Uncovering Nursing Communication Strategies and Relational Styles to Foster Patient Engagement in Oncology: A Scoping Review.

Nurses play an active role in fostering engagement of oncological patients, and, therefore, adopting effective communication and interpersonal skills is crucial. However, the nurse-patient relationship and communication strategies are frequently undervalued. This scoping review aims to address this gap with a twofold objective: (1) to explore the existing literature to identify communication strategies and relational styles employed by nurses to promote patient engagement in non-pediatric oncology patients; (2) to assess current knowledge on this topic to determine the need for future research. The search was conducted on different scientific databases and grey literature. The review was conducted following the methodology outlined in the Joanna Briggs Institute guidance for scoping reviews and the updated version of the PRISMA-ScR Checklist. Thirteen articles were included in the study. The studies in total enrolled 863 participants. Four clusters of nursing interventions were identified, encompassing communication strategies and relational styles of varying complexity, along with ten categories of general outcomes emerging from their implementation. This study summarizes the current knowledge regarding nursing communication strategies and relational styles used to promote patient engagement in oncological patients. Further research is needed, to evaluate and integrate the researched techniques, tools, and interventions for future clinical nursing practice.

Interprofessional Collaboration in Palliative Care-The Need for an Advanced Practice Nurse: An Ethnographic Study.

OBJECTIVES: The literature highlights the importance of an interprofessional approach in palliative care to improve the quality of care, favoring an effective use of resources. Members of the interprofessional team include all professionals involved in patient care; in some contexts, the advanced practice nurse (APN) has a clearly defined role. This study aimed to define the possible role of the APN within the interprofessional palliative care team in our context. DATA SOURCES: A focused ethnographic approach was taken involving participant observation and semistructured interviews. CONCLUSION: From the participant observations, interaction of the participants, discussion content, and styles of meeting management were described. From the thematic analysis of the interviews, 15 themes emerged, grouped into four macro-themes: interprofessional collaboration, the interprofessional meeting, nurse's role, and developments. IMPLICATIONS FOR NURSING PRACTICE: The study has identified current nursing practice within the interprofessional palliative care team and areas where interprofessional collaboration can be improved. These are both organizational (role definition and team meeting management) and professional (development of nursing culture, expanded nursing role, and introduction of the APN within the team). Nurses must develop advanced skills to ensure more effective care for patients and caregivers. The introduction of an APN could be appropriate to address this need.

Protocol for a pilot and feasibility study evaluating a complex nurse-led patient education intervention to promote cancer patient engagement in healthy lifestyle (O-PHE programme).

INTRODUCTION: Literature suggests that patient engagement in healthy lifestyle is of crucial importance in ensuring a more effective management of side effects of cancer therapies and better quality of life for patients. While many studies describe educational interventions to promote healthy lifestyles, few are focused on promoting active patient engagement in this field. This protocol paper outlines a study to determine the feasibility of a complex nurse-led patient education intervention aimed to promote cancer patient engagement in a healthy lifestyle. METHOD AND ANALYSIS: This is a randomised pilot and feasibility study. Research nurses will recruit 40 adult patients newly diagnosed with cancer. Consenting participants will be randomised to undergo the patient engagement in healthy lifestyle intervention or the control group by means of a four-block randomisation procedure. The intervention will be delivered by a clinical nurse trained in patient engagement strategies. The primary outcome will be a description of study feasibility (recruitment and retention rates, protocol adherence and stakeholder acceptability). Secondary outcomes include changes between and within groups in healthy lifestyle behaviours (ie, increase in healthy diet, smoke cessation or reduction, increase in physical activity), in quality-of-life rates after the intervention, in patient engagement levels, in the perception of the quality of care, in nutritional status; the number of recurrences or the onset of new cancer diagnosis; the number of hospitalization. ETHICS AND DISSEMINATION: The study protocol has been approved by the Canton Ticino Ethical Committee (Protocol ID: 2020-02477 TI). The results will be published in peer-reviewed journals and will be presented at national and international congresses. Finally, patients' organisations, such as the Swiss Cancer League, will be involved in the dissemination process. This study will inform the decision to proceed with a randomised controlled trial to assess the effect of this intervention.

Patient Engagement in Oncology Practice: A Qualitative Study on Patients' and Nurses' Perspectives.

Patient engagement has gained increasing attention in cancer care as it is widely acknowledged as an essential element of high-quality care. There are limited data on how oncology nurses might apply techniques that encourage patient engagement. Therefore, this study aims to understand which nursing strategies can favour patient engagement in oncological care from patients' and nurses' perspectives. We conducted a qualitative study involving oncology patients and oncology nurses. Patients were interviewed, while nurses were involved in focus groups (FGs). Both interviews and FGs were analysed by the means of thematic analysis. We interviewed six patients and conducted two FGs, involving 17 nurses. Five themes were identified from patients' interviews: effective information, having the opportunity to choose, being considered a person, trusted relationship with nurses, and receiving support and advice. Additionally, five themes were identified from the FGs: the nurse-patient relationship, personalisation of care, information style, engagement strategies, and the team. The participants highlighted the importance of comprehensive information in order for patients to feel more involved. Great importance was given to the nurse-patient relationship, which must be based on trust and mutual respect. Both nurses and patients emphasised the importance of person-centred care. A more systematic implementation of suggestions from the participants in this study is desirable for the future.

Nurse's bedside screening of dysphagia: an umbrella review.

INTRODUCTION: Dysphagia often results in serious, poor health outcomes. Nurses have an important role in assessing dysphagia. Therefore, they need reliable and effective screening tools to detect dysphagia. The purpose of this umbrella review is to locate the most valid, reliable, and usable bedside screening tools that allow nurses to identify dysphagia in institutionalized patients. METHODS: Umbrella Review as suggested by the Joanna Briggs Institute. Inclusion criteria were: systematic reviews of randomized controlled trials or cross-sectional studies. We excluded: pediatric and psychiatric patients. We searched on PubMed, CINAHL, Scopus, Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, and the Joanna Briggs Institute Evidence-Based Practice Database. RESULTS: Six reviews were included. Four tools were reported in all the reviews: 3 oz swallowing water test, Mann Assessment of Swallowing Ability, Toronto Bedside Swallowing Screening Test, Gugging Swallowing Screen. They have shown fair to good sensitivity and specificity. The reviews analysed did not allow for a comparative analysis between instruments, which may be hindering the selection of the optimal instrument for clinical practice. CONCLUSIONS: Almost all reviews have considered stroke patients. The next steps will be to determine if there is a tool applicable in multiple settings with different patients and if this intervention is cost-effective.

Nursing interventions to promote patient engagement in cancer care: A systematic review.

BACKGROUND: Patient engagement is becoming increasingly relevant in cancer care. Nurses have been recognized as crucial in promoting active engagement of people with carcer. Despite the growing interest on this topic and the relevance of patient engagement interventions to improve patient' conditions, to the best of our knowledge there is no synthesis of the literature on the characteristics and impact of nurse-led patient engagement intervention for adults with cancer. OBJECTIVE: This review aims to systematically summarize nurse-led patient engagement interventions for adult patients diagnosed with cancer and to describe the state of the art on the impact of these interventions on patients' outcomes. DESIGN: Systematic review. SETTING(S): Hospital and outpatient care. PARTICIPANTS: Adults with cancer. METHODS: We searched PubMed, CINAHL, Embase, Scopus, Web of Science and Cochrane library from 2005 to 2021. We included randomized clinical trials, quasi-experimental studies and single-arm, pre-test/post-test studies written in English, Spanish, French and Italian. All the included articles reported nurse-led patient engagement interventions designed to improve patient engagement in the management of their own disease and to assess outcomes related to patient engagement. We appraised the methodological quality of the included articles with the Joanna Briggs Institute appraisal tools. RESULTS: Twenty-four articles met the inclusion criteria. Four distinct types of nurse-led engagement interventions, showing different degrees of complexity, were classified: (i) generic health information delivery, (ii) patient-specific information delivery, (iii) personalized decision support and (iv) motivational support. These interventions were effective in supporting behavioral changes and reducing symptoms burden of adults with cancer. In addition, many of the retrieved studies showed significant increase in patients' knowledge, informed decisions making, perceived quality of nurse-patient interaction and quality of life after the engagement intervention. CONCLUSIONS: This systematic review summarized a wide variety of nurse-led patient engagement interventions with different degrees of complexity. In addition, a significant positive effect of these interventions was found on outcomes such as patient activation, self-efficacy, health literacy and quality of life. Among those identified, nurse-led motivational interventions appear to be the most effective ones for improving engagement outcomes in adults with cancer. REGISTRATION NUMBER: PROSPERO Nr: CRD42020146189.

Nursing management of fatigue in cancer patients and suggestions for clinical practice: a mixed methods study.

BACKGROUND: Fatigue is a complex and frequent symptom in cancer patients, influencing their quality of life, but it is still underestimated and undertreated in clinical practice. The aims of this study were to detect the presence of fatigue in cancer patients, describe how patients and nurses perceived it and how nurses managed fatigue. METHODS: This is a mixed methods study. Data were collected in two oncological wards using the Brief Fatigue Inventory (BFI), an ad hoc questionnaire, patient interviews, focus groups with nurses and the review of nursing records. Interviews and focus groups were analysed through thematic analysis. We used SPSS 22.0 for quantitative data and Nvivo 10 for qualitative data analysis. RESULTS: A total of 71 questionnaires were analysed (39 males, mean age 65.7 years). Fatigue was reported 5 times (7%) in nursing records, while in 17 cases (23.9%) problems associated to it were reported. Twelve patients were interviewed. Five themes were identified: feeling powerless and aggressive, my strategies or what helps me, feeling reassured by the presence of family members, feeling reassured by nurses' gestures, and being informed. Three themes were identified through the focus groups: objectivity and subjectivity in the assessment of fatigue, nurses' contribution to the multidisciplinary management of fatigue, and difficulty in evaluating outcomes. CONCLUSIONS: The approach to the management of fatigue was unstructured. Patients were satisfied with the care they received but needed more information and specific interventions. Useful aspects were identified that could be used to change health professionals' approach towards the management of fatigue.

Patients' and Nurses' Perceptions of the Effectiveness of an Oral Cancer Agent Education Process: A Mixed-Methods Study.

BACKGROUND: The increase in the use of oral cancer drugs implies that nurses take on new roles for which education and support to patients and family members become fundamental for promoting therapeutic adherence. OBJECTIVE: To describe the patients' and nurses' perceptions on the effectiveness of the educational process in oral cancer treatment. METHODS: A mixed method with a convergent design was used. Data were collected using a questionnaire (structured according to the Multinational Association of Supportive Care in Cancer Teaching Tool for Patients Receiving Oral Agents for Cancer guidelines) and semistructured interviews with patients. Focus groups were used with the nurses. Quantitative data were analyzed with SPSS 22.0 (IBM SPSS 22.0, Armonk, New York). Qualitative data were analyzed using semantic analysis. RESULTS: One hundred forty-two questionnaires were analyzed. Patients were usually informed by physicians and nurses (81%), alone (33%) or in the presence of an informal carer (29.6%). Language comprehension was high, with a significant difference between those 70 years or older (P = .04) and those younger than 70 years. From the interviews (n = 16), 3 themes were identified: emotions during communication, feeling reassured by the presence of family members and nurses, feeling welcomed and an active part of the educational process. Three themes were identified from the focus groups (n = 4): prerequisites for an effective therapeutic education, nurses' skills, and educational process barriers. CONCLUSIONS: Overall, patients were satisfied with the education received. They perceived nurses as people who can help them understand the information they have received and manage their treatment and adverse effects. IMPLICATIONS FOR PRACTICE: This study highlighted some important points for an effective educational process: having a nurse to refer to, technical relationship competences, joint visits with physicians, and being available by phone.

Nurses' interventions to promote cancer patient engagement and related outcomes: a systematic review and meta-analysis protocol.

BACKGROUND AND AIM OF THE WORK: Due to the ageing of cancer patients, new approaches that require a more active participation in the self-management of cancer treatment at home are needed. Nurses are strategic in improving the patient's engagement capability in this regard. Knowing which interventions are more effective for the promotion of patient engagement could be useful to improve the effectiveness of the care provided. Therefore, this study aims to systematically review nursing interventions or programs that promote patient engagement in oncological nursing care and summarizing the main evidence related to their impact on relevant clinical and psychosocial outcomes. METHOD: This is a systematic review and meta-analysis protocol based on Cochrane Handbook for the systematic review of interventions. We will search the most important electronic databases (PUBMED, CINAHL, EMBASE, SCOPUS, ISI Web of Science, Cochrane library) to find out which patient engagement interventions (active adult patient involvement) are implemented in oncological settings and understand what is the effectiveness of these interventions on the outcomes reported in the literature. The GRADE methodology will be used to synthetize the evidence. If possible, also a meta-analysis will be performed. We registered the study protocol on the PROSPERO database (N° CRD42020146189). DISCUSSION AND CONCLUSION: To our knowledge, this is the first systematic review to address this clinical question in the field of oncology. This review will offer health professionals indications on the most frequently adopted patient engagement interventions and verify their clinical effectiveness. Furthermore, any gaps in the scientific literature will be highlighted.

Efficacy of Live Versus Recorded Harp Music in Reducing Preoperative Stress and Fear Related to Minor Surgery: A Pilot Study.

CONTEXT: Before surgery, people can become concerned about risks that may arise, experiencing fear and stress. It is possible to implement nonpharmacological interventions to reduce fear and preoperative stress using expressive arts, including music therapy. OBJECTIVE: The aim of this study was to assess the effectiveness of live harp music and compare it with that of recorded harp music in reducing preoperative stress and fear and changes in blood pressure (BP) and heart rate (HR). DESIGN: The study was a pilot study, with a quasi-experimental design. SETTING: The study took place in a surgery unit's clinic, held weekly, in a teaching hospital in Milan, Italy. PARTICIPANTS: Participants were 46 people undergoing day surgery, divided into 2 groups: 24 in the intervention group and 22 in the control group. No one dropped out of the study. INTERVENTION: The intervention group listened to live harp music and the control group listened to recorded harp music, immediately before a surgical intervention. The research team had defined a musical protocol based on the theoretical principles of harp therapy. OUTCOME MEASURES: Before and after the musical intervention, the research team investigated each patient's level of fear and stress, using the same self-evaluation questionnaire (HR) and blood pressure (BP). RESULTS: Of the 46 participants, 46% were male, and 54% were female. Fear values were reduced significantly and in equal measure in the intervention (P = .001) and control (P = .0001) groups. The live harp music was more effective in reducing HR (P = .001) and diastolic BP (P = .007), than was recorded harp music, with P = .151 and P = .164, respectively. Based on the results, the research team determined that a randomized controlled trial (RCT) would require 90 patients for both the intervention and control groups. CONCLUSIONS: Harp therapy brought benefits by significantly reducing fear and stress and HR and BP. It would be useful to perform a multicenter RCT to confirm these results.

Effectiveness of hyaluronic acid gel (Jalosome soothing gel) for the treatment of radiodermatitis in a patient receiving head and neck radiotherapy associated with cetuximab: A case report and review.

One of the principal side effects in patients that receive radiotherapy is radiodermatitis. Radiodermatitis can be highly invalidating for patients, causing pain, ulceration, swelling, and increased infection risk, with a negative effect on the quality of life, requiring dressings and medications. Therapeutic approaches reported so far in the literature have not proved to be effective in treating radiodermatitis. Therefore, new approaches are needed to deal with these side effects more effectively. The aim of the study was to evaluate the effectiveness of hyaluronic acid gel (HAG) (Jalosome soothing gel) for the treatment of a case of radiodermatitis. This is a case study of a patient affected by squamous cell carcinoma at the tongue base, who was treated with head and neck radiotherapy associated with the administration of cetuximab. About 1 month after this therapy was started the patient developed radiodermatitis, which did not regress with standard treatment. Therefore, HAG was applied once a day for about 20 days. The regression of radiodermatitis was measured using the Radiation Toxicity/Oncology Grading scale, pain relief was measured with a numerical scale, and patient satisfaction was done through a semi-structured interview. The patient presented a dramatic reduction of skin toxicity, which had been resistant to all previous therapeutic approaches. Pain, which was severe at the beginning, gradually disappeared. The patient showed great satisfaction for the reduction of pain and the regression of the radiodermatitis. The effectiveness of HAG appears to be promising for the treatment of radiodermatitis.

Development of a screening tool to assess dehydration in hospitalized older population: a diagnostic, observational study.

INTRODUCTION: dehydration is a frequent condition in older people and is associated with an increased risk of negative health outcomes. In order to adopt strategies to prevent complications, an early recognition of this status is of primary importance. For this reason, a comprehensive assessment tool to monitor hydration status in older people could be useful. AIM: to develop a screening tool to detect dehydration in older people in hospital settings. METHODS: this is a diagnostic, observational study. The new tool is a modified version of the Geriatric Dehydration Screening Tool (GDST), integrated with seven questions and two clinical signs based on updated literature. We tested the new tool with people aged 65 or over. We used as reference standard serum osmolarity. Cronbach's alpha was used to measure the tool's reliability and subscales. We calculated the Area Under ROC Curve (AUC) to choose the cut-off that gave the best balance between sensibility and specificity. RESULTS: 127 patients participated in the study. The reliability of the new GDST was acceptable (Cronbach's alpha 0.63). The diagnostic accuracy, measured with AUC analysis, was 0.83 ± 0.04, p 0.0001 95% CI 0.72-0.87. The best cut-off value was 6 and showed a sensibility of 78%, specificity of 70%. Tongue dryness proved to be the most significant clinical sign associated with poor hydration status (AUC 0.78; p 0.0001, 95% CI 0.69-0.86). CONCLUSION: The new GDST presented an acceptable reliability and diagnostic accuracy that increased with the assessment of some items, such as tongue dryness. This is the first screening tool that presents a promising cut-off value.

[Observational study on interruptions during nurses work in two surgical wards of a hospital in Liguria]. / Work interruption: indagine in due reparti chirurgici di un ospedale ligure sulle interruzioni a cui gli infermieri sono sottoposti durante le attività assistenziali.

INTRODUCTION: Interrumption that occur during nursing practice are hazardous for patient safety, resulting in a heavy cognitive load for the health care professionals and increases the risk of making mistakes. METHODS: An observational study was carried out in UU.OO operation of Neurosurgery and Vascular Surgery at a hospital in Liguria. The observation lasted one months, from July 1st, 2012 to August 1st, 2012. For data collection were used three form, one for each work shift, in which each health care professional had to report what activity was interrupted and why. RESULTS: A total of 7744 interruptium (in 5676 in Neurosurgery and 2068 Vascular Surgery). The major source of interruption was the bell, followed by the phone and relatives' questions. In general, activities interrupted were mainly made beds / hygiene care, administration and preparation of medication, handover and completion of the nursing documentation CONCLUSIONS: Interrumption will be an inevitable part of nursing practice, because of its very nature. It is therefore necessary to intervene on interruptions deemed avoidable and organizational variables that generate them, in order to increase patient safety and improve care activities.