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Moody KM, Andersen C, Bradley J, Draper L, Garrington T, Gill J, Harrison D, Hayashi M, Heaton A, Holladay C, Lion A, Rajan A, Rozo B, Runco D, Salvador L, Ferguson V, Arnold R. In-person and virtual adaptation of an interprofessional palliative care communications skills training course for pediatric oncology clinicians. RESEARCH SQUARE 2023:rs.3.rs-3228580. [PMID: 37609163 PMCID: PMC10441465 DOI: 10.21203/rs.3.rs-3228580/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose Effective, empathic communication is crucial for pediatric oncology clinicians when discussing palliative and end-of-life (PC/EOL) care with parents of children with cancer. Unfortunately, many parents report inadequate communication at these distressing times. This study evaluates the communication skills training (CST) clinicians received to deliver a PC/EOL communication intervention as part of a multi-site randomized-controlled trial (RCT). Methods Clinicians from eight sites formed dyads (one physician and one nurse [RN] or advanced practice provider [APP]) and were trained over 3 days (in-person or virtually). Training was adapted from VitalTalk™ and included didactic instruction, videos, visual aids, and dedicated time to practice with simulated patients. Study participants completed a confidential, post-training online evaluation survey. A self-reported quality assurance checklist was used to measure fidelity to the communication protocol when delivered to parents during the RCT. Results Thirty clinicians completed training; 26 completed post-training surveys including twelve (46.1%) physicians, 8 (30.8%) RNs and 6 (23.1%) APPs. Most were female (65.4%); white (80.8%), not Latinx (88.5%); 40-50 years old (53.9%); and in practice over 10 years (65.4%). Nine (34.6%) trained in-person; the rest trained virtually. Ninety-two percent reported the course was valuable or very valuable for developing their PC/EOL communication skills and 96% reported learning something new. Dyads trained virtually had similar fidelity to those trained in-person (95% and 90% respectively) when delivering the PC/EOL communication intervention to parents. Conclusion This PC/EOL CST was valuable for improving pediatric oncology clinicians' communication skills, successfully implemented in-person and virtually, and translated effectively into practice.
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Abstract
BACKGROUND Weighing implications of multiple intensive cancer-directed therapies over time, oncology nurses are more prone to intrinsic distress compared to nurses in non-oncologic settings. This vulnerability may give rise to moral distress. Yet, little is known about moral distress experiences of oncology nurses. OBJECTIVE This systematic review and meta-analysis examined the frequency and intensity of moral distress among oncology nurses with an exploratory focus on nurse-level and work-related characteristics. METHODS We conducted a systematic search of 7 electronic databases (2000-2020) supplemented by hand-search strategy. Means and standard deviations of moral distress scores in the included studies were extracted and pooled in our meta-analysis. RESULTS Our sample of 8 cross-sectional studies consisting of 2686 participants with 1654 oncology nurses met criteria for inclusion. A random-effects model was used in our meta-analysis given considerable heterogeneity. Our results suggest that moral distress was of low to moderate frequency, but of high intensity. Moral distress among oncology nurses was a significant predictor for burnout, provider communication, decisions surrounding end-of-life care, work conditions (eg, patient assignment, type of unit), and inability to provide compassionate care. CONCLUSION Moral distress in oncology nurses is associated with burnout syndrome, compassion fatigue, and secondary traumatic stress syndrome, all of which are linked to poor patient care and outcomes. Robust psychological well-being is critical in minimizing unintended consequences of moral distress. IMPLICATIONS FOR PRACTICE Oncology nurses are at high risk for moral distress due to the nature of their work. Future studies should examine the prevalence among oncology nurses to help inform targeted interventions.
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Terrasson J, Rault A, Seigneur É, Doz F, Dolbeault S, Brédart A. [Announcing treatment resistance in pediatric oncology: A qualitative study of nurses' experiences]. Bull Cancer 2022; 109:1154-1161. [PMID: 35985866 DOI: 10.1016/j.bulcan.2022.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The announcement of treatment resistance is a key moment in the management of children treated for cancer. Although nurses are present at various stages of this announcement, few studies have examined their role and experience. This study proposes to enhance understanding of the experience of nurses at this time of the pediatric cancer trajectory in France. METHOD A qualitative study was conducted in two pediatric oncology departments. Semi-structured research interviews were conducted with seven pediatric nurses (five women) with an average age of 36.9 years. RESULTS Nurses report not being systematically present during announcements of treatment resistance but being present with the families before and after these announcements. Nurses described their role at this point in the management process as multifaceted. The emotional burden associated with these announcements is significant: nurses must manage their own emotions when faced with the discovery of resistance to treatment, those of the families, and must often answer difficult questions about the prognosis or end of life. In this context, teamwork is an important support. DISCUSSION Better awareness and recognition of the role of nurses and the associated emotional burden would enable them to fully carry out their missions.
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Affiliation(s)
- Johanna Terrasson
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France.
| | - Aude Rault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France
| | - Étienne Seigneur
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France
| | - François Doz
- Institut Curie, centre SIREDO - soins, innovation, recherche, en oncologie de l'enfant, de l'adolescent et de l'adulte jeune, 75005 Paris, France; Université de Paris, 12, rue de l'École de Médecine, 75006 Paris, France; Institut Curie, UMR 144 CNRS, 75005 Paris, France
| | - Sylvie Dolbeault
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université Paris-Saclay, centre de recherche en épidémiologie et santé des populations (CESP), U1018, Inserm, 94807 Villejuif, France
| | - Anne Brédart
- PSL université Paris, institut Curie, unité de psycho-oncologie, 75005 Paris, France; Université de Paris, laboratoire psychopathologie et processus de santé, 92100 Boulogne-Billancourt, France
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Schuster MA. Creating the Hematology/Oncology/Stem Cell Transplant Advancing Resiliency Team: A Nurse-Led Support Program for Hematology/Oncology/Stem Cell Transplant Staff. J Pediatr Oncol Nurs 2021; 38:331-341. [PMID: 33988484 DOI: 10.1177/10434542211011046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Burnout, moral distress, compassion fatigue, and posttraumatic stress disorder are concerns for health-care staff. Due to the high mental, physical, and emotional demands of the pediatric hematology/oncology profession, workplace supports should be in place to address the needs of the staff. A nurse-led support program is one strategy to enhance staff well-being. Methods: The Hematology/Oncology/Stem Cell Transplant Advancing Resiliency Team (HART) is a nurse-led peer-to-peer on-site support program for multidisciplinary staff caring for hematology/oncology patients. HART coaches, working 8-hour shifts, covering both day and night shift hours, are present 3 days a week on the unit. HART offers a confidential space for one on one or group interactions, educational sessions, assistance with work related, patient-care based, or personal concerns, and various forms of integrative therapies. Results: There have been over 1,100 coach consults and 98 HART shifts worked. The most commonly reported changes since HART began include staff feeling more supported by leadership and staff making time for breaks during the work shift. A 25.6% increase in staff reporting to be extremely satisfied with unit support was found. Discussion: Cultivating a culture of staff support is important. Due to COVID-19, physical HART coach presence was put on hold for 4 weeks and virtual interventions were trialed. Since its return, coach consult numbers have been steadily rising. Having a support program led by coaches with direct experience understanding the emotional toll of caring for the pediatric hematology/oncology patient population was found to be well utilized, feasible through donor funding, and measurable via staff report.
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Affiliation(s)
- Michelle A Schuster
- Department of Hematology/Oncology/Stem Cell Transplant Unit, 1862Boston Children's Hospital, Boston, MA, USA
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Ventovaara P, Sandeberg MA, Räsänen J, Pergert P. Ethical climate and moral distress in paediatric oncology nursing. Nurs Ethics 2021; 28:1061-1072. [PMID: 33706607 PMCID: PMC8408826 DOI: 10.1177/0969733021994169] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Ethical climate and moral distress have been shown to affect nurses' ethical behaviour. Despite the many ethical issues in paediatric oncology nursing, research is still lacking in the field. RESEARCH AIM To investigate paediatric oncology nurses' perceptions of ethical climate and moral distress. RESEARCH DESIGN In this cross-sectional study, data were collected using Finnish translations of the Swedish Hospital Ethical Climate Survey-Shortened and the Swedish Moral Distress Scale-Revised. Data analysis includes descriptive statistics and non-parametric analyses. RESPONDENTS AND RESEARCH CONTEXT Ninety-three nurses, working at paediatric oncology centres in Finland, completed the survey. ETHICAL CONSIDERATIONS According to Finnish legislation, no ethical review was needed for this type of questionnaire study. Formal research approvals were obtained from all five hospitals. Return of the questionnaire was interpreted as consent to participate. RESULTS Ethical climate was perceived as positive. Although morally distressing situations were assessed as highly disturbing, in general they occurred quite rarely. The situations that did appear often reflected performing procedures on school-aged children who resist such treatment, inadequate staffing and lack of time. Perceptions of ethical climate and frequencies of morally distressing situations were inversely correlated. DISCUSSION Although the results echo the recurrent testimonies of busy work shifts, nurses could most often practise nursing the way they perceived as right. One possible explanation could be the competent and supportive co-workers, as peer support has been described as helpful in mitigating moral distress. CONCLUSION Nurturing good collegial relationships and developing manageable workloads could reduce moral distress among nurses.
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Affiliation(s)
| | | | | | - Pernilla Pergert
- 27106Karolinska Institutet, Sweden; Karolinska University Hospital, Sweden
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Cheng Q, Duan Y, Wang Y, Zhang Q, Chen Y. The physician-nurse collaboration in truth disclosure: from nurses' perspective. BMC Nurs 2021; 20:38. [PMID: 33676508 PMCID: PMC7937200 DOI: 10.1186/s12912-021-00557-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/25/2021] [Indexed: 01/16/2023] Open
Abstract
Background Collaboration between physicians and nurses is critical. However, a limited number of studies have provided insights into the status of physician–nurse collaboration in truth disclosure. Methods A cross-sectional survey was conducted using an electronic questionnaire among Chinese nurses who attended a provincial conference. The Nurse–Physician Collaboration Scale was administered to nurses to assess the collaboration in truth disclosure from their perspective. A multiple-choice question was asked to assess the perceived difficulties in truth disclosure. Descriptive statistics, univariate, and multiple stepwise regression analyses were performed to evaluate physician–nurse collaboration in truth disclosure. Results A total of 287 nurses completed the survey, and 279 of them reported that they had carried out truth disclosures among patients. The average score for physician–nurse collaboration in truth disclosure was 3.98 ± 0.72. The majority of nurses (73.1–81%) responded positively to different dimensions of collaboration in truth disclosure. The results of multiple stepwise regression analysis showed that seniority (B = − 0.111, 95% confidence interval [CI] = − 0.167−− 0.055, p < 0.001) and frequency of truth disclosure (B = 0.162, 95%CI = 0.076–0.249, p < 0.001) were the only two factors associated with collaboration in truth disclosure between physicians and nurses. The most common barrier perceived by nurses was fear of patients’ negative emotions or their suicide attempts after truth telling. Conclusions Most nurses responded positively to physician–nurse collaboration in truth disclosure. Various difficulties existed in the practice of truth-telling collaboration. Further studies are required to test the potential interventions to promote cooperation between nurses and physicians in truth disclosure.
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Affiliation(s)
- Qinqin Cheng
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Yinglong Duan
- The Third Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Ying Wang
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Qinghui Zhang
- Hunan University of Chinese Medicine, Changsha, People's Republic of China
| | - Yongyi Chen
- Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, People's Republic of China.
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Exploring Non-Pharmacological Management among Anesthesia Providers to Reduce Preoperative Distress in Children. J Pediatr Nurs 2020; 50:105-112. [PMID: 31805493 DOI: 10.1016/j.pedn.2019.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 11/23/2022]
Abstract
Preparation for surgery with the induction of general anesthesia is one of the most stressful events that a child can experience. It produces several threats to the child, including physical harm, parent separation, and fear of the unknown. Anesthesia providers utilize non-pharmacological and pharmacological interventions to decrease this preoperatively. However, little is known about the non-pharmacological interventions utilized by anesthesia providers in practice. The purpose of this study was to explore non-pharmacological interventions utilized by anesthesia providers before and during the induction of general anesthesia to reduce preoperative distress in children ages one to six years old. A qualitative descriptive approach was used in this study. Twenty anesthesia providers, fourteen registered nurse anesthetists and six anesthesiologists, participated in face to face, in-depth interviews in South Florida. Content analysis was used to identify and define the major themes that emerged from the interviews. A total of seven main themes were identified. Only the three themes directly related to parent-provider-child relationship are discussed in this paper: (I) Communication, (II) Observational Skills, and (III) Parental Presence. The anesthesia providers who participated in this study offered an opportunity to better understand the non-pharmacological interventions used to impact the management of preoperative distress among children. Study findings provide evidence about non-pharmacological anesthesia providers' clinical work not found elsewhere in the literature. Non-pharmacological interventions are effective in reducing preoperative distress in children.
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Newman AR, Linder L, Haglund K. The Nurse's Role in Prognosis-Related Communication in Pediatric Oncology Nursing Practice. J Pediatr Oncol Nurs 2019; 37:313-320. [PMID: 31833447 DOI: 10.1177/1043454219891989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The experiences of pediatric oncology nurses with prognosis-related communication (PRC) remain largely unknown. The purpose of this article is to report results of focus groups wherein 15 pediatric oncology nurses from three Midwestern pediatric cancer programs provided descriptions of PRC and how they experience PRC within their daily practice. Data from focus groups were analyzed via an interpretive descriptive approach, which resulted in three themes: (1) nurses' operational definition of PRC, (2) nurses' roles in PRC, and (3) nurses' preparation for engagement in PRC. From discussions within the focus groups, nurses recognized that PRC occurs across a continuum. Nurses distinguished that the definition of PRC expands beyond simply reporting life expectancy to describing the consequences of cancer- and treatment-related toxicities and effects. When nurses are not actively invited by their physician partners to participate in PRC, nurses will often develop workarounds to ensure that they understand what was said to patients and families. This allows them to function more effectively as supporters, advocates, and informants. Nurses described little preparation to participate in such challenging conversations. Pediatric oncology nurses need to acknowledge and embrace that they are an integral part of PRC. Interprofessional communication training is necessary to enhance the comfort and confidence of nurses engaging in PRC.
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Affiliation(s)
- Amy R Newman
- Marquette University, Milwaukee, WI, USA.,Children's Hospital of Wisconsin, Wauwatosa, WI, USA
| | - Lauri Linder
- University of Utah, Salt Lake City, UT, USA.,Primary Children's Medical Center, Salt Lake City, UT, USA
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Newman AR, Haglund K, Rodgers CC. Pediatric oncology nurses' perceptions of prognosis-related communication. Nurs Outlook 2018; 67:101-114. [PMID: 30527513 DOI: 10.1016/j.outlook.2018.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/25/2018] [Accepted: 11/05/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Disclosure of prognosis-related information is an essential aspect of communication with pediatric patients with cancer and their families. The nurse is believed to play an important role in this process, but nurse perceptions and experiences have not been well-described. PURPOSE Provide an exploration of pediatric oncology nurses' experiences with prognosis-related communication (PRC). METHOD Mixed-methods, multiphase design. This paper highlights the qualitative portion of the study. FINDINGS Three themes were identified: Importance of collaboration, impact of PRC, and delivery of prognostic information. DISCUSSION Collaboration is a critical element of PRC. Nurses are often not included in the disclosure process, which limits the ability of nurses to fully function in their roles, compromising patient, family, and nurse outcomes. A paradigm shift is required to empower nurses to be more active participants. More education of physicians and nurses is necessary to consistently engage nurses in PRC and prepare nurses for critical conversations.
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Affiliation(s)
- Amy R Newman
- Marquette University Milwaukee, WI; College of Nursing, University of Utah, Salt Lake City, UT; Department of Pediatrics-Hematology/Oncology/Transplant, Medical College of Wisconsin, Milwaukee, WI.
| | | | - Cheryl C Rodgers
- Duke University School of Nursing, Durham, NC (published posthumously: DOD July 7, 2018)
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