Compassionate communities and collective memory: a conceptual framework to address the epidemic of loneliness.

In recent years, tackling loneliness has become the focus of increased scholarly debate, social intervention and the development of international policy. One response to the 'epidemic of loneliness' has been the development of the compassionate communities model. The diversity of compassionate communities approaches has led to scholars such as Allan Kellehear (2005; 2017) to highlight a lack of a cohesive underpinning theory to support and drive policy development. In this paper, we propose the use of 'collective memory' as a novel approach to linking loneliness, memory and identity in a way that draws out conceptual links between the role compassionate communities play in tackling social isolation and loneliness. We suggest that the service-led approach that seeks to identify and transpose strategies from one community to another is ineffective; instead, we emphasise the need to develop bespoke community-centred models that can be used by community nurses.

Improving the waiting times within a hospice breathlessness service.

Background: Breathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one's life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision. Aim: The aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%-from a median of 19.5 to 11.5 working days. Methods: Using a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team 'huddles', streamlining the internal referral process and reallocating staff resources. Results: Using quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim. Conclusions: This project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

Sexual health care provision in cancer nursing care: A systematic review on the state of evidence and deriving international competencies chart for cancer nurses.

BACKGROUND: Sexual health care should be an integral part of holistic, person-centred care for patients with cancer. Nurses can have a pivotal role, but nurse-led care in this context has been historically challenging. OBJECTIVES: To update the state of scientific knowledge pertinent to nurses' competencies in delivering sexual health care to patients with cancer; better understand moderating factors; and evaluate interventions developed/tested to enhance nurses' competencies. DESIGN: Systematic literature review in line with published PRISMA Statement guidelines. DATA SOURCES: Electronic bibliographic databases; journal content lists; reference lists of included studies; author/expert contact REVIEW METHODS: Nine electronic databases were searched (June 2008-October 2018) to identify studies employing diverse research methods. We applied pre-specified eligibility criteria to all retrieved records and integrated findings in a narrative synthesis. RESULTS: Of 2,614 returned articles, we included 31 unique studies. Five articles reported on two randomised controlled trials and three single-arm, before-and-after trials. Current evidence suggests that nurses' knowledge and skill in providing sexual health care still varies widely across different settings, phases and cancers. A plethora of intra-personal, inter-personal, societal and organisational factors may hinder nurse-led care in this context. Nurses' perceived professional confidence was repeatedly examined as influencing provision of care in this context; unfortunately, it was found lacking and complicated by unhelpful views and beliefs about SHC. Despite the magnitude of the problem, the few trials that tested, sexual health-targeted continuing professional development programmes for nurses, were of low-to-moderate methodological quality, while the associated high risk of methodological bias downgraded the evidence on the interventions' effectiveness. CONCLUSION: Our systematic review replicates previous findings and highlights a continuing problem: nurse-led provision of sexual health care in cancer care remains sub-optimal and challenging, due mainly to nurses' assumptions and prejudices towards sexuality, lack of professional confidence in dealing with sensitive issues, and a complex health care system environment. To realistically deal with this problem, we propose a flexible, two-level chart to promote development of basic competence among all nurses caring for patients with cancer (entry-level), and facilitate subsequent transition to a more specialised, self-pursued role for a subset of nurses (champion-level). The chart itself can be relevant to an international audience, while it might be transferable to other long-term conditions. Accordingly, we propose additional rigorous research to test multi-component educational programmes, customised to meet entry-level and champion-level requirements to realise continuous nursing provision of sexual health care in cancer care.