“Promoting continuity of care”-Specialist nurses’ role experiences in gynaecological oncology: A qualitative study

The role experience of advanced practice nurses in oncology: An interpretative phenomenological study

AIM(S)

To understand the experiences of advanced practice nurses working in cancer care.

DESIGN

Phenomenological qualitative study.

METHODS

Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software.

RESULTS

Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role.

CONCLUSION

Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments.

IMPLICATIONS FOR THE PROFESSION

These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles.

REPORTING METHOD

Reporting complied with COREQ criteria for qualitative research.

PATIENT OR PUBLIC CONTRIBUTIONS

No patient or public contribution.

The impact of job stress on perceived professional benefits among Chinese nurses caring for patients with gynecological cancer: mediating effects of perceived social support and self-efficacy

Introduction

Nurses caring for patients with gynecological cancer experience significant job stress, which adversely impacts their mental health. Previous studies have indicated that perceived professional benefits serves as a protective factor for nurses' mental health, and factors such as job stress, perceived social support and self-efficacy influence their perceived professional benefits. However, the relationships between these factors and the associated mechanisms have remained incompletely understood. This study explored the role of perceived social support and self-efficacy in job stress and perceived professional benefits among nurses caring for patients with gynecological cancer.

Methods

During June and July 2023, an investigation was conducted in Anhui Province. The Nurse Job Stressors Scale, Perceived Social Support Scale, Nurses' Perceived Professional Benefits Questionnaire and General Self-Efficacy Scale were administered to 311 nurses caring for patients with gynecological cancer. A chained-mediated effect model was constructed and validated.

Results

Job stress negatively affected nurses' perceived professional benefits. Perceived social support was a mediator in job stress and nurses' perceived professional benefits, with a mediating effect value of -0.093. Additionally, perceived social support and self-efficacy functioned as sequential mediators in this relationship, with a mediating effect value of -0.032.

Conclusion

This study unveils the influencing mechanisms of job stress on perceived professional benefits of nurses caring for patients with gynecological cancer. It is essential for nursing managers to alleviate nurses' job stress, provide sufficient and effective social support and improve their self-efficacy, ultimately enhancing their perceived professional benefits.

Rapport between nurses and adult patients with cancer in ambulatory oncology care settings: A scoping review

BACKGROUND

Although the importance of the nurse-patient relationship in oncology is established, a consolidated body of research describing nurse-patient rapport, especially in ambulatory care, is lacking.

OBJECTIVES

This scoping review aimed to explore knowledge about rapport between adult patients with cancer and their nurses in ambulatory oncology care, including nurse, patient, nurse-patient dyad, and system-level factors that influence rapport.

METHODS

A scoping review was conducted to explore sources of evidence and gaps in knowledge pertinent to future research. The Joanna Briggs Institute methodology for Systematic Reviews was used with searches in MEDLINE, CINAHL, and ProQuest Dissertations and Theses Global databases. Experimental, descriptive observational, and qualitative study designs that focused on patients with cancer and their nurses within an ambulatory care setting were included. Results were reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.

RESULTS

The search strategy collected 4538 studies of which 10 met study criteria after screening. Forward and backward citation tracking of included articles resulted in 4 additional studies. In total, 14 studies were extracted and analyzed. Synthesis of results from the individual sources resulted in three key observations: (a) there is an absence of studies that focus directly on nurse-patient rapport; (b) the majority of extracted data on rapport-related factors described aspects of nurses' attitudes; and (c) there was minimal information on patient, nurse-patient dyad, and system-level factors reported in these studies.

CONCLUSIONS

The lack of studies focused specifically on nurse-patient rapport in oncology ambulatory care indicates a notable gap in our empirical understanding of relationship-based care, a hallmark of cancer care provision.

TWEETABLE ABSTRACT

Nurse-patient rapport in oncology ambulatory care requires additional research @paula_koppel.

Perceived professional benefits and their associated factors among Chinese registered nurses caring for women diagnosed with gynecological cancer

PROPOSE

Registered nurses (RNs) are considered to be a major source of professional supportive care for women diagnosed with gynecological cancer (GC). This study described the level of perceived professional benefits and explored association between perceived professional benefits, sense of coherence (SOC), and coping strategies in Chinese RNs caring for women diagnosed with GC.

METHOD

A cross-sectional survey was employed to collect data using the Nurses' Perceived Professional Benefits Questionnaire (NPPBQ), Sense of coherence scale (SOC-13), and Brief Coping Orientation to Problems Experienced (Brief COPE). The questionnaires were administered to 250 RNs in China. The correlations between NPPBQ, SOC-13, and Brief COPE were evaluated with Pearson's correlation coefficient. Multiple regression analysis was performed to assess the relative contribution of each possible factor in explaining variance in the increased NPPBQ.

RESULTS

The total score for the NPPBQ was 142.4 (range 33.0-165.0). SOC, dysfunctional coping strategies, and problem-focused coping strategies were recognized as predictors of RNs' perceived professional benefit, while, emotion-focused coping strategies were not significantly associated with RNs' perceived professional benefits.

CONCLUSIONS

The findings indicate that RNs who have high levels of SOC, dysfunctional coping strategies, and problem-focused coping strategies tend to experience more perceived professional benefit. These findings propose new perspectives for nursing managers to promote RNs' perceived professional benefit by helping RNs to find meaningfulness when caring for women diagnosed with GC, increasing RNs' communication skills to improve their relationship with patients, and training RNs to use coping strategies effectively.

Supportive care needs of women with gynaecological cancer: A systematic review and synthesis of qualitative studies

AIMS

To synthesize existing qualitative research evidence on the supportive care needs of women with gynaecological cancer.

DESIGN

Qualitative systematic review.

DATA SOURCES

A comprehensive literature search was performed using nine databases (PubMed, Web of Science, PsycINFO, CINAHL, Embase, CBM, CNKI, VIP and WanFang) without restrictions regarding publication date; qualitative studies published in English or Chinese were included. Initial search in December 2021 and updated in October 2022.

REVIEW METHODS

This study was conducted according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. The Critical Appraisal Skills Programme tool for qualitative research was used to assess the quality of all included papers. Finally, we adopted a thematic synthesis method, synthesized the main findings, and constructed themes.

RESULTS

Eleven studies published between 2010 and 2021 were included in the review. Based on the thematic synthesis method, 10 descriptive themes were generated and five analytical themes were derived: psychological support, information support, social support, disease-specific symptom management and form of care. Women with gynaecological cancer expressed a desire for psychological support from empathetic healthcare professionals; information support included access to adequate and appropriate information, as well as communication and involvement; social support highlighted women's desire for peer support, family-related support and financial support; disease-specific symptom management described women's desire for support in coping with reproduction/sexual issues and form of care highlighted the need for continuity of care and holistic care.

CONCLUSION

The supportive care needs of women with gynaecological cancer are multidimensional and complex. The future care practice should take women's needs as a starting point and provide ongoing holistic and individualized support. Healthcare providers' understanding and support of these needs are critical to improving women's clinical outcomes and quality of care.

IMPACT

The present findings can help further develop supportive care programmes and make nursing interventions more targeted and effective.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Geriatrische Patient_innen in der Notfallambulanz

Zusammenfassung. Hintergrund: Die steigenden Zahlen geriatrischer Patient_innen stellen im Setting Notfallambulanz (NFA) wachsende Herausforderungen dar. Ziel: Ziel dieser Arbeit ist es, anhand der Erfahrungen von Ärzt_innen und Pflegenden Veränderungsbedarfe in der notfallambulanten Versorgung zu identifizieren und den Einsatz einer Advanced Practice Nurse (APN) zu diskutieren. Der Fokus liegt auf der interdisziplinären Zusammenarbeit. Methode: Im Rahmen eines qualitativen Forschungsansatzes wurden leitfadengestützte Interviews mit fünf Ärzt_innen und sieben Pflegenden aus zwei österreichischen NFAs durchgeführt. Die Auswertung erfolgte gemäß der qualitativen Inhaltsanalyse nach Mayring. Ergebnisse: Fünf zentrale Hauptkategorien ergaben sich. Bedingt durch die hohe Arbeitsbelastung, Zeitdruck und Ressourcenmangel beschrieben die Pflegenden und Ärzt_innen zunehmende Herausforderungen in der NFA sowie eine Versorgung, die den Bedürfnissen der geriatrischen Patient_innen nur unzureichend entspricht. Der Einsatz geriatrisch spezialisierter Pflegender wurde mit einer optimierten Patient_innenversorgung assoziiert. Entlang von Struktur-, Prozess- und Outcome-Kriterien des Nursing Role Effectiveness Model (NREM) werden die zentralen Inhalte der Advanced Nursing Practice (ANP)-Rolle beschrieben. Schlussfolgerunge໿n: Ein Ausbau von Kompetenzen und Tätigkeitsbereichen der Pflegenden sowie die Entwicklung definierter Versorgungspfade sollen forciert werden. Die in das NREM integrierten Forschungsergebnisse stellen eine Vorarbeit für die Beschreibung der Rolle der Pflegexpert_innen Geriatric Practice Nurse (GPN) in der NFA dar.

Exploring non-physician care professionals' roles in cancer multidisciplinary team meetings: A qualitative study

The growing complexity of cancer care necessitates collaboration among different professionals. This interprofessional collaboration improves cancer care delivery and outcomes. Treatment decision-making within the context of a multidisciplinaire team meeting (MDTMs) may be seen as a particular form of interprofessional collaboration. Various studies on cancer MDTMs highlight a pattern of suboptimal information sharing between attendants. To overcome the lack of non-medical, patient-based information, it might be recommended that non-physician care professionals play a key patient advocacy role within cancer MDTMs. This study aims to explore non-physician care professionals' current and aspired role within cancer MDTMs. Additionally, the perceived hindering factors for these non-physician care professionals to fulfil their specific role are identified. The analysis focuses on nurses, specialist nurses, head nurses, psychologists, social workers, a head of social workers and data managers. The results show that non-physician care professionals play a limited role during case discussions in MDTMs. Neither do they actively participate in the decision-making process. Barriers perceived by non-physician care professionals are classified on two main levels: 1) team-related barriers (factors internally related to the team) and 2) external barriers (factors related to healthcare management and policy). A group of non-physician care professionals also belief that their information does not add value in the decision-making proces and as such, they underestimate their own role in MDTMs. To conclude, a change of culture is needed towards an interdisciplinary collaboration in which knowledge and expertise of different professions are equally assimilated into an integrated perspective to guarantee a true patient-centred approach for cancer MDTMs.

The evolving challenges of specialist gynaecological cancer nurse roles - A qualitative study

AIMS

To determine how specialist gynaecological cancer nurses experience and perceive their role.

DESIGN

An Interpretive Description qualitative study employing semi-structured interview methods was conducted.

METHODS

Specialist nurses working in Australia or New Zealand were recruited via the Australia and New Zealand Gynaecological Oncology Group and the Cancer Nurses Society of Australia to contribute to focus group, dyadic and/or individual interviews. Audio-recordings of the interviews were transcribed, de-identified, and subjected to a thematic analysis.

RESULTS

Specialist cancer nurses participated in the study via one focus group interview (N = 6), one dyadic interview (N = 2) and 13 individual interviews between April - August 2016. Three major themes were inductively derived from 19 minor themes: 'Working between worlds' locates the role of the specialist nurse in the provision of gynaecological cancer care; 'The patient's 'go-to' person' highlights participants' relationships with patients; and 'When so much depends on one person' explores the personal and professional impact of working in a specialist nursing role.

CONCLUSION

Specialist nurses identified themselves as an accessible source of support and expertise for both women with gynaecological cancers throughout their disease trajectory and multidisciplinary team members. The main challenges they faced were the evolving and expanding nature of their bespoke roles and the dependence on them as individuals in these roles. Clearer role boundaries, guidelines for practice, effective professional support, and active succession planning are recommended.

IMPACT

This study explored the experiences and perceptions of gynaecological oncology specialist nurses. Despite similar roles being in place across many countries for several years, the roles continue to evolve and lack clear definition which is burdensome to their incumbents. This research indicates that it is now time for nursing leaders and the broader nursing profession to delineate scope of practice, standardise nomenclature and practice and embed these roles in nursing career and education pathways.

Die Advanced Practice Nurse (APN) in der gynäkologischen Onkologie

Zusammenfassung. Hintergrund: Die Advanced Practice Nurse (APN) kann für Frauen mit einer gynäkologischen Krebserkrankung eine bedeutsame Unterstützung im Behandlungsprozess darstellen. In Österreich und der Schweiz steht die APN-Entwicklung allerdings erst am Anfang und es fehlt an systematisch entwickelten Konzepten. Fragestellung: Welche Merkmale sollte ein auf wissenschaftlichen Erkenntnissen basierendes APN-Konzept in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz beinhalten? Methode: Die Entwicklung des Konzepts erfolgte mit Hilfe einer Matrix, die basierend auf dem PEPPA plus-Framework entstand, Inhalte des Nursing Role Effectiveness Models (NREM) enthielt und Daten aus vier vorangegangenen Einzelstudien zusammenführte. Dreizehn Expertinnen und Experten aus Pflege und Medizin waren an der Vernehmlassung des Konzepts beteiligt. Ergebnisse: Unterteilt in Struktur-, Prozess- und Outcome-Kriterien beschreibt das Konzept zentrale Inhalte der APN-Rolle in der gynäkologischen Onkologie im Versorgungskontext Österreich und Schweiz. Zusätzlich werden die Beziehungen zwischen Struktur-Prozess, Struktur-Outcome und Prozess-Outcome dargestellt. Schlussfolgerungen: Das in dieser Studie entwickelte Konzept bietet eine Grundlage zur (1) weiteren Ausgestaltung einer APN-Rollenbeschreibung in der gynäkologischen Onkologie auf institutioneller Ebene sowie (2) curricularen Entwicklung entsprechender Studiengänge. Durch die gemeinsame Basis kann eine Harmonisierung der APN-Rolle im Versorgungskontext Österreich und Schweiz gefördert werden.

Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan

Objectives

Cancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer.

Methods

A total of 14,240 working-age patients (20 <age ≤65 years) with oral cavity cancer treated with radiotherapy (RT) during 2000–2013 were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database. We evaluated the effects of the Continuity of Care Index (COCI) proposed by Bice and Boxerman, sociodemographic factors, and comorbidities on the survival rate. This study categorized COC into three groups—low (COCI < 0.23), intermediate (COCI = 0.23–0.37), and high (COCI ≥ 0.38)—according to the distribution of scores in our sample. A multivariate Cox proportional hazards regression model was used to determine the demographic factors and comorbidities associated with the survival rate.

Results

Among all the relevant variables, low COCI, male sex, low socioeconomic status, no receipt of prior dental treatment before RT, residence outside northern Taiwan, chemotherapy receipt, and a history of diabetes increased the risk of mortality. Pre-RT dental evaluation and management was significantly associated with reduced post-RT mortality (adjusted hazard ratio [aHR] = 0.767, 95% confidence interval [CI] = 0.729–0.806, p < 0.001). Compared with patients with a high COCI, those with a low COCI exhibited an increased risk of mortality (aHR = 1.170, 95% CI = 1.093–1.252, p < 0.001). The mortality risk in the intermediate COC group was significantly higher than that in the high COC group (aHR = 1.194, 95% CI = 1.127–1.266, p < 0.001). To balance the distribution of the potential risk factors, propensity-score matching was used for the high COC (COCI > 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074–1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107–1.277, p = 0.001, respectively).

Conclusions

In Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers’ attention.