Longitudinal qualitative exploration of cancer information-seeking experiences across the disease trajectory: the INFO-SEEK protocol

Introduction Α substantial corpus of literature has sought to describe the information-seeking behaviour of patients with cancer. Yet, available evidence comes mainly from cross-sectional studies, which provide ‘snapshots’ of patients’ information needs and information-seeking styles at a single time point. Only a few longitudinal studies currently exist; however, these are quantitative in nature and, despite successfully documenting changes in patients’ information needs throughout the clinical course of cancer, they have failed to provide an evidence-based interpretation of the causes and consequences of change. The goal of this study is threefold: First, we wish to provide a holistic understanding of how cancer information-seeking behaviour may evolve across different stages of the patient journey. Second, we will seek to elucidate the contextual and intervening conditions that may affect possible changes in information seeking. Third, we will attempt to identify what the consequences of these changes are, while heightening their implications for clinical practice and policy. Methods and analysis We will carry out a longitudinal qualitative study, based on face-to-face, in-depth interviews with approximately 25 individuals diagnosed with cancer. Patients will be recruited from 2 oncology hospitals located in Ticino, Switzerland, and will be interviewed at 3 different time points: (1) within 2 weeks after receiving the cancer diagnosis; (2) within 2 weeks after their initial treatment; and (3) 6 months after their initial treatment. All interviews will be recorded and transcribed verbatim. A grounded theory approach will be used for the analysis of the data. Ethics and dissemination The study protocol has been approved by the Ethics Committee of Canton Ticino (CE 2813). Participation in the study will be voluntary, and confidentiality and anonymity ensured. Prior to study participation, patients will be asked to provide signed informed consent. Findings will be disseminated in international peer-reviewed journals and presented in relevant conferences

Patient safety competencies in undergraduate nursing students: a rapid evidence assessment

Aims To identify patient safety competencies, and determine the clinical learning environments that facilitate the development of patient safety competencies in nursing students. Background Patient safety in nursing education is of key importance for health professional environments, settings, and care systems. To be effective, safe nursing practice requires a good integration between increasing knowledge and the different clinical practice settings. Nurse educators have the responsibility to develop effective learning processes and ensure patient safety. Design Rapid Evidence Assessment. Data Sources MEDLINE, CINAHL, SCOPUS, and ERIC were searched, yielding 500 citations published between 1 January 2004 - 30 September 2014. Review Methods Following the Rapid Evidence Assessment process, 17 studies were included in this review. Hawker's (2002) quality assessment tool was used to assess the quality of the selected studies. Results Undergraduate nursing students need to develop competencies to ensure patient safety. The quality of the pedagogical atmosphere in the clinical setting has an important impact on the students’ overall level of competence. Active student engagement in clinical processes stimulates their critical reasoning, improves interpersonal communication, and facilitates adequate supervision and feedback. Conclusion Few studies describe the nursing students’ patient safety competencies and exactly what they need to learn. In addition, studies describe only briefly which clinical learning environments facilitate the development of patient safety competencies in nursing students. Further research is needed to identify additional pedagogical strategies and the specific characteristics of the clinical learning environments that encourage the development of nursing students’ patient safety competencies

Conoscere per cambiare: gli infermieri dell'Istituto Oncologico della Svizzera Italiana (IOSI) e il loro rapporto con l'Evidence Based Practice e la ricerca infermieristica

Per favorire lo sviluppo di una cultura e di una prassi professionale basata sulle "prove di efficacia", la Direzione Infermieristica IOSI ha istituito uno specifico Ufficio, che ha deciso di definire le proprie linee d'azione in base ai risultati di una indagine interna condotta fra gli infermieri dell'Istituto, avendo come riferimento il modello dell'action research. Agli infermieri, luglio 2010, è stato inviato un questionario semi-strutturato (self-made) per conoscere le loro opinioni ed esperienze su questi temi e per rilevare le loro proposte e la loro disponibilití  a far parte di una rete di collaboratori interni. Sono tornati 63 questionari su 98 inviati (70,8 %). Molti infermieri hanno conoscenze e/o esperienze in questi campi, ma modificano il loro comportamento professionale soprattutto su pressione del contesto esterno, più che per scelta autonoma. Considerano l'EBP sostanzialmente utile, ma di difficile applicazione soprattutto senza un loro coinvolgimento diretto. Due su tre ne hanno sentito la necessití  nel corso della loro attivití  professionale e vi è disponibilití  a sviluppare ricerche infermieristiche (56 %) e/o a svolgere un ruolo attivo di referente su questi temi nella propria sede di lavoro (35 %). L'indagine ha evidenziato che allo IOSI esiste un substrato favorevole per l'EBP e la ricerca infermieristica (per conoscenze di base e disponibilití ). I dati raccolti sono serviti a definire linee d'azione interne in uno stretto rapporto di collaborazione con le aree cliniche, secondo il modello dell'action research. E' un processo che richiede visione, interventi coordinati, costanza e tempo. Parole Chiave: pratica basata su evidenze, ricerca infermieristica, infermiere, diffusione delle innovazioni, indagine conoscitiva, ricerca-azione ABSTRACT To promote the development of a culture and a professional practice based on "evidence of effectiveness", the IOSI Nursing Officer instituted a specific Unit which decided to establish its own lines of action based on the results of an internal investigation conducted among nurses employed within IOSI, with reference to the model of action research. In July 2010, a semi-structured questionnaire self compiled was sent to all nurses to find out their opinions and experiences on EBP and nursing research, to recognize their proposals, and willingness to be part of an internal network. 63 out of 98 questionnaire were filled in. Several nurses have knowledge and experience in these fields, but change their professional behavior especially under pressure from the external environment, rather than by autonomous choice. They consider EBP substantially useful, but difficult to implement especially without their direct involvement. Two third of the sample have felt the need of EBP during their professional activity and there is a general willingness to develop nursing research (56%) and/or play an active role of "referent" on these issues within own Unit (35%). The survey showed that at IOSI there is a favorable substrate for EBP and nursing research (for basic knowledge and availability). The data collected have served to define internal lines of action in a narrow relationship with the clinical areas, according to the model of action research. It is a process that requires vision, coordinated efforts, perseverance and time.Key words: Evidence-Based Practise, Nursing Research, Nurses, Diffusion of Innovations, Survey, Action Researc

NURSES\u2019 INTERVENTIONS TO PROMOTE CANCER PATIENT ENGAGEMENT AND RELATED OUTCOMES: A SYSTEMATIC REVIEW AND META-ANALYSIS PROTOCOL

Background and aim of the work. Due to the ageing of cancer patients, new approaches that require a more active participation in the self-management of cancer treatment at home are needed. Nurses are strategic in improving the patient\u2019s engagement capability in this regard. Knowing which interventions are more effective for the promotion of patient engagement could be useful to improve the effectiveness of the care provided. Therefore, this study aims to systematically review nursing interventions or programs that promote patient engagement in oncological nursing care and summarizing the main evidence related to their impact on relevant clinical and psychosocial outcomes. Method. This is a systematic review and meta-analysis protocol based on Cochrane Handbook for the systematic review of interventions. We will search the most important electronic databases (PUBMED, CINAHL, EMBASE, SCOPUS, ISI Web of Science, Cochrane library) to find out which patient engagement interventions (active adult patient involvement) are implemented in oncological settings and understand what is the effectiveness of these interventions on the outcomes reported in the literature. The GRADE methodology will be used to synthetize the evidence. If possible, also a meta-analysis will be performed. We registered the study protocol on the PROSPERO database (N\ub0 CRD42020146189). Discussion and Conclusion. To our knowledge, this is the first systematic review to address this clinical question in the field of oncology. This review will offer health professionals indications on the most frequently adopted patient engagement interventions and verify their clinical effectiveness. Furthermore, any gaps in the scientific literature will be highlighted

Burnout precursors in oncology nurses: A preliminary cross-sectional study with a systemic organizational analysis

Burnout negatively affects nurses' health and performance. Healthcare managers have an ethical duty to create healthy organizations that reduce burnout, especially within critical settings such as oncology. The aim of this study was twofold: (1) to measure the presence of nurses' burnout to formulate organizational strategies to prevent the syndrome onset, and (2) to evaluate the effect of recent organizational changes on the burnout phenomenon. A descriptive, cross-sectional design supported by a systemic organizational analysis was conducted in a Swiss Oncology Institute in 2013. Of 103 nurses working in the Institute, 52 (51.4%) completed the Burnout Potential Inventory (BPI) questionnaire. Data were analyzed using descriptive statistics and Mann-Whitney and Kruskal-Wallis tests. Burnout risk levels were low to moderate. Only 2 nurses out of the 52 showed moderate burnout risk levels. Inpatient nurses showed a higher risk of burnout than outpatient nurses, particularly due to ambiguity and feelings of powerlessness. Nurses with post-basic education showed a higher risk when considering poor teamwork values and ambiguity in the workplace. Poor middle-management was found to negatively influence worker wellbeing. The working environment set by management resulted in low burnout risk levels. Managers must carefully select middle-management because inappropriate leadership might promote the onset of burnout

The contribution of nursing doctoral schools to the development of evidence 10 years after their establishment in Italy: An exploratory descriptive survey of former and current doctoral students’ publications

AimTo analyse through an exploratory descriptive survey how former and current doctoral students’ publications have contributed to the development of evidence between the establishment of the doctoral schools of nursing between 2006 - 2015.Design An exploratory descriptive survey.Methods We analysed the papers published in peer-reviewed journals by the four Italian PhD Schools of Nursing between 2006 - 2015. Additional missing information was retrieved from Web of Science.Results We identified 478 scientific papers. The papers increased from 12 in 2006 to 110 in 2015. Most are published in 29 journals, of which 15 have an impact factor ranging between 0.236-3.755. These results show the increasingly significant contribution of nursing doctoral programs to the production of evidence, which can be used to improve the quality of nursing and inform health policies. Nursing doctoral schools deserve a greater recognition, especially by Italian funding agencies and political institutions

La concettualizzazione dell'assistenza infermieristica nella letteratura italiana: un'analisi integrativa a supporto dello sviluppo di una teoria

Introduction: Nursing theories are essential for orienting nursing practice. To date, three models for nursing practice have been developed in Italy. In addition, significant epistemological reflections have been published, sparking a rich professional debate regarding the theoretical foundations of nursing in Italy. However, conceptual models from other countries are often still used, despite many difficulties associated with applying them in practice. In order to investigate and redress this ‘theoretical gap’ and related implications for intervention, three scoping reviews of the Italian nursing literature were conducted to examine three categories of nursing knowledge: (a) nursing practice in Italy; (b) the basic nursing concepts of person, health, environment and nursing; and (c) regulatory/normative statements regarding what nursing practice should be in Italy. Objective: The purpose of this investigation was to identify how nursing is conceptualized in the Italian literature through an integrative narrative analysis of three scoping reviews. Methods: The Scoping Review according to the recommendations published by Arksey and O'Malley and subsequently implemented by Levac et al. has been selected as the optimal methodology for mapping nursing knowledge. At the end of the reviews carried out to answer the three research questions, the researchers integrated the results by conducting a coding of the results. Results: The narrative synthesis highlighted a systemic conception of persons in their social context, ‘incorporated’ within relational systems. Persons are imagined as active agents with self-determination toward promoting their own health. Health, derived from levels of equilibrium between multiple systemic components and based on the person's holistic view, is a fundamental right and a collective social interest. Maintaining or promoting a person’s health requires careful consideration of all these constitutive and integral elements. The nursing process is implemented through technical acts as well as relational and caring skills. Professional autonomy, influenced by clinical and organizational contexts, is expressed in collaboration with other professionals who contribute to the healthcare process. The results of this integrative narrative analysis suggest the need for a holistic vision of persons, with an active role in their health management, indissociable from the system of relationships in which this is contextualized, within which nurses are embedded. Conclusion: In light of the results of our investigation, the promotion of a conceptualization of nursing based on the centrality of the person-social relational system and on the active role of persons that nurses work with, this could guide approaches used in nursing education and administration. This could help enhance care provided by nurses and persons' participation in decisions regarding their own health. Keywords: nursing theory, nursing discipline, review, metaparadigm Introduzione: Le teorie infermieristiche costituiscono un riferimento imprescindibile per la prassi infermieristica. In Italia sono stati elaborati e proposti tre modelli professionali italiani. Oltre ad essi, il dibattito professionale si è arricchito anche di significative riflessioni di tipo epistemologico. Tuttavia, ancora oggi risultano essere spesso adottati modelli concettuali provenienti da altri Paesi con la difficoltà del loro utilizzo nella prassi infermieristica. Allo scopo di studiare e approfondire “questo divario teorico” e le possibili linee di intervento sono state realizzate tre revisioni della produzione scientifica infermieristica italiana su tre categorie di conoscenze infermieristiche: la pratica infermieristica in Italia, i concetti fondanti di persona, salute, ambiente e assistenza e tutte le dichiarazioni normative riguardo a cosa dovrebbe essere in Italia la pratica infermieristica. Obiettivo: Lo scopo di questo studio è la produzione di una sintesi narrativa che identifica la concezione di infermieristica nella letteratura italiana attraverso un’analisi integrativa di scoping reviews. Metodi: La Scoping Review secondo le raccomandazioni pubblicate da Arksey and O’Malley e successivamente implementate da Levac et al. è stata selezionata come la metodologia ottimale per eseguire la mappatura delle conoscenze infermieristiche. Al termine delle revisioni realizzate per rispondere alle tre domande di ricerca, i ricercatori hanno integrato i risultati conducendo una codifica dei risultati. Risultati: La sintesi narrativa ha evidenziato una concezione sistemica di base riguardante le persone nel loro contesto sociale, “incorporate” nei sistemi di relazioni. La persona è identificata come agente attivo nell'autoderminazione della salute. La salute derivante da livelli di equilibrio tra più componenti sistemiche e basata sulla visione olistica della persona è un bene fondamentale e un interesse sociale collettivo. Mantenere o promuovere la salute della persona richiede un'attenta considerazione di tutti quelli elementi che ne sono parte costituiva e integrante. La processualità dell'assistenza è messa in atto attraverso atti di natura tecnica e attraverso competenze relazionali e di caring. L'autonomia professionale, influenzata dai contesti clinici e organizzativi si esprime anche nella collaborazione con gli altri professionisti che contribuiscono alla realizzazione del processo di cura. I risultati di questa analisi integrativa suggeriscono la necessità di una visione olistica della persona, del suo ruolo attivo nella gestione della salute e della sua inscindibilità dal sistema di relazioni in cui questa è contestualizzata e del quale l’infermiere entra a far parte. Conclusione: Alla luce dei risultati del nostro studio, la promozione di una concezione di assistenza infermieristica basata sulla centralità dell’intero sistema persona-relazioni sociali e sul ruolo attivo della persona assistita potrebbero orientare sia i processi formativi sia le amministrazioni infermieristiche così da consentire e valorizzare la presa in carico globale da parte dei professionisti infermieri e la partecipazione della persona alla presa di decisioni riguardanti la propria salute

La gestione del dolore nei pazienti di un Istituto Oncologico Svizzero e il ruolo degli infermieri: dai programmi alla realtí

Introduzione. Nel 2004, l'Istituto Oncologico della Svizzera Italiana (IOSI), ha avviato un programma per migliorare il trattamento del dolore cronico oncologico, attraverso la formazione degli operatori e l'introduzione di strumenti di monitoraggio. Scopo. Fare un valutazione dei risultati ottenuti per i pazienti (efficace controllo del loro dolore), con attenzione al ruolo richiesto agli infermieri (accertamento, monitoraggio e documentazione del dolore).Metodo. Studio retrospettivo, sulla documentazione sanitaria dei pazienti ricoverati negli ultimi tre mesi dell'anno 2010, per verificare come sia stato rilevato e gestito il dolore da loro provato.Risultati. Su 177 ricoveri considerati, 93 (52.6%) hanno provato dolore durante il ricovero e 85 sono stati inclusi nell'analisi. A 62/85 (72.9%) sono stati somministrati farmaci in riserva >= 2 giorni. Hanno trascorso da 2 a 28 giorni con dolore (mediana 4). Per 56/62 (90.3%) la terapia antalgica è stata modificata una o più volte e a 40 (63.4%) sono stati somministrati oppioidi forti durante il ricovero. In 8/62 casi il dolore non è stato documentato e complessivamente, sugli 85 pazienti con dolore, per 25 (29.4 %) non ne viene segnalata l'intensití  o eventuali altre caratteristiche.Conclusioni. Allo IOSI vi è un buon controllo farmacologico del dolore. I farmaci analgesici sono prescritti gií  all'ingresso e vengono modulati in funzione delle necessití  dei pazienti, con anche ampia somministrazione di oppioidi. Da migliorare il monitoraggio e la misurazione del dolore da parte degli infermieri, il cui ruolo appare soprattutto orientato a contribuire alla gestione farmacologica di questo sintomo. Pain management in patients of a Swiss Institute of Oncology and the role of nurses: from programs to realityParole chiave: gestione del dolore, valutazione del dolore, ruolo infermieristico, pazienti oncologici, linee guida sul dolore oncologico. Introduction. In 2004, the Oncology Institute of Southern Switzerland (IOSI) started a program to improve cancer pain treatment, through training of health professionals and the introduction of monitoring tools .Aim. The aim is to evaluate patient relief from pain (effective pain control), with attention to nursing role (pain assessment, monitoring and documentation).Method. Retrospective study. The health records of patients admitted in the last three months of 2010 were consulted to evaluate how pain was assessed and managed.Results. Out of 177 patients admitted, 93 (52.6 %) experienced pain during hospitalization and 85 were included in the analysis . Sixty-two out of 85 (72.9 %) received drugs in reserve > = 2 days. They had pain from 2 to 28 days (median 4). For 56/62 patients ( 90.3 %) analgesic therapy was changed one or more times and 40 of them ( 63.4 % ) received strong opioids during hospitalization . In 8/62 cases pain wasn't documented, and overall, in 25/85 (29.4 %) intensity or any other feature weren't documented.Conclusions. At IOSI there is a good pharmacological control of pain. Analgesics are prescribed upon entry and are modulated according to patient needs, even with wide administration of opioids. The issue to improve is pain assessment and monitoring by nurses, whose role is mainly oriented to contribute to the pharmacological management of this symptom.Key words: pain management, pain assessment, nursing role, cancer patients, cancer pain guidelines

Ethical conflict and its psychological correlates among hospital nurses in the pandemic: a cross-sectional study within Swiss COVID-19 and Non-COVID-19 wards

Background: during the Covid-19 pandemic, nurses experienced increased pressure. Consequently, ethical concerns and psychological distress emerged. This study aimed to assess nurses' ethical conflict, resilience and psychological impact, and compare these variables between nurses who worked in Covid-19 wards and nurses who did not. Methods: design Multicentre online survey. Setting Multi-site public hospital; all nursing staff were invited to participate. The survey included validated tools and a novel instrument to assess ethical conflict. Spearman's rho coefficient was used to assess correlations between ethical conflict and psychological distress, logistic regressions to evaluate relationships between nurses' characteristics and outcome variables, and the Mann-Whitney/t-test to compare groups. Results: 548 questionnaires out of 2039 were returned (275 = Covid-19; 273 = non-Covid-19). We found a low-moderate level of ethical conflict (median = 111.5 [76-152]), which emerged mostly for seeing patients dying alone. A moderate and significant positive correlation emerged between ethical conflict and psychological distress rs (546) = 0.453, p < 0.001. Nurses working in Covid-19-ICUs (OR = 7.18; 95%CI = 3.96-13.01; p < 0.001) and Covid-19 wards (OR = 5.85; 95%CI = 3.56-9.6; p < 0.001) showed higher ethical conflict. Resilience was a protective factor for ethical conflict. Conclusions: ethical conflict was significantly linked to psychological distress, while a higher level of resilience was found to be a protective factor. These results can be informative for nursing management in future similar crises

Exploring the Interaction Between Nursing Decision Making and Patient Outcomes in 2 European Cancer Centers: A Qualitative Study

BACKGROUND:: In some clinical settings, nurses have difficulty describing the outcomes of their caring activities. Understanding the reasons for this could help nurse leaders to improve the effectiveness and visibility of nursing practice and safeguard nurses\ue2\u80\u99 working conditions. OBJECTIVE:: The aims of this study were to understand how nurses working in 2 different adult cancer centers make healthcare decisions and assess the respective outcomes on their patients. METHODS:: Through a constructivist grounded theory approach, we involved 15 clinical cancer nurses with different experiences and educational backgrounds and 6 nurse managers, working in 2 comprehensive cancer centers, 1 in Italy and 1 in Switzerland. Data were collected in 2 phases using 20 semistructured interviews and 9 field observations. RESULTS:: Six macrocategories emerged: interacting with situational factors, deciding relevant interventions, using multiple decision-making approaches, evaluating interventions and reporting them, pursuing healthcare outcomes, and clarifying professional identity and roles. Nurses\ue2\u80\u99 decision-making processes varied and were influenced by various factors, which mutually influenced one another. This process was interpreted using an explicative theory called \ue2\u80\u9cdynamic decision-making adaptation.\ue2\u80\u9d CONCLUSIONS:: The present study showed how the aims, contents, and degree of autonomy in the nurses\ue2\u80\u99 decision-making process are strongly influenced by the dialectic interaction between professional and contextual factors, such as competency and professional identity. IMPLICATIONS FOR PRACTICE:: Cancer nurses could influence their clinical practice by developing nursing competencies that effectively resolve patients\ue2\u80\u99 problems. This is a key factor that nurses govern autonomously and therefore a responsibility that involves the entire nursing educational, organizational, and scientific leadership