Beginning Level Nursing Students’ Experiences with Cancer Patients in their First Clinical Placement: a Qualitative Appraisal in Turkey

Objective: This study was conducted to evaluate beginning nursing students’ point of view related to caring cancer patients in their first clinical placement. Methods: Data were collected by evaluating the diaries kept by four beginning level nursing students who were assigned to do their fundamentals of nursing clinical practice in hematology clinic from February to May 2011. A qualitative research method was used and data were analyzed using inductive method. Findings: Nursing students experienced anxiety, had difficulties while communicating with cancer patients and observed some negative practices related to patient care and treatment. Conclusions: During their clinical placement nursing students were able to differentiate right and wrong practices in clinical environment, they tried to tailor their theoretical knowledge to the clinical practice and reported decrease in their anxiety by the end of clinical rotation. Being assigned to care for cancer patients was a stressful experience for the first year students. According to these results, it can be said that clinics such as hematology can be used as a clinical placement only in mandatory conditions for beginning level nursing students because of their limited clinical experience and the knowledge requirement related to these patients.     

“I couldn't even talk to the patient”: Barriers to communicating with cancer patients as perceived by nursing students

Communication is closely related to safe practice and patient outcomes. Given that most clinicians fall into routines when communicating with patients, it is important to address communication issues early. This study explores Taiwanese nursing students’ experiences of communication with patients with cancer and their families. Senior nursing students who had cared for cancer patients were recruited to participate in focus group interviews. These semi‐structured interviews were recorded and transcribed for content analysis. Among the 45 participants, about 36% of them never received any communication training. Up to 76% of the participants stated that their communication with cancer patients was difficult and caused them emotional stress. Subsequent data analysis revealed four themes: disengagement, reluctance, regression and transition. Students’ negative communication experiences were related to the patients’ terminally ill situation; the students’ lack of training, low self‐efficacy and power status, poor emotional regulation, and cultural considerations. The findings of this study provide a deeper understanding of nursing students’ communication experiences in oncology settings within the cultural context. Early and appropriate communication training is necessary to help students regulate their emotions and establish effective communication skills. Further studies are needed to examine the relationship among students’ emotional labour, communication skills and outcomes.     

Clinical nurses' expressions of the emotions related to caring and coping with cancer patients in Pakistan: a qualitative study

BANNING M. & GUMLEY V.A. (2012) European Journal of Cancer Care Clinical nurses' expressions of the emotions related to caring and coping with cancer patients in Pakistan: a qualitative study Nursing in Pakistan is a developing profession. This was the first study to examine nurses' views and emotions related to nursing cancer patients in an oncology hospital in Pakistan. Semi‐structured interviews explored the concept of emotions and their interpretation by nurses. A purposive sample of nurses was recruited from hospital departments and wards. Twenty nurses were interviewed. Data were analysed using thematic analysis. Four themes emerged from the data. These were: the importance of expressing empathy, feelings of helplessness, developing emotions and tailoring moods to match the patient environment. The significance of the patients' cancer journey was multilayered with highs and lows that were imbued with the hope of cure and remission and by an emotional catalogue of feelings; joy at nursing patients in remission to helplessness for patients in advanced stage. Male domination and a negative public perception of cancer were significant issues that nurses acknowledged. The strategies nurses use to manage emotional situations needs further research with workshops to enhance nurse's skills in emotional intelligence when caring for cancer patients.     

Love and work: oncology nurses' view of the meaning of their work.

Phenomenological interviews with 23 nurses and more than 200 hours of participant observation on units of one cancer hospital were conducted to obtain a better understanding of how nurses caring for patients with cancer view their work. When asked to discuss a "critical incident" that captures the essence of oncology nursing for them, most nurses described acute physiologic emergencies. A few nurses described psychosocial needs and explained how they had helped or were unable to help patients and families deal with these needs. A major theme in these incidents was how they related to the nurses' own lives. These findings suggest the need to provide nurses with support and an opportunity to discuss their work. Oncology nurses appear to be motivated by a deep concern for patients and families that creates tremendous stress when conditions such as poor staffing, excessive use of registry nurses, and unexpected crises occur. The task orientation of these nurses also seems to be based on their fundamental concern for patient welfare.     

Exploring Communication Difficulties in Pediatric Hematology: Oncology Nurses

Background: Communication plays an important role for the well being of patients, families and also healthcare professionals in cancer care. Conversely, ineffective communication may cause depression, increased anxiety,hopelessness and decreased of quality life for patients, families and also nurses. Objective: This study aimed toexplore communication difficulties of pediatric hematology/oncology nurses with patients and their families,as well as their suggestions about communication difficulties. Materials and Methods: It was conducted in apediatric hematology/oncology hospital in Ankara, Turkey. Qualitative data were collected by focus groups, with21 pediatric hematology/oncology nursing staff from three groups. Content analysis was used for data analysis.Results: Findings were grouped in three main categories. The first category concerned communication difficulties,assessing problems in responding to questions, ineffective communication and conflicts with the patient’s families.The second was about the effects of communication difficulties on nurses and the last main category involvedsuggestions for empowering nurses with communication difficulties, the theme being related to institutionalissues. Conclusions: Nurses experience communication difficulties with children and their families during longhospital stays. Communication difficulties particularly increase during crisis periods, like at the time of firstdiagnosis, relapse, the terminal stage or on days with special meaning such as holidays. The results obtainedindicate that pediatric nurses and the child/family need to be supported, especially during crisis periods. Feelingof empowerment in communication will improve the quality of care by reducing the feelings of exhaustion andincompetence in nurses.     

Communication Competencies of Oncology Nurses in Malaysia

This paper reports on part of a large study to identify competencies of oncology nurses in Malaysia. It focuseson oncology nurses’ communications-related competency. As an important cancer care team member, oncologynurses need to communicate effectively with cancer patients. Literature shows that poor communication canmake patients feel anxious, uncertain and generally not satisfied with their nurses’ care. This paper deliberateson the importance of effective communication by oncology nurses in the context of a public hospital. Four focusgroup discussions were used in this study with 17 oncology/cancer care nurses from Malaysian public hospitals.The main inclusion criterion was that the nurses had to have undergone a post-basic course in oncology, or havework experience as a cancer care nurse. The findings indicated that nurses do communicate with their patients,patients’ families and doctors to provide information about the disease, cancer treatment, disease recurrence andside effects. Nurses should have good communication skills in order to build relationships as well as to providequality services to their patients. The paper concludes by recommending how oncology nursing competenciescan be improved.     

The forgotten team member: meeting the needs of oncology support staff

INTRODUCTION: The impact of working in an oncology setting has been widely researched for physicians, nurses, social workers, and chaplains. The experiences of nonlicensed support staff in an oncology setting have rarely been acknowledged or addressed. Few studies have addressed support or education initiatives for support staff caring for oncology patients. The intent of this study was to understand the work experiences of oncology support staff. Emotional impact, patient relationships, and team relationships were addressed. These data would help shape the development of an oncology support staff program. METHODS: A qualitative and quantitative approach was used to explore the experiences of support staff. Seven focus groups and individual interviews were conducted addressing work life in a cancer center. The quantitative survey collected baseline data on job satisfaction, working relationships, patient relationships, burnout, and support programs. RESULTS: Four predominant themes emerged from the focus groups. These included: relationships with patients and families, coping with death and dying, value and recognition, and balancing function with emotion. The quantitative survey reported the highest satisfaction with patient relationships and the lowest satisfaction with job recognition and supervisor support. High personal accomplishment scores declined with duration of employment. Educational grand rounds were a high interest. DISCUSSION: This study provides insight into the impact of caring for oncology patients on support staff. Burnout and job satisfaction can be costly. Recognizing the challenges inherent in the oncology environment is essential to supporting a successful oncology practice for licensed and nonlicensed support staff.     

Helping students respond to stressful interactions with cancer patients and their families: a pilot program

This pilot program was designed to help medical students improve their ability to respond to the psychological needs of cancer patients and their families. Third-year students on the hematology/oncology rotation were offered a series of seminars dealing with the psychological and social impact of cancer on patients and their families. The goal of these seminars was to help the students develop working knowledge, understanding, and skills for dealing with cancer patients and families. The seminars used didactic input, videotaped interactions, and guided discussion. Experienced counselors, with the help of an oncologist, led the seminars. Findings from this pilot program suggest that medical students can benefit from specific training in the psychosocial aspects of cancer.     

Information for teenagers with cancer: current state in French pediatric oncology units

In France, teenagers with cancer are managed mainly in paediatric units, given that there are only few teenage cancer units. This situation leads to the following question: are teenagers with cancer provided with tailored patient education? The object of this study was to identify education programmes specifically designed for teenagers in French paediatric oncology units. This study was conducted first by questionnaires, second by interviews with health care providers in units where information programs had been implemented. Nine information programmes or projects were identified: 2 booklets, one log book, one Web chat, one video, one DVD, one educative muppet, one peer based education group project, one nursing education session project and one qualitative study project. Only 5 from these programmes or project were specifically designed for teenagers. Four approaches can be identified: conception of education materials, individual patient education, group patient education, informal patient education.     

Non‐pharmacological interventions to manage fatigue and psychological stress in children and adolescents with cancer: an integrative review

Cancer‐related fatigue (CRF) is the most stressful and prevalent symptom in paediatric oncology patients. This integrative review aimed to identify, analyse and synthesise the evidence of non‐pharmacological intervention studies to manage fatigue and psychological stress in a paediatric population with cancer. Eight electronic databases were used for the search: PubMed, Web of Science, CINAHL, LILACS, EMBASE, SCOPUS, PsycINFO and the Cochrane Library. Initially, 273 articles were found; after the exclusion of repeated articles, reading of the titles, abstracts and the full articles, a final sample of nine articles was obtained. The articles were grouped into five categories: physical exercise, healing touch, music therapy, therapeutic massage, nursing interventions and health education. Among the nine studies, six showed statistical significance regarding the fatigue and/or stress levels, showing that the use of the interventions led to symptoms decrease. The most frequently tested intervention was programmed physical exercises. It is suggested that these interventions are complementary to conventional treatment and that their use can indicate an improvement in CRF and psychological stress.     

‘It stays with me’: the experiences of second‐ and third‐year student nurses when caring for patients with cancer

Little is known about student nurses experiences of nursing patients with cancer in the UK. With the increasing survival of people with cancer and with cancer no longer seen as a terminal illness it is useful to understand student nurses clinical experience when nursing those with cancer. This study takes a phenomenological approach involving three focus group interviews with 20 student nurses from the second and third year of their course in one centre in the UK. All the students had experience of caring for patients with cancer. The key themes emerging from the study were: Communication, Impact on Self, Lack of Support and End‐of‐Life‐Care. Students emphasised the need to have more knowledge and support in relation to cancer care. They describe how they lack communication skills and found it difficult to handle their emotions. A number of students found the whole experience of caring for patients with cancer emotionally distressing and draining and they describe avoiding contact with these patients by using distancing and avoidance strategies. Student nurses need additional support through demystifying cancer, using reflective practice and good mentoring in the clinical area to enable students to feel supported, and develop confidence in their capacity for care for people with cancer.     

The teaching of clinical oncology in Italian medical schools. A survey among teachers and students

BACKGROUND:: Oncologists, health care workers and health organizations considerwell-performed teaching programs in clinical oncology a fundamentalstep in cancer control. The aim of our study was to assess theviews of teachers and students on the present status of oncologyteaching in Italian medical schools and on the most common shortcomingsin cancer education. MATERIALS AND METHODS:: A survey was carried out among teachers and students of 17 Italianmedical schools using two different questionnaires. Six hundredforty-seven students of Northern, Central and Southern Italyin the final two years (5th and 6th) of their medical curriculumand 87 professors of pathology, surgery, internal medicine andmedical oncology completed the questionnaires. RESULTS:: Doctor/patient relationships and integration among disciplineswere the most unsatisfactory aspects of oncology teaching, accordingto students. Biology, epidemiology, radiotherapy, and medicaltreatment were felt to be in-sufficiently treated, whilst diagnosticaspects, clinical management and surgery were rated sufficient.The median number of cancer patients to whom each student hadaccess during his/her training was limited, averaging only 13patients; however, a high degree of variability was noted. Alarger number of patients was generally observed in smaller,less crowded medical schools, with notable exceptions. Althoughthe majority of teachers had clinical practices related to theirdisciplines, only a small number of students underwent a periodof clinical training. Traditional methods of teaching were preferredto innovative methods, while interaction among disciplines wasuncommon. CONCLUSIONS: This survey emphasizes the dualism between students' expectationsand teachers' ideas about cancer teaching. Doctor/patient relationshipsand poor attention to practical clinical problems seem the mostcritical issues for clinical oncology training in Italian medicalschools. curriculum, medical education, medical oncology, medical schools, survey, teaching methods     

Hospital-based home care for children with cancer: a qualitative exploration of family members' experiences in Denmark

The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment, as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory. Our study highlights the importance of providing hospital-based home care with consideration for the family members' need for the sense of security achieved by home care by experienced paediatric oncology nurses and regular contact with the doctor. In future studies, interviews with children and siblings could be an important source of information for planning and delivering care suited to the families' perceived needs.     

Unconventional cancer treatments: professional, legal, and ethical issues.

A significant number of patients with cancer use or seriously consider using unconventional treatments. When patients or their families seek or use unproven treatment methods, the oncology nurse may face complex professional, legal, and ethical issues. This article addresses the possible reasons why patients and families may choose unconventional treatments. Oncology nurses are challenged to become aware of their many and varied nursing responsibilities. These responsibilities are examined in light of applicable codes and nursing practice standards, the clinical situation, and the values that are unique to each patient and family. Guidelines are offered for the oncology nurse to assist patients and families in choosing among treatment options.     

The role of the specialist nurse in paediatric oncology in the United Kingdom

National guidance in the United Kingdom on the provision of services for children and young people with cancer and their families has consistently emphasised the need for specialist nursing as central to the delivery of safe and effective care. The temptation when examining the role of the specialist nurse is to look at those posts that carry a recognised 'specialist' label. It is equally important, however, to look at the development of nursing practice across the speciality and at how this can be both supported and recognised. Nurses with specialist knowledge, skills and expertise in paediatric oncology are needed in positions where they are able to develop nursing practice, direct service development, lead nursing research, and guide education and training. Effective clinical leadership is essential at the point at which nursing care is delivered whether that is at the hospital bedside, in the clinic and day care unit, or in the family home.     

Burnout,psychiatric morbidity,and work‐related sources of stress in paediatric oncology staff: a review of the literature

Objective: A growing body of research suggests that staff working in adult oncology services are at risk of burnout and psychiatric morbidity, but whether or not these findings can be generalised to staff working in paediatric oncology is questionable. This paper reports the findings of a comprehensive review of the literature on burnout, psychiatric morbidity, and sources of work‐related stress in paediatric oncology staff. Methods: Electronic searches of MEDLINE and PSYCHINFO. This was followed by a screening process, during which papers where checked against inclusion and exclusion criteria, and the quality of study reporting was assessed. Information about the study design and methods was then extracted from each paper so that the methodological quality could be critiqued. Results: Ten studies meeting the review inclusion criteria were identified. No studies were identified which compared paediatric and adult oncology staff. Research on paediatric oncology staff has failed to use the well‐established standardised measures of burnout and psychiatric morbidity employed in studies of adult oncology staff. There is some qualitative evidence to suggest paediatric oncology nurses experience a unique, additional set of stressors not encountered by colleagues in adult oncology services. Conclusion: The evidence on stress and burnout in paediatric oncology staff is extremely limited. In order to devise appropriate and effective interventions to support staff, we need to have a much better understanding of the level of burnout and psychiatric morbidity experienced by all members of the paediatric oncology multi‐disciplinary team, as well as the factors that contribute to these experiences. Copyright © 2009 John Wiley & Sons, Ltd.     

Site of childhood cancer care in the Netherlands

BackgroundDue to the complexity of diagnosis and treatment, care for children and young adolescents with cancer preferably occurs in specialised paediatric oncology centres with potentially better cure rates and minimal late effects. This study assessed where children with cancer in the Netherlands were treated since 2004.MethodsAll patients aged under 18 diagnosed with cancer between 2004 and 2013 were selected from the Netherlands Cancer Registry (NCR) and linked with the Dutch Childhood Oncology Group (DCOG) database. Associations between patient and tumour characteristics and site of care were tested statistically with logistic regression analyses.ResultsThis population-based study of 6021 children diagnosed with cancer showed that 82% of them were treated in a paediatric oncology centre. Ninety-four percent of the patients under 10 years of age, 85% of the patients aged 10–14 and 48% of the patients aged 15–17 were treated in a paediatric oncology centre. All International Classification of Childhood Cancers (ICCC), 3rd edition, ICCC-3 categories, except embryonal tumours, were associated with a higher risk of treatment outside a paediatric oncology centre compared to leukaemia. Multivariable analyses by ICCC-3 category revealed that specific tumour types such as chronic myelogenous leukaemia (CML), embryonal carcinomas, bone tumours other type than osteosarcoma, non-rhabdomyosarcomas, thyroid carcinomas, melanomas and skin carcinomas as well as lower-staged tumours were associated with treatment outside a paediatric oncology centre.ConclusionThe site of childhood cancer care in the Netherlands depends on the age of the cancer patient, type of tumour and stage at diagnosis. Collaboration between paediatric oncology centre(s), other academic units is needed to ensure most up-to-date paediatric cancer care for childhood cancer patients at the short and long term.     

Coping strategies of family caregivers in hospice homecare.

Although stresses associated with family caregiving during illness have been well-documented, little attention has been focused on how families cope with hospice home care of a relative with advanced cancer. A longitudinal, qualitative study examined the experiences of hospice caregiving families. This article focuses on coping strategies identified by hospice families caring for their dying relative at home. Semistructured interviews and observations were conducted with 14 individuals from 10 families. Fifty-five interviews were audiotaped and transcribed. Constant comparative analysis was used to search inductively for recurrent themes. Specific coping strategies were used with each of the three areas of stress identified by families. "Windows of time," social comparison, cognitive reformulation, and avoidance were used to cope with the overall caregiving experience. "Taking one day at a time" helped to manage uncertainty. Acceptance and rationalization helped families to deal with changes in a relative's mental status. Social support was used with all three areas of stress. Identifying effective coping strategies that families are using directs the development, testing, and implementation of nursing interventions that enhance coping of hospice caregiving families.