Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews

Aims and objectives To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions. Background Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence. Methods This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007?2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data. Results The effectiveness of educational nursing interventions was inconsistent on quality of life, attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients? coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue. Conclusions Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions. Relevance to Clinical Practice Implementation of these nursing interventions into clinical practice is important to improve patients? knowledge and quality of life (QoL) as well as reducing various symptoms and side effects related to cancer and its treatment. This article is protected by copyright. All rights reserved.</p

Wrongdoing and whistleblowing in health care

AIM(S): To describe healthcare professionals' experiences of observed wrongdoing and potential whistleblowing acts regarding it. The main goal is to strengthen the whistleblowing process described based on the existing literature and to make it more visible for future research.DESIGN: A descriptive cross-sectional survey.METHODS: Data were collected between 26 June 2015-17 July 2015 from the Finnish trade union's membership register, electronically using one open question. A total of 226 healthcare professionals participated providing written narratives, which were analysed using inductive content analysis.FINDINGS: The whistleblowing process in health care was strengthened, identifying the content of observed wrongdoings and whistleblowing acts regarding them. Three themes were identified: wrongdoing related to patients, healthcare professionals, and healthcare managers. Whistleblowing acts were performed internally, externally, or left undone. Three main paths: internal, external, and no whistleblowing, between an observation of wrongdoing and whistleblowing act were identified.CONCLUSION: The whistleblowing process should be further developed and ethically effective programmes and interventions should be developed for increasing whistleblowing and preventing wrongdoing in health care.</p

Ethical issues in the care of patients with stroke: A scoping review

Aims and objectives: The aim was to identify and analyse the ethical issues in the care of patients with stroke (PwS). The goal was to understand the nature of the existing knowledge on the topic and to identify whether there are ethical issues specific to the care of PwS. Background: Stroke is a disease with possible multiple effects on the patient's overall condition and experienced ethical issues in the care. Additionally, stroke impacts the life of the significant other. For health professionals, the care of PwS is challenging at different stages of the care process. The care of stroke includes several ethically sensitive situations from the perspectives of all participants. Design: Scoping review. Methods: The review was conducted following the five-stage methodological framework of Arksey and O'Malley (2005). The literature search was conducted in several electronic databases and complemented with a manual search, resulting in 15 reviewed articles. The analysis was conducted by charting descriptive numerical data and by content analysis of the narrative representations. Results: The studies focused on hospital or rehabilitation contexts and a high number of studies had a qualitative approach. Three main themes were identifiable: “decision-making as an ethically challenging act,” “care process-specific ethical issues” and “environmental ethical issues.”. Conclusions: Ethical issues occur at different stages of the care process of PwS and from the viewpoints of all those involved. However, not all the recognised ethical issues were stroke specific. As the number of the reviewed articles was limited, more research is needed for a comprehensive understanding of the topic. Relevance to clinical practice: Individual health professionals may use the results in observing their own action from an ethical perspective and to deepen the ethical understanding of the care of PwS. In health care organisations, the results may be used in developing the ethical quality of care.</p

Missed Care from the Patient’s Perspective – A Scoping Review

Missed care, defined as any aspect of patient care that is omitted or delayed, is receiving increasing attention. It is primarily caused by the imbalance between patients’ nursing care needs and the resources available, making it an ethical issue that challenges nurses’ professional and moral values. In this scoping review, conducted using the five-stage approach by Arksey and O’Malley, our aim is to analyze the patients’ perspective to missed care, as the topic has been mainly examined from nurses’ perspective. The search was conducted in April 2019 in PubMed, CINAHL, PsycINFO, Web of Science, ProQuest and Philosophers Index databases using the following terms: omitted care, unfinished nursing care, care undone, care unfinished, missed care, care left undone, task undone and implicit rationing with no time limitation. The English-language studies where missed care was examined in the nursing context and had patients as informants on patient-reported missed care or patients’ perceptions on nurse-reported missed care were selected for the review. Thirteen studies were included and analyzed with thematic content analysis. Twelve studies were quantitative in nature. Patients were able to report missed care, and mostly reported missed basic care, followed by missed communication with staff and problems with timeliness when they had to wait to get the help they needed. In statistical analysis, missed care was associated with patient-reported adverse events and patients’ perceptions of staffing adequacy, and in patients’ perception, it was mainly caused by lack of staff and insufficient experience. Furthermore, patients’ health status, as opposed to gender, predicted missed care. The results concerning patients’ age and education level were conflicting. Patients are able to identify missed care. However, further research is needed to examine patient-perceived missed care as well as to examine how patients identify missed care, and to get a clear definition of missed care.</p

Association between diabetes-related self-care activities and positive health: A cross-sectional study

Objectives: The study aimed to examine the diabetes-related self-care activities (DRSCA) in association with positive health consisting of resilience, subjective well-being (SWB) and disease-related quality of life (DRQoL), and the associations of background information with resilience, SWB and DRQoL.Design: A cross-sectional study.Methods: A convenience sample of people with type 2 diabetes (T2DM) was recruited from two tertiary hospitals in eastern China. Self-reported survey data included DRSCA, resilience, SWB, DRQoL, and background information comprising demographics and social support. Data were analysed using hierarchical multiple regression analyses.Results: Two hundred and forty-six valid questionnaires were analysed. Among the components of positive health, hierarchical multiple regression analysis showed that DRSCA were significantly associated with improved SWB (β=0.140, p=0.020), but not with resilience and DRQoL after adjusting for background information. Participants with higher level of education had higher resilience and men had higher SWB than women. Social support (β=0.186, p=0.003) in Model 1 and resilience (β=0.298, pConclusions: This study indicated an association between DRSCA and one component of positive health, namely SWB. This finding could help motivate patients to perform DRSCA and to improve SWB in people with T2DM. In addition, the fact that demographics, for example, gender, were associated with SWB and education was associated with resilience also needs to be accommodated when aiming to improve SWB and build resilience.</p

Being respected by nurses: Measuring older patients' perceptions

AIM AND OBJECTIVE: To investigate older patients' perceptions of respect in hospital nursing care and to test a newly developed instrument measuring the phenomenon.BACKGROUND: Respect manifests itself in the older patient-nurse relationship in terms of nurses being with and doing for the patient. Empirical studies investigating respect from the older patients' perspective are rare. There is a need to maintain respectful behaviours and attitudes within hospital-based nursing practice. Furthermore, there is a lack of instruments measuring respect in the care provided by nurses.DESIGN AND METHODS: A descriptive, cross-sectional explorative survey design was used. Data were collected between February and May 2016 by interviewing face-to-face 196 older patients in two hospitals in Finland. Respect was measured using the ReSpect scale (Parts A and B) developed for this study. Respect is based on the two dimensions of respect, nurses' Being with and Doing for patients. Data were analysed using descriptive and inferential statistical methods including the psychometric testing of the new instrument.RESULTS: Older patients perceived respect in their care frequently and to a great extent, although there were also shortcomings. The findings highlight the need to improve respect to patients in care delivery by showing an interest in their views, acknowledging them positively and supporting their individual capacities. A two-factor structure of the ReSpect scale Part A and a four-factor structure of the Part B were confirmed.CONCLUSIONS: Findings from this study suggest that older hospital patients perceived respect by nurses overall, but the area where there is the most room for improvement is that of listening and encouraging. The psychometric analysis demonstrated that the ReSpect scale shows promise in measuring respect.IMPLICATIONS FOR PRACTICE: The ReSpect scale could be a useful tool to measure respect, an important element of value-based health care.</p

Longer wings for faster springs – wing length relates tospring phenology in a long-distanc e migrant across its range

In migratory birds, morphological adaptations for efficient migratory flight often oppose morphological adaptations for efficient behavior during resident periods. This includes adaptations in wing shape for either flying long distances or foraging in the vegetation and in climate-driven variation of body size. In addition, the timing of migratory flights and particularly the timely arrival at local breeding sites is crucial because fitness prospects depend on site-specific phenology. Thus, adaptations for efficient long-distance flights might be also related to conditions at destination areas. For an obligatory long-distance migrant, the common nightingale, we verified that wing length as the aerodynamically important trait, but not structural body size increased from the western to the eastern parts of the species range. In contrast with expectation from aerodynamic theory, however, wing length did not increase with increasing migration distances. Instead, wing length was associated with the phenology at breeding destinations, namely the speed of local spring green-up. We argue that longer wings are beneficial for adjusting migration speed to local conditions for birds breeding in habitats with fast spring green-up and thus short optimal arrival periods. We suggest that the speed of spring green-up at breeding sites is a fundamental variable determining the timing of migration that fine tune phenotypes in migrants across their range

Polynomial super-gl(n) algebras

We introduce a class of finite dimensional nonlinear superalgebras $L = L_{\bar{0}} + L_{\bar{1}}$ providing gradings of $L_{\bar{0}} = gl(n) \simeq sl(n) + gl(1)$. Odd generators close by anticommutation on polynomials (of degree $>1$) in the $gl(n)$ generators. Specifically, we investigate `type I' super-$gl(n)$ algebras, having odd generators transforming in a single irreducible representation of $gl(n)$ together with its contragredient. Admissible structure constants are discussed in terms of available $gl(n)$ couplings, and various special cases and candidate superalgebras are identified and exemplified via concrete oscillator constructions. For the case of the $n$-dimensional defining representation, with odd generators $Q_{a}, \bar{Q}{}^{b}$, and even generators ${E^{a}}_{b}$, $a,b = 1,...,n$, a three parameter family of quadratic super-$gl(n)$ algebras (deformations of $sl(n/1)$) is defined. In general, additional covariant Serre-type conditions are imposed, in order that the Jacobi identities be fulfilled. For these quadratic super-$gl(n)$ algebras, the construction of Kac modules, and conditions for atypicality, are briefly considered. Applications in quantum field theory, including Hamiltonian lattice QCD and space-time supersymmetry, are discussed.Comment: 31 pages, LaTeX, including minor corrections to equation (3) and reference [60