for use with Australian populations can be challenging. This study adapted the United Kingdom's version of the 20-item Diabetes Management Self-Efficacy Scale and tested it psychometrically with Australians. Face validity of the adapted instrument was established through consultation with diabetes educators and people with type 2 diabetes. Data from a convenience sample of 88 people with type 2 diabetes were analysed to determine the psychometric properties of the adapted instrument. The results indicate that the Australian/English version of the instrument is internally consistent, stable over time and it measures self-efficacy. However, there was evidence to show that there might be some redundant items in the scale. Further psychometric testing is warranted with a larger sample to determine whether the scale requires refinement

Risk factors for intensive care delirium: A systematic review.

Delirium has been a recognised syndrome in the intensive care unit for some years. This systematic review reports risk factors for delirium studied in the intensive care unit. Four predisposing and 21 precipitating factors, including nine laboratory blood values and seven items relating to the use or the administration of medication, were found to influence the onset of delirium in the intensive care unit in six publications. The APACHE II score and hypertension were the only factors reported twice. Risk factors for the development of intensive care delirium were understudied and underreported in the literature

Curbing the urge to care : A Bourdieusian analysis of the effect of the caring disposition on nurse middle managers’ clinical leadership in patient safety practices

Background Nurse managers play an important role in implementing patient safety practices in hospitals. However, the influence of their professional background on their clinical leadership behaviour remains unclear. Research has demonstrated that concepts of Bourdieu (dispositions of habitus, capital and field) help to describe this influence. It revealed various configurations of dispositions of the habitus in which a caring disposition plays a crucial role. Objectives We explore how the caring disposition of nurse middle managers’ habitus influences their clinical leadership behaviour in patient safety practices. Design Our paper reports the findings of a Bourdieusian, multi-site, ethnographic case study. Settings Two Dutch and two American acute care, mid-sized, non-profit hospitals. Participants A total of 16 nurse middle managers of adult care units. Methods Observations were made over 560 h of shadowing nurse middle managers, semi-structured interviews and member check meetings with the participants. Results We observed three distinct configurations of dispositions of the habitus which influenced the clinical leadership of nurse middle managers in patient safety practices; they all include a caring disposition: (1) a configuration with a dominant caring disposition that was helpful (via solving urgent matters) and hindering (via ad hoc and reactive actions, leading to quick fixes and ‘compensatory modes’); (2) a configuration with an interaction of caring and collegial dispositions that led to an absence of clinical involvement and discouraged patient safety practices; and (3) a configuration with a dominant scientific disposition showing an investigative, non-judging, analytic stance, a focus on evidence-based practice that curbs the ad hoc repertoire of the caring disposition. Conclusions The dispositions of the nurse middle managers’ habitus influenced their clinical leadership in patient safety practices. A dominance of the caring disposition, which meant ‘always’ answering calls for help and reactive and ad hoc reactions, did not support the clinical leadership role of nurse middle managers. By perceiving the team of staff nurses as pseudo-patients, patient safety practice was jeopardized because of erosion of the clinical disposition. The nurse middle managers’ clinical leadership was enhanced by leadership behaviour based on the clinical and scientific dispositions that was manifested through an investigative, non-judging, analytic stance, a focus on evidence-based practice and a curbed caring disposition