Research priorities in haemato-oncology nursing: Results of a literature review and a Delphi study

PurposeThe study aimed to review the nursing haemato-oncology literature followed by a Delphi study to determine research priorities of UK nurses working in haemato-oncology.Methods and SampleThe review analysed relevant literature from 1996–2008. In the Delphi study, all members of the Royal College of Nursing (UK), Haematology and Bone Marrow Transplant Forum (n = 1444) were invited to participate. Data were collected in three sequential rounds of postal questionnaires. Research topics identified in round 1 were used to compile subsequent questionnaires.Key ResultsA final list of 33 research priorities was identified. Clear research themes emerged from the data including chemotherapy, psychosocial issues and information giving, psychological support needs of nurses, ethical considerations and palliative care, nurse-led services and guidelines.ConclusionsResults show both similarities and differences to priorities identified in previous haemopoietic stem cell transplant and cancer nursing studies. Further exploration of priority areas is required but priorities identified in this study provide a good starting point for further exploration and development of research programmes.     

Intensive care nurses’ perceptions of Inter Specialty Trauma Nursing Rounds to improve trauma patient care—A quality improvement project

BackgroundTrauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses’ knowledge.ObjectivesThe purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement.MethodsThe project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients’ care. The rounds were evaluated to assess the nurse’s perception of improvement.ResultsThere were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues.ConclusionsInter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge.     

Investigating the self-perceived educational priorities among oncology nurses

AimTo understand the self-perceived educational priorities among oncology nurses.BackgroundOncology nurses are the main providers of care to people affected by cancer. However, little is known about the educational needs and priorities of oncology nurses when providing care to people living with cancer.DesignA national online survey.SettingThe Cancer Nurses Society of Australia (CNSA) is an Australian wide professional body for cancer nurses. At the time of conducting the research, there were approximately 1300 members. All members were invited to participate in the survey. CNSA provided access to nurses working in all areas of cancer care, including inpatient wards, outpatient centres, ambulatory day oncology units, radiation oncology, bone marrow transplant units, educational, and research units.ParticipantsRegistered nurses involved in direct care of people affected by cancer who were members of CNSA, and ability to communicate in English.MethodsThe instrument consisted of a 15-item online questionnaire which included demographic and professional questions related to the self-perceived oncology educational needs which were free-text. This survey was hosted using an online electronic data capture system (i.e., SurveyMonkey®), and the electronic link was sent to the CNSA who then sent an email invitation to the 1300 members.Results610 educational needs were identified and ranked. These individual answers were grouped into seven overarching categories with various sub-categories within each group. The oncology nurses identified important educational topics which included: a) cancer biology, b) treatments, c) direct patient care, d) age-specific cancer care, e) leadership and research, and f) law and ethics.ConclusionAs the number of people affected by cancer continue to rise, addressing the educational needs and priorities of oncology nurses has never been so important. Higher educational institutions and healthcare institutions should consider these findings in addressing the learning needs for the current oncology nursing workforce.     

Nursing Research Priorities in the Pediatric Emergency Care Applied Research Network (PECARN): Reaching Consensus Through the Delphi Method

IntroductionPediatric emergency nurses who are directly involved in clinical care are in key positions to identify the needs and concerns of patients and their families. The 2010 Institute of Medicine report on the future of nursing supports the active participation of nurses in the design and implementation of solutions to improve health outcomes. Although prior efforts have assessed the need for research education within the Pediatric Emergency Care Applied Research Network (PECARN), no systematic efforts have assessed nursing priorities for research in the pediatric ED setting.MethodsThe Delphi technique was used to reach consensus among emergency nurses in the PECARN network regarding research priorities for pediatric emergency care. The Delphi technique uses an iterative process by offering multiple rounds of data collection. Participants had the opportunity to provide feedback during each round of data collection with the goal of reaching consensus about clinical and workforce priorities.ResultsA total of 131 nurses participated in all 3 rounds of the survey. The participants represented the majority of the PECARN sites and all 4 regions of the United States. Through consensus 10 clinical and 8 workforce priorities were identified.DiscussionThe PECARN network provided an infrastructure to gain expert consensus from nurses on the most current priories that researchers should focus their efforts and resources. The results of the study will help inform further nursing research studies (for PECARN and otherwise) that address patient care and nursing practice issues for pediatric ED patients.     

Self-reported competence in long term care provision for adult cancer survivors: A cross sectional survey of nursing and allied health care professionals

BackgroundCancer survival is increasing as patients live longer with a cancer diagnosis. This success has implications for health service provision in that increasing numbers of adults who have received cancer therapy are requiring monitoring and long-term health care by a wide range of practitioners. Given these recent trends there is a need to explore staff perceptions and confidence in managing the consequences of cancer diagnosis and treatment in cancer survivors to enhance an integrated cancer service delivery.ObjectiveThis study examines the self-reported perceptions of competence in nurses and professionals allied to medicine providing survivorship services caring for adults after cancer treatment in both secondary and primary care.DesignA cross sectional survey of the adult cancer workforce using a self-assessment tool for assessing confidence in providing long-term cancer patient management. This study was a health service evaluation.SettingThe study was conducted within the United Kingdom.ParticipantsRespondents were 618 health care professionals of these 368 were specialist adult cancer nurses in oncology and the community setting and 250 cancer allied health professionals.MethodThe survey tool was developed with experts in cancer management, nurses professionals allied to medicine such as physiotherapists and dieticians, educationalists, patient groups as well as health service managers. Competence was assessed in 4 domains clinical practice, symptom management, care co-ordination and proactive management. Perceptions of training needs were also ascertained. Data were collected using an Internet survey distributed through cancer services, community settings and professional institutions.ResultsIn total 618 practitioners who responded were providing services for adults’ 1-year post cancer therapy. Practitioners felt confident in managing psychosocial care and communicating with patients. Deficits in self-reported confidence were found in long-term medications management, care planning, long-term and complex symptom management, for those providing dimensions of care coordination and proactive care. Differences in confidence were seen between practitioner groups. Community nurses felt less skilled in managing adult cancer patients long-term.ConclusionsNurses and allied health professionals self-reported confidence, in managing all areas of care for adult cancer survivors, is variable with deficits in important areas of practice. Despite this being a small proportion of practitioners who are working in cancer care, those responding had perceived gaps in knowledge and educational needs. In providing cancer aftercare there is a requisite shift to proactive care, supported self-management and collaborative management if patient's long-term consequences of cancer and its treatment are to be addressed.Implications for practiceIf health care providers are to transform cancer survivor services then investment is required in education and capability planning across nurses, allied health professionals in both the hospital and the community setting.     

Interviews following physical trauma: A thematic analysis

IntroductionMental health problems are common in trauma survivors. In particular, depression, anxiety, acute stress disorder and post-traumatic stress disorder. Yet little is known about how these can be brought to the early attention of medical professionals through patients’ accounts of trauma within days of being admitted to emergency care. This study aims to understand how physical trauma patients with early signs of psychological distress, stemming from the trauma, might be supported through their communications with healthcare professionals.Methods42 semi-structured interviews with trauma victims attending the Royal London Hospital Trauma Clinic, taken as part of a larger project, were analysed using a qualitative thematic analysis method with a critical realist approach.ResultsFour key themes were highlighted: Pain and Death, Positivity, Powerlessness, and Remembering and Blame, each with relating subthemes such as Facing Death, Heroism, Waiting Time and Self-blame.DiscussionThe themes present within the data suggest that there are cues shared by trauma survivors that medical professionals should attend to with regard to the future mental health of their patients. Results may further equip nurses and clinical staff to spot early signs immediately and shortly after trauma.     

Home health care nursing research priorities

The purpose of this study was to determine research priorities for home health care nursing. A Delphi study was undertaken to generate and prioritize research topics. The first round consisted of members of the Home Health Nurses Association Research Committee (n = 27); subsequent rounds also included nurse researchers who had conducted research in home health care (n = 17). Consensus emerged after three rounds, with the four most important priorities identified as outcomes, health policy, the use of advanced practice nurses, and models of care/best practice. These areas are consistent with the regulatory events in home health care in the last 10 years.     

Burnout and health among critical care professionals: The mediational role of resilience

ObjectivesTo analyse the mediational role of resilience in relationships between burnout and health in critical care professionals; to determine relationships among resilience level, three burnout dimensions, and physical/mental health; and to establish demographic differences in psychological variables evaluated.DesignCross-sectional study.Participants/settingA total of 52 critical care professionals, mainly nurses, were recruited from an intensive care unit of Madrid (Spain).MethodAll participants were assessed with the questionnaires 10-item Connor-Davidson Resilience Scale, Maslach Burnout Inventory-Human Services Survey, and Short Form-12 Health Survey.ResultsNo demographic differences were found. Three burnout dimensions were negatively associated with mental health and resilience. Mediational analyses revealed resilience mediated 1) the relationships between emotional exhaustion and depersonalisation with mental health (partial mediations) and 2) the relationship between personal accomplishment and mental health (total mediation).ConclusionsResilience minimises and buffers the impact of negative outcomes of workplace stress on mental health of critical care professionals. As a result, resilience prevents the occurrence of burnout syndrome. Resilience improves not only their mental health, but also their ability to practice effectively. It is therefore imperative to develop resilience programs for critical care nurses in nursing schools, universities and health centres.     

Establecimiento de prioridades de investigación en enfermería en España: estudio Delphi

ObjectiveTo identify nursing research priorities in Spain as suggested by nurses and service users.MethodA Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users.ResultsMain priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care.ConclusionsResults may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions.     

Mobile health applications for the care of patients with breast cancer: A scoping review

ObjectivesIn recent years, the use of mobile health applications (mHealth apps) to deliver care for patients with breast cancer has increased exponentially. This study aimed to summarize the available evidence on developing mHealth apps to care for patients with breast cancer and identify the need for systematic efforts.MethodsA scoping review was performed according to Arksey and O’Malley’s framework, aiming to identify eligible research studies in PubMed, CINAHL, and Web of Science between January 2010 and December 2020. All identified studies were screened, extracted, and analyzed independently by two reviewers.ResultsA total of 676 studies were retrieved, and eight eligible studies were finally included. Four themes emerged: the involvement of patients and health professionals in the phases of design and development, patients’ preferences, the characteristics of patients, and the motivators to use mHealth apps. The results indicated promising prospects for using mHealth apps to care for patients with breast cancer and identified the need for systematic efforts to develop and validate relevant apps.ConclusionsThe attributes of patient characteristics, needs, and patient-reported outcomes data are vital components for developing mHealth apps for patients with breast cancer. Additionally, collaborative efforts, including patients, nurses, and other significant health professionals, should develop mHealth apps for breast cancer care. Additional research focusing on the design and development of mHealth apps for patients with breast cancer is warranted.     

Identifying research priorities in nursing and midwifery service delivery and organisation: a scoping study

This paper reports on a scoping study commissioned by the National Co-ordinating Centre Service Delivery and Organisation (NCCSDO) Research and Development (R&D) to identify priorities for nursing and midwifery research funding in England and Wales. The study comprised three strands (i) nationally held focus groups with service user representatives (32, plus six written submissions) (ii) semi-structured telephone interviews with 64 stakeholders (nursing, midwifery, medical, social care and allied health professionals; research commissioners; policy makers; educators; managers; researchers) and (iii) literature analysis. Five priority areas for research were identified-appropriate, timely and effective interventions; individualised services; continuity of care; staff capacity and quality; user involvement and participation-from which exemplar research questions and issues for strategic commissioning are suggested.     

Setting a research agenda for pediatric complementary and integrative medicine: A consensus approach

BackgroundPediatric use of complementary medicine (CM) is common and offers numerous research questions about diverse therapies and conditions. Although research priorities for pediatric CM have been identified, there was a need to update in light of the rapid evolution of the field.MethodsBuilding on previous work, we conducted an international, consensus-based 4-step modified Delphi process to develop and refine a pediatric CM research agenda, including on-line questionnaires and an in-person meeting. Participants included health care professionals, researchers, and educators.ResultsWe received 376 responses; participants included conventional and CM providers, researchers, educators, administrators, and policy-makers from 15 countries (Australia, Bangladesh, Belgium, Canada, China, Germany, India, Israel, Italy, New Zealand, Norway, Sri Lanka, The Netherlands, United Kingdom, and United States). While it was recognized that each region must set their own priorities based on use, access, and expertise, a “minimum set” for a pediatric CM research agenda was identified.After three rounds of surveys, participants identified the highest priorities for pediatric CM research as: (i) safety of CM therapies for infants, children, and adolescents; (ii) conditions for which CM use is highly prevalent and for which conventional medicine lacks safe, cost-effective therapies; iii) therapies/therapists to be examined for quality and reproducibility of interventions, comparative and cost effectiveness, dose, etc.; and iv) identification of relevant outcomes and outcome measurement tools.ConclusionsThe results of our study identify that “first do no harm” is the leading research priority for pediatric CM research, followed by more research on effectiveness of CM therapies for conditions not safely and effectively treated with conventional care. In order to improve pediatric health care, interdisciplinary collaborative approaches are needed between CM and conventional providers and researchers.     

Improving the handover of complex trauma patients by implementing a standardised process

BackgroundPatient handover continues to be an international health priority in the prevention of patient harm. Transitioning patients from the intensive care unit (ICU) to the ward is complex, particularly for trauma patients, due to the multifaceted aspects of their care requirements as a result of multiple injuries and different speciality teams.Objectives/aimTo design, implement, and evaluate the efficacy of a standardised handover process and tool for the transfer of ICU trauma patients.MethodsA multimethod before/after study design was used. This included observations before and after an implemented transfer process and semistructured interviews with ICU and ward nurses caring for trauma patients. Comparisons were made of data before and after the intervention.ResultsEleven patient handovers were observed, and 21 nurses (11 from the ICU and 10 from the ward) were interviewed. Patients and family members were included during the handover following the intervention (n = 0/10 [0%] vs n = 4/11 [36%]) and the ward nurses were asked if they had any concerns (n = 5/10 [50%] vs n = 10/11 [91%]). Improvements in patient observations handed over were reported following the intervention. However, omissions remained in some key areas including patient introduction, patient identity, fluid balance, and allergies/alerts. Thematic analysis of interviews revealed that the new handover process was perceived advantageous by both ICU and ward nurses because of its structured and comprehensive approach. Identified future improvements included the need for hospital service managers to ensure integration of ICU and ward electronic health record systems.ConclusionPrecise, accurate, and complete handover remains a patient safety concern. Improvements were achieved using a standardised process and handover tool for the transfer of complex trauma patients. Further improvements are required to reduce the failure to hand over essential patient information.