Palliative care in the community for children with cancer in South East England.

In-depth interviews and discussions were held with 40 different professionals in South East England involved in managing palliative care for children with cancer in the community. Participants included paediatric oncologists and outreach nurse specialists in tertiary centres, paediatricians in shared care units, children's community nurses, general practitioners, social workers and child psychologists. The research examined palliative care services available in the region, exploring attitudes to both current provision and possible service improvements. Providing palliative care in the community involves multi-agency collaboration and the study highlighted a range of different approaches to case management with the diversity of resources available. Key improvements proposed by health-care professionals included: better communication and liaison between all the professionals involved; clearer allocation of roles and responsibilities; 24-hour availability of specialist advice on palliative care for children with cancer; faster access to social work and psychology services at the community level; continuity of nursing and respite care. The provision of specialist local palliative care services for children with cancer was generally rejected. The participants favoured improving community palliative care for all children with life-limiting or life-threatening conditions with community nursing teams providing continuity of care and outreach nurses providing specialist advice and support.     

Healthcare professionals’ values about and experience with facilitating end-of-life care in the adult intensive care unit

ObjectivesTo evaluate values and experience with facilitating end-of-life care among intensive care professionals (registered nurses, medical practitioners and social workers) to determine perceived education and support needs.Research designUsing a cross-sectional study design, 96 professionals completed a survey on knowledge, preparedness, patient and family preferences, organisational culture, resources, palliative values, emotional support, and care planning in providing end-of-life care.SettingGeneral adult intensive care unit at a tertiary referral hospital.ResultsCompared to registered nurses, medical practitioners reported lower emotional and instrumental support after a death, including colleagues asking if OK (p = 0.02), lower availability of counselling services (p = 0.01), perceived insufficient time to spend with families (p = 0.01), less in-service education for end-of-life topics (p = 0.002) and symptom management (p = 0.02). Registered nurses reported lower scores related to knowing what to say to the family in end-of-life care scenarios (p = 0.01).ConclusionFindings inform strategies for practice development to prepare and support healthcare professionals to provide end-of-life care in the intensive care setting. Professionals reporting similar palliative care values and inclusion of patient and family preferences in care planning is an important foundation for planning interprofessional education and support with opportunities for professionals to share experiences and strengths.     

Nursing workforce,education, and training challenges to implementing extracorporeal membrane oxygenation services in Australian intensive care units: A qualitative substudy

BackgroundThe use of extracorporeal membrane oxygenation (ECMO) is increasing in the management of critical care patients. ECMO service delivery requires an organisation-supported approach to ensure appropriate resources to deliver training, equipment, capacity, staffing, and the required model of care for quality care delivery. The aim of this nested substudy was to explore challenges specific to nursing staff in ECMO services in Australian intensive care units.MethodsThis was a nested substudy within a qualitative study using semistructured focus group discussions conducted with 83 health professionals, which included 40 nurses. There were 14 focus groups across 14 ECMO centres participating in the binational ECMO (EXCEL) registry of Australia and New Zealand. An inductive thematic analysis focused on the nurse's experiences of the barriers and facilitators for nursing in providing an ECMO service.ResultsFour themes emerged relating to the nurse's experience of implementing ECMO services: workforce requirements, workload demands, models of care, and level of experience. The complexity and intensity of caring for ECMO patients may need to be considered an additional factor in the burnout in critical care nurses. Current nursing ratios and responsibilities in critical care need to be considered, with the opportunity for the development of specialist advanced practitioner nursing roles.ConclusionThis study highlights the challenges for nursing in providing ECMO services in the intensive care setting. The complexity and intensity of ECMO is challenging and leads to concerns regarding burnout and workforce preparedness. New models of care need to be considered to mitigate the barriers for nursing identified across ECMO centres.     

Cough in lung cancer: A survey of current practice among Australian health professionals

BackgroundSystematic reviews and guidelines are available to guide management of cough in lung cancer, but evidence for intervention efficacy is limited, and little research has yet described current practice.AimTo canvass the experiences and perspectives of Australian health professionals with regard to the clinical importance and current management of cough in people with lung cancer.MethodsAn open, online, cross-sectional survey was conducted in 2018. Health professionals of all disciplines were eligible, and recruitment was by direct approach to lung cancer multidisciplinary teams, professional listservs and conferences.FindingsFifty-eight people completed the survey, of whom 26 (45%) were medical practitioners, 21 (36%) registered nurses, and 10 (17%) allied health practitioners. Nearly all (>90%) considered cough to be of clinical concern and welcomed efforts to improve management. In most services, ≤25% of patients with clinically concerning cough receive management. Opiates were perceived to be the most consistently effective pharmacological strategy, with ≥50% participants indicating minimal or variable effectiveness for all others. The few participants who had experience of non-pharmacological strategies perceived these to be only somewhat or variably effective.DiscussionResults from this study identified variability in the management of cough associated with lung cancer, and suggest this problem may be under-treated in most services. Unmet needs identified by this study are likely under-estimated due to the volunteer effect associated with open surveys.ConclusionFurther efforts are needed to raise awareness about the importance of managing cough and provide evidence-based strategies for this population.     

Spiritual care in critically ill patients during COVID-19 pandemic

IntroductionSpiritual care has a positive influence when patients are subjected to serious illnesses, and critically ill situations such as the case of the COVID-19 pandemic.PurposeThe purpose of this study was to investigate the perceptions and attitudes of nurses working at critical care units and emergency services in Spain concerning the spiritual care providing to patients and families during the COVID-19 pandemic.MethodsA qualitative investigation was carried out using in-depth interviews with 19 ICU nursing professionals.FindingsDuring the pandemic, nurses provided spiritual care for their patients. Although they believed that spirituality was important to help patients to cope with the disease, they do not had a consensual definition of spirituality. Work overload, insufficient time and lack of training were perceived as barriers for providing spiritual healthcare.DiscussionThese results support the role of spirituality in moments of crisis and should be considered by health professionals working in critical care settings.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

The training needs of Korean intensive care unit nurses regarding delirium

ObjectivesThe aim of this study was to investigate high-priority training needs by analysing the perceived importance and self-reported performance of nurses’ delirium care competency.DesignA cross-sectional survey with a convenience sample of 255 Korean intensive care units nurses.SettingIntensive care units in the Republic of Korea.Main outcome measuresIntensive care unit nurses’ delirium care competency.ResultsExploratory factor analysis of the Nurse Delirium Care Competency Scale showed a six-factor structure, which accounted for 67.51% of the variance in nurses’ delirium care competency: management algorithm, prevention, communication, nursing management, assessment, and collaboration. The self-reported performance scores of all six factors were significantly lower than their perceived importance scores. The delirium assessment factor was identified as a high training priority on the importance-performance matrix for new graduate nurses.ConclusionTraining programmes should be developed considering the six delirium care competency factors identified in this study. Further, nurse educators must adopt active educational modalities such as case-based small group learning and simulation-based learning to improve nurse competency in recognising and managing delirium.     

Managing agitation during early recovery in adults with traumatic brain injury: An international survey

BackgroundManaging agitation is a significant challenge in the early stages of recovery after traumatic brain injury (TBI), and research investigating current practice during this period is lacking.ObjectivesThis study examined how clinicians worldwide conceptualise, measure and manage agitation during early TBI recovery.MethodsA cross-sectional anonymous online survey was distributed via email, newsletters, conferences and social media to clinicians involved in early TBI care worldwide. Respondents were 331 clinicians (66% female) from 34 countries worldwide who worked in inpatient and outpatient settings in disciplines including medicine, nursing and allied health. Participants had an average of 13 years’ clinical experience working specifically with an adult TBI population.ResultsAgitated behaviour was commonly defined as aggression and restlessness. Three quarters of clinicians reported that their services measure agitation, and clinicians in North America more frequently use standardised assessment tools. Common non-pharmacological approaches used across all regions surveyed included providing familiarising information (85%) and environmental cues (82%), managing patients in single rooms (81%) and reducing noise levels (80%). Most clinicians (90%) reported pharmacology use, particularly atypical antipsychotic agents. Clinicians’ mean rating of confidence in managing agitation was 7 out of 10 (10 being excellent) and was higher for services that provided staff with written guidelines for agitation management. Only half of clinicians reported sufficient training for managing agitation and 52% were satisfied with current agitation management practices.ConclusionsDespite high rates of agitation measurement and management, many clinicians reported dissatisfaction with current agitation management and insufficient training. This study supports the development of international guidelines and training to ensure consistent and effective agitation management in early TBI care.     

The effect of COVID-19 pandemic on the mental health of Canadian critical care nurses providing patient care during the early phase pandemic: A mixed method study

BackgroundHealthcare workers have historically experienced symptoms of post-traumatic stress disorder, depression and anxiety with previous infectious outbreaks. It is unknown if critical care nurses have similar experiences.ObjectivesThe study aimed to examine the mental health of Critical Care Registered Nurses providing direct patient care during the initial phase of the COVID-19 pandemic in Canada.DesignThis was a convergent parallel mixed method study utilizing validated questionnaires and semi-structured qualitative interviews.SettingCritical care units in a single large 650 bed academic teaching hospital in western Canada. The critical care units serve a general mixed medical – surgical adult patient population.ParticipantsCritical Care Registered Nurses providing direct patient care in the intensive care and high acuity units at the designated site.Methods109 participants completed two self-reported validated surveys, the Impact of Events Scale – Revised and the Depression, Anxiety and Stress Scale. 15 participants completed one-on-one semi-structured interviews that were analyzed using inductive thematic analysis.ResultsIn the surveys, the participants reported clinical concern for (23%), probable (13%) and significant (38%) symptoms of post-traumatic stress disorder, as well as mild to severe depression (57%), anxiety (67%) and stress (54%). In the interviews, psychological distress was described as anxiety, worry, distress and fear related to: 1) rapidly changing policy and information, 2) overwhelming and unclear communication, 3) meeting patient care needs in new ways while staying safe, and 4) managing home and personal commitments to self and family.ConclusionsCritical care nurses experienced psychological distress associated with providing care to COVID-19 patients during the early phases of the pandemic.     

The roles of community health nurses for older adults during the COVID-19 pandemic in Northeastern Thailand: A qualitative study

ObjectiveCommunity health nurses play an important role in primary health care service, especially during the spread of COVID-19. This study aimed to describe the work and activities of community health nurses focusing on the care of older adults during the COVID-19 pandemic in Northeastern Thailand.MethodThis was a qualitative research study. The methods, including observation, in-depth interview, secondary data, and focus group discussion, were employed to obtain data from 46 key informants. The process started from February to August 2022 in northeastern Thailand. Data were analyzed using content analysis.ResultsThe results of this study were organized into 3 main themes focusing on 1) Community health nurses’ role for older adults during the COVID-19 pandemic, which consists of 12 sub-themes; 2) Barriers of community health nurses in caring for older adults during the pandemic consisted of 2 sub-themes; and 3) Factors contributing to the success of community health nurses in managing health and providing care for older adults during the pandemic consisted of 4 sub-themes.ConclusionsThe findings showed that community health nurses had played important roles, such as educating and advocating health, providing care, promoting and empowering people in the community toward health, and giving emotional and nutritional support to older adults during the COVID-19 pandemic. This study can be used as a guideline for policymakers and health-related agencies to develop healthcare strategies and to optimize the management of community health nurses in caring for older adults during the pandemic. COVID-19 is a major public health challenge; therefore, understanding the roles and activities of community health nurses helps improve primary care cluster development, strengthens healthcare services in community, and for everyone in the community to be ready for possible challenge of future global pandemics.     

Health-care professionals coping responses to the COVID-19 pandemic in Pakistan

BackgroundIn the initial stage of infectious diseases such as COVID-19 creates a prodigious uncertainty not only in general population but also in health care professionals. This often leads to emotional distress in general public and particularly in health care professionals.ObjectivesDuring COVID-19 pandemic in Pakistan, the health care professionals experienced unusual stressors. This study aimed to examine the coping responses, optimism, pessimism and psychiatric morbidity of health professionals serving the COVID-19 patients.ParticipantsTotal 87, health care professionals take part in study, whom 36 were physicians and 51 nursing staff. Among these 44 were male, and 43 were female.MethodResearchers used cross sectional research design in this study. Physicians and nurses completed self-reported questionnaires. Participants provided demographics data and recorded their responses to self-administered questionnaires. Researchers administered Brief coping orientation to problems experiences (COPE) for assessing the coping strategies, while they assessed psychiatric morbidity through general health questionnaires. Similarly, future expectancy of health care professional was assessed by using life orientation scale. Participants were recruited from quarantine words in two federal government hospitals providing health care services to COVID-19 patients in Pakistan.ResultThe result showed a significant relationship in optimism and problem focus coping style and avoidance coping style. Moreover, male health professionals score high on optimism as compared to female health professionals. While, avoidance coping style were seen higher in female health professional as compare to male. The result revealed that optimism and psychiatric morbidity were significantly positive in health professionals having problem focus and avoidance coping style.     

Scope of practice of the breast care nurse: A comparison of health professional perspectives

AimThe Breast Care Nurse (BCN) supports people with breast cancer, co-ordinating services, and providing information and psychosocial support, yet there is ambiguity surrounding the scope of the role, with implications for both BCNs and service provision. The current studies investigated the scope of practice of BCNs from the perspective of both BCNs and other health professionals.MethodIn study 1, semi-structured in-depth interviews were conducted with 11 BCNs and 7 other key health professionals (HPs) involved in the care of those with breast cancer. Participants were questioned about the scope of practice of the BCN role and the challenges facing the role. In Study 2, 27 BCNs and 21 HPs then completed a survey asking about the importance of the different elements of practice identified in Study 1, together with the extent to which each aspect of practice was part of the day to day practice of BCNs.Results and conclusionProvision of information and support to people with breast cancer and their families were identified as core to the role. BCNs and other health professionals differed in their perceptions of both the length and breadth of practice of the BCN, with implications for workload and burnout in BCNs, as well as multidisciplinary team functioning and patient care. Scope of practice also differed across practice contexts.     

The impact of emotional intelligence in health care professionals on caring behaviour towards patients in clinical and long-term care settings: Findings from an integrative review

BackgroundOver recent years there has been criticism within the United Kingdom’s health service regarding a lack of care and compassion, resulting in adverse outcomes for patients. The impact of emotional intelligence in staff on patient health care outcomes has been recently highlighted. Many recruiters now assess emotional intelligence as part of their selection process for health care staff. However, it has been argued that the importance of emotional intelligence in health care has been overestimated.ObjectivesTo explore relationships between emotional intelligence in health care professionals, and caring behaviour. To further explore any additional factors related to emotional intelligence that may impact upon caring behaviour.DesignAn integrative review design was used.Data sourcesPsychinfo, Medline, CINAHL Plus, Social Sciences Citation Index, Science Citation Index, and Scopus were searched for studies from 1995 to April 2017.Review methodsStudies providing quantitative or qualitative exploration of how any healthcare professionals’ emotional intelligence is linked to caring in healthcare settings were selected.ResultsTwenty two studies fulfilled the inclusion criteria. Three main types of health care professional were identified: nurses, nurse leaders, and physicians. Results indicated that the emotional intelligence of nurses was related to both physical and emotional caring, but emotional intelligence may be less relevant for nurse leaders and physicians. Age, experience, burnout, and job satisfaction may also be relevant factors for both caring and emotional intelligence.ConclusionsThis review provides evidence that developing emotional intelligence in nurses may positively impact upon certain caring behaviours, and that there may be differences within groups that warrant further investigation. Understanding more about which aspects of emotional intelligence are most relevant for intervention is important, and directions for further large scale research have been identified.     

International Operating Room Nurses' Challenges in Providing Person-Centered Care During Organ Procurement Surgery

PurposeInternational operating room (OR) nurses assisting in organ procurement surgery believe that it is their responsibility to provide continued and comprehensive person-centered care to donors through their surgical journeys. This study explored the challenges these nurses encountered in providing person-centered care during surgical care stages of organ procurement surgery in Australia.DesignThe phenomenological approach by van Manen was used to portray 18 OR nurses' organ procurement experiences.MethodsSemistructured interview data were transcribed verbatim.FindingsInternational OR nurses encountered challenges in providing person-centered care during organ procurement surgery, which were described in different surgical care stages. They faced emotional challenges in handling family grief and clinical challenges in interacting with other health professionals. These challenges could cause personal distress and affect their professional practice.ConclusionsRecognizing and managing these challenges is essential for supporting staff and providing quality person-centered care to deceased donors and their families during the organ procurement process.     

Relocating an intensive care unit: An exploratory qualitative study

BackgroundAs new hospitals are built to replace old and ageing facilities, intensive care units are being constructed with single patient rooms rather than open plan environments. While single rooms may limit hospital infections and promote patient privacy, their effect on patient safety and work processes in the intensive care unit requires greater understanding. Strategies to manage changes to a different physical environment are also unknown.ObjectivesThis study aimed to identify challenges and issues as perceived by staff related to relocating to a geographically and structurally new intensive care unit.MethodsThis exploratory ethnographic study, underpinned by Donabedian's structure, process and outcome framework, was conducted in an Australian tertiary hospital intensive care unit. A total of 55 participants including nurses, doctors, allied health professionals, and support staff participated in the study. We conducted 12 semi-structured focus group and eight individual interviews, and reviewed the hospital's documents specific to the relocation. After sorting the data deductively into structure, process and outcome domains, the data were then analysed inductively to identify themes.FindingsThree themes emerged: understanding of the relocation plan, preparing for the uncertainties and vulnerabilities of a new work environment, and acknowledging the need for change and engaging in the relocation process.Discussion and conclusionsA systematic change management strategy, dedicated change leadership and expertise, and an effective communication strategy are important factors to be considered in managing ICU relocation. Uncertainty and staff anxiety related to the relocation must be considered and supports put in place for a smooth transition. Work processes and model of care that are suited to the new single room environment should be developed, and patient safety issues in the single room setting should be considered and monitored. Future studies on managing multidisciplinary work processes during intensive care unit relocation will add to the learnings we report here.     

A qualitative study to evaluate breast care nursing in North Wales from the user perspective

Background to the study: Breast care services for Wales developed in response to government requirements that breast cancer care should be delivered only by specialist multi-disciplinary teams in cancer units treating at least 100 new breast cancer patients per year.Study aims: A study was conducted to evaluate the Breast Care Nursing Service within North Wales from the perspectives of both staff and patients. This paper presents the findings of the second stage of the patient survey, the aim of which was to investigate patients’ experiences using a qualitative interview.Methodological issues: Thirteen patients were interviewed using a semi-structured interview guide developed from the findings of the patient questionnaire survey.Findings/Conclusion: Although patients valued the BCNS service for the support offered around the time of diagnosis, improvements were also identified. Initial referral could be improved by training practice nurses and district nurses in recognising early signs of breast cancer. BCNSs could provide support and supervision in this role. During diagnosis and treatment, BCNSs could be more proactive in providing information and support to women and their families. Further research is needed in order to develop a tool to determine how patients would like this need to be assessed. Finally, improvements in follow up care require either additional resources in the form of BCNSs, or more involvement of community nurses in performing certain procedures and offering long-term support.