Family resiliency during childhood cancer: the father's perspective.

Most studies of childhood cancer have focused on mothers, but few studies have examined the views of fathers on the effects of their child's cancer diagnosis and treatment on the family. The purpose of this study was to explore the resources that help fathers adapt to life after their child's diagnosis using the resiliency model of family stress, adjustment, and adaptation as a framework. Eight fathers whose children had received treatment in a university pediatric oncology clinic in the prior 12 months were interviewed in depth. Data were coded thematically using NVivo. Results indicated that support from extended family, the church, and health care professionals was necessary for fathers to remain positive during their child's illness; spousal and parent-child relationships strengthened; and changes in family life varied based on the composition of the household. Further studies are warranted to better understand how fathers cope, so that pediatric oncology nurses and other health care professionals can provide holistic care that addresses the unique needs of all family members.     

Addressing holistic healthcare needs of oncology patients: Implementation and evaluation of a complementary and alternative medicine (CAM) course within an elective module designed for healthcare professionals

BackgroundPatients, and especially oncology patients, increasingly demand information and application of complementary therapies to supplement their conventional medical treatment and follow-up care. Due to the widespread interest in holistic treatment opportunities in oncology populations, healthcare professionals need to be prepared in differentiating evidence-based methods of the complementary and alternative medicine (CAM) spectrum and how to consult with patients about it.ObjectiveThis paper reports on the implementation and evaluation of a newly designed module “Complementary and Alternative Medicine in oncological healthcare” in the bachelor degree program Interprofessional Health Care (B.Sc.).DesignThe study applied a developed evaluation questionnaire to capture students’ perspectives on the CAM contents. This assessment instrument was administered pre and post the CAM teaching unit.SettingInterprofessional medical education, University Hospital Heidelberg, Germany.ResultsThe integration of the CAM elective module was possible and was met by positive response. Students’ interest was reflected in an increase of their self-reported knowledge gain and positive CAM attitude. Comparison of pre and post evaluation data demonstrate that, particularly, students’ expectations on developing their own opinion about CAM, and getting an overview of the evidence-base of different CAM methods have been met.ConclusionsEvaluation results indicate that the module content was in line with the students’ expectations and may have positively impacted on their general CAM attitude. The results support us in continuing to offer this CAM course within the elective module to prepare today’s healthcare professionals for patient-oriented healthcare delivery.     

Nurses’ Perspectives on the Care of Adults with Mental Health Problems and Histories of Childhood Sexual Abuse

Despite growing awareness and evidence linking childhood sexual abuse (CSA) to numerous ongoing health problems in adulthood, the integration of this knowledge into nursing practice remains inconsistent. This article reports the results of a study that explored nurses’ perspectives on, and experiences with, providing care for adults with mental health problems who may also have histories of CSA. Nurses’ views underscore the challenges and complexities involved when providing care for this population. The themes of nurses’ knowledge and comfort levels, ethical practice, patient care considerations, and system issues are used to discuss nurses’ understandings, perspectives, and experiences.     

Factors influencing oncology nurses’ approaches to accommodating cultural needs in palliative care

Aims and objectives. The purpose of this study is to explore the social construction of cultural issues in palliative care amongst oncology nurses. Background. Australia is a nation composed of people from different cultural origins with diverse linguistic, spiritual, religious and social backgrounds. The challenge of working with an increasingly culturally diverse population is a common theme expressed by many healthcare professionals from a variety of countries. Design. Grounded theory was used to investigate the processes by which nurses provide nursing care to cancer patients from diverse cultural backgrounds. Methods. Semi‐structured interviews with seven Australian oncology nurses provided the data for the study; the data was analysed using grounded theory data analysis techniques. Results. The core category emerging from the study was that of accommodating cultural needs. This paper focuses on describing the series of subcategories that were identified as factors which could influence the process by which nurses would accommodate cultural needs. These factors included nurses’ views and understandings of culture and cultural mores, their philosophy of cultural care, nurses’ previous experiences with people from other cultures and organisational approaches to culture and cultural care. Conclusions. This study demonstrated that previous experiences with people from other cultures and organisational approaches to culture and cultural care often influenced nurses’ views and understandings of culture and cultural mores and their beliefs, attitudes and behaviours in providing cultural care. Relevance to clinical practice. It is imperative to appreciate how nurses’ experiences with people from other cultures can be recognised and built upon or, if necessary, challenged. Furthermore, nurses’ cultural competence and experiences with people from other cultures need to be further investigated in clinical practice.     

Thai nurses’ perspectives on the use of complementary and alternative medicine among Thai breast cancer survivors in northern Thailand

Breast cancer survivors are more likely to seek complementary and alternative medicine (CAM) for their health and well‐being than other cancer patients. The purpose of the study was to describe how Thai nurses perceive the use of CAM in Thai breast cancer survivors. An ethno‐nursing research method was used. Fifteen Thai nurses who had experience in taking care of Thai breast cancer survivors who used CAM from a tertiary care referral and resource centre in the lower northern part of Thailand were interviewed. Two major themes emerged from this study: Meaning of care practices in CAM was seen as: (i) an additional beneficial choice for health; and (ii) emotional and psychological healing. Nurses should be concerned about CAM use in Thai breast cancer survivors. Open communication about CAM helps ensure that safe and holistic care is provided. Further research to enhance integration of CAM into health care is needed.     

Patient-held records in cancer and palliative care: a randomized,prospective trialt

OBJECTIVES: To evaluate prospectively the introduction of a patient-held record (PHR) in the management of patients with advanced cancer and palliative care needs. DESIGN: a) A prospective, parallel group, randomized controlled trial. b) A postal survey of the opinions of health professionals whose patients had a PHR. SETTING: Out-patient oncology centres in Glasgow and Edinburgh, hospice home-care services across the central belt in Scotland. PARTICIPANTS: A total of 244 patients with advanced cancer recruited either from oncology outpatient clinics or hospice home-care services. The baseline interview was completed by 231 patients and 117 were randomized to receive the PHR. Between 4 and 6 months later, 80 patients with the PHR and 97 without were interviewed. Of the 83 health professionals caring for patients known to have received the PHR 63 replied to a postal questionnaire. MAIN OUTCOME MEASURES: Subjective views of patient satisfaction with communication and perception of communication between patient and health care professionals as determined by structured interview at baseline and after 4-6 months. RESULTS: We could identify no improvement in the provision of information to patients, or patients' satisfaction with information provided by outpatient doctors, GPs, practice and community nurses and hospice or palliative home care staff. Overall, patients' perception of communication between all staff involved in their care with and without PHRs was excellent in 24% and 21 %, respectively, or very good in 56% and 58% (P=0.89). The PHR made no difference to information passing between health professionals, or to the degree of family involvement. Most of those who had a record found it of some use and benefit. CONCLUSION: This study provides no evidence on which to base the widespread promotion of PHRs, although local projects with committed clinicians and patients may well prove popular and effective.     

Georgia’s healthcare system and integration of complementary medicine

BackgroundAn increasing number of people in the Republic of Georgia use complementary and alternative medicine (CAM). CAM has long been practiced in the country, but is not currently part of the formal medical system. The aim of this study was to explore patients’ CAM use and their perspectives of CAM complementation of existing services in Georgia’s health care system.MethodologyWe conducted a qualitative study exploring patient needs and wants by performing in-depth, contextual interviews with patients using CAM. We recruited participants at CAM clinics and collected data until we reached saturation. A thematic analysis involving line by line coding explored perspectives and allowed us to formulate recommendations of CAM integration in Georgia.ResultsStudy participants voiced that they pursued cure beyond symptom relief; their disappointment in that regard with conventional medicine in Georgia directed them towards CAM as a safe and effective care setting. Most sought natural approaches as a sustained approach to their health and perceived CAM as empathetic therapeutic and preventive space. Participants were in favor of integration of CAM with conventional health services through government support and regulation. They saw coverage of payments for CAM visits and treatments as important aspect for an effective and sustainable integration.ConclusionPatients favor an integration of CAM into Georgia’s current healthcare systems to ensure CAM’s broad availability as well as effective regulation and financing, including coverage by health insurance.     

Management of terminal cancer patients: attitudes and training needs of primary health care doctors and nurses

 The objective of the study was to ascertain the attitudes and training needs of primary health care (PHC) professionals regarding the management of terminal cancer patients. A cross-sectional study involving 30 PHC teams (15 urban and 15 rural) in the health district of Majorca (Spain) was carried out. Out of the 224 doctors and 186 nurses initially included, 157 and 156, respectively, completed a questionnaire designed to elicit the participant's opinions on the role of PHC in palliative care, their needs in terms of training and their management of clinical and psychological symptoms. Forty percent of professionals considered that terminal care should be the responsibility of PHC, whereas 59.5% thought it preferable for such care to be given either in Palliative Care Units or by oncologists. All kinds of relationships between PHC professionals and specialists were highly valued. Seventy-five percent of general practitioners referred to pain control, and 83% of doctors and nurses provided emotional support. Most health professionals felt training in emotional aspects would be the most desirable. One group of professionals considered palliative care to be an asset in PHC, whereas another group thought that patient care should be provided by specialists. The majority of doctors and nurses pinpointed the need for improving co-ordination with specialists. A need for tuition in palliative care was clearly stated. In conclusion, the planning of palliative care should take into account the attitudes and opinions of PHC doctors and nurses. Published online: 21 June 2000     

Is a biopsychosocial–spiritual approach relevant to cancer treatment? A study of patients and oncology staff members on issues of complementary medicine and spirituality

Background Complementary and alternative medicine (CAM) is increasingly being used by patients with cancer.Objectives Our aim is to compare the attitudes of cancer patients who use CAM to those of nonusers, on issues of CAM, biopsychosocial considerations, and spiritual needs.Methods Questionnaires were administered to patients and medical care providers in a tertiary teaching hospital with a comprehensive cancer center.Results Forty-nine percent of the study patients reported integrating CAM into their conventional care. Health care providers considered psychological and spiritual needs as major reasons for CAM use, while patients considered the familial–social aspect to be more important.Conclusions Cancer patients do not correlate CAM use with spiritual concerns but expect their physicians to attend to spiritual themes. Health care providers involved in oncology cancer care should emphasize spiritual as well as CAM themes. The integration of these themes into a biopsychosocial–spiritual approach may enrich the dialogue between patients and health providers.     

Nurse prescribing by children’s nurses: views of doctors and clinical leads in one specialist children’s hospital

Aim. To explore the views of doctors and clinical leads (CLs), who care for children and young people, on nurse prescribing in one specialist children’s hospital. Background. Nearly 14,000 nurses in the UK have virtually the same prescribing rights as doctors. Benefits of nurses adopting this role have been reported, but doctors do have some concerns. Increasing numbers of specialist nurses involved in the care of children in the hospital setting are undertaking prescribing training. No research has explored the views of health care professionals on nurse prescribing in this setting. Design. A subset of qualitative data taken from a larger study that adopted an intrinsic case study design. Method. Interviews were conducted between October 2006–July 2007 with 11 doctors and three clinical leads in one specialist children’s hospital. A thematic analysis was conducted on the interview data. Results. Nurse prescribing improved access to medicines and continuity of care. Concerns included the need for doctors to have confidence in the ability of the nurse who wanted to become a prescriber, the selection of nurses for prescribing training, the effects of nurse prescribing on the individual roles and responsibilities of doctors and nurses’ clinical skills. Conclusion. Doctors and clinical leads working in a specialist children’s hospital in the UK recognise that nurse prescribing makes a positive contribution to the delivery of services. However, it is important that nurses have the appropriate clinical skills and doctors understand nurse prescribing. This will only take place if there is good communication across professional boundaries. Relevance to clinical practice. Selection processes for the prescribing programmes must ensure that students have the necessary course prerequisites. Communication across professional boundaries is crucial to the successful implementation of nurse prescribing in the care of children and young people in the hospital setting.     

Integrating complementary medicine and supportive care: patients' perspectives toward complementary medicine and spirituality

Abstract Objectives: The association of spirituality and complementary and alternative medicine (CAM) in oncology is unfolding as a research theme that may have practical implications in supportive care. The purpose of this study was to explore patients' perspectives regarding CAM and spirituality in order to address their needs in an integrative oncology program. Methods: A 27-item questionnaire was developed that was administered by research assistants to a convenience sample of patients attending a community-based oncology service in northern Israel. Results: Of the 509 respondents, 302 (67.4%) were undergoing active oncological treatment and 146 (32.6%) were doing follow-up surveillance. Current and/or previous year CAM use for oncology treatment was reported by 244 of 495 respondents (49%). A logistic regression model indicated that CAM use was associated with younger age, Jewish religion, and higher cancer-related spiritual quest [EXP(B)=2.102, 95% confidence interval for EXP(B) 1.236-3.575, p=0.006]. Compared with patients with lower spiritual quest, CAM users with higher spiritual quest expressed more expectations of CAM counseling in the following themes: improving daily functioning and coping with disease, lessening chemotherapy side-effects, and supporting the patient and family emotionally and spiritually. In addition, they expected their social worker to be more involved in building the CAM treatment plan compared to patients with average spiritual quest (35.3% versus 16.3%, p=0.038). Conclusions: Higher degree of spiritual quest is associated with increased CAM use, and higher expectations from CAM providers and social workers in the context of CAM integration within cancer care.     

Nurses’ communication regarding patients’ use of complementary and alternative medicine

Background

: Many people integrate complementary and alternative medicine (CAM) into their health care. Nurses potentially play a significant role in communicating with patients about their CAM utilisation.

Graduate nurses' communication with health professionals when managing patients' medications

Aim and objectives. The aim was to examine how graduate nurses communicated with other health professionals about their medication management activities in the acute care context. The objectives were to determine the types of information communicated about patients’ medications and the communication processes used during interactions with other nurses, doctors and pharmacists. Background. Graduate nurses are challenged with enormous responsibilities and their competence is constantly tested in an ever‐changing arena. One of their responsibilities involves communicating with other health professionals about patients’ medications. Design. A qualitative exploratory research design was used for this study. Methods. Participant observation and semi‐structured interviews were conducted to elicit information from 12 graduate nurses with university degrees employed in a metropolitan public hospital, in Melbourne, Australia. Graduate nurses were observed once for two hours and interviewed on the same day of the observation at a mutually convenient time. The purpose of these interviews was to clarify activities observed and to obtain further information. Results. The results highlighted how work dynamics of the clinical setting had an impact on the ability of graduate nurses to communicate effectively with other nurses, doctors and pharmacists. These work dynamics included the availability of doctors and the structure of ward rounds. The results also demonstrated the value graduate nurses placed on communicating particular information such as evaluating the effect of medication changes and organizing discharge medication. Conclusions. Graduate nurses were effective in communicating about medication management activities when they initiated or were prepared for such interactions. When graduate nurses were not prepared, such as during impromptu ward rounds, they did not participate effectively and important information was not communicated. Relevance to clinical practice. It is important to understand how collegial communication facilitates accurate exchange of information and effective decision‐making to achieve optimal health care outcomes for patients.     

Oncology nursing: our past is the prologue ... can we author the future?

The development of the standards of care, roles in oncology nursing, and role competencies was an opportunity for Canadian nurses to revisit their professional roots, review and validate their present roles, and revise or reaffirm their future roles. The standards of care for individuals with cancer and their families affirmed the centrality of the individual and family in any nursing interaction and gave voice to the stated needs of Canadians at risk for, or living with cancer. For the first time in Canada, a specialty nursing organization has taken the lead to clearly define contemporary nursing roles and competencies. This new vision has captured the interest of oncology nurses. CANO, the nursing profession, other health care professionals, and health care decision-makers must now also consider how this enlightened view of oncology nursing can be operationalized. The presenters have had the opportunity to "hear" the stories of Canadian oncology nurses and their experiences in striving for excellence in their practice. These stories highlight the evidence supporting the standards of oncology nursing. In addition, the challenges and facilitators for achieving excellence in oncology nursing practice are identified. Through these stories, the future for the development of oncology practice and operationalization of the new standards of care emerges.     

Doctor–patient communication and cancer patients’ choice of alternative therapies as supplement or alternative to conventional care

Scand J Caring Sci; 2013; 27; 70–76 Doctor–patient communication and cancer patients’ choice of alternative therapies as supplement or alternative to conventional care Cancer patients’ use of complementary and alternative medicine (CAM) is widespread, despite the fact that clinical studies validating the efficacy of CAM remain sparse in the Nordic countries. The purpose of this study was to explore possible connections between cancer patients’ communication experiences with doctors and the decision to use CAM as either supplement or alternative to conventional treatment (CT). The Regional Committee for Medical and Health Research Ethics and the Norwegian Data Inspectorate approved the study. From a group of 52 cancer patients with self‐reported positive experiences from use of CAM, 13 were selected for qualitative interviews. Six used CAM as supplement, and seven as alternative to CT, periodically or permanently. Communication experiences with 46 doctors were described. The analysis revealed three connections between doctor–patient communication and patients’ treatment decisions: (i) negative communication experiences because of the use of CAM; (ii) negative communication experiences resulted in the decision to use CAM, and in some cases to decline CT; and (iii) positive communication experiences led to the decision to use CAM as supplement, not alternative to CT. The patients, including the decliners of CT, wanted to discuss treatment decisions in well‐functioning interpersonal processes with supportive doctors. In doctors’ practices and education of doctors, a greater awareness of potential positive and negative outcomes of doctor–patient communication that concern CAM issues could be of importance. More research is needed to safeguard CAM users’ treatment decisions and their relationship to conventional health care.     

Comprehensive geriatric assessment of frail older people: ideals and reality

ABSTRACT

We explored different professionals’ views on and experiences of comprehensive geriatric assessment (CGA) of frail older people. Forty-six professionals working in hospitals, primary care, or municipal health and social care participated in 10 focus groups. Professional groups comprised of occupational therapists, physiotherapists, nurses, physicians, and social workers. Participants shared an ideal image of how the CGA of frail elderly people should be conducted. Experience-based competence was more often used as an assessment tool than standardized tests. The ideal image contrasted with reality, listening to the needs expressed, with the person’s problems, needs, and priorities in the foreground, as described by the categories: a need that can be met; different perspectives on needs; needs can be hidden; and needs assessment is affected by the collaboration around the person, by the context, and by the dialogue. The health and social care professionals’ first priority is to make a person-centred tailor-made comprehensive geriatric assessment and not be bound to instruments. Clear guidelines need to be developed, stating which profession assesses what, when and how in order to ensure that person-centred needs are assessed including structures and procedures for how communication and collaboration within the team as well as between the organizations are achieved in order to perform a good person-centred CGA.