Prospective multicentre multifaceted before-after implementation study of ICU delirium guidelines: a process evaluation.

OBJECTIVE: We aimed to explore: the exposure of healthcare workers to a delirium guidelines implementation programme; effects on guideline adherence at intensive care unit (ICU) level; impact on knowledge and barriers, and experiences with the implementation. DESIGN: A mixed-methods process evaluation of a prospective multicentre implementation study. SETTING: Six ICUs. PARTICIPANTS: 4449 adult ICU patients and 500 ICU professionals approximately. INTERVENTION: A tailored implementation programme. MAIN OUTCOME MEASURE: Adherence to delirium guidelines recommendations at ICU level before, during and after implementation; knowledge and perceived barriers; and experiences with the implementation. RESULTS: Five of six ICUs were exposed to all implementation strategies as planned. More than 85% followed the required e-learnings; 92% of the nurses attended the clinical classroom lessons; five ICUs used all available implementation strategies and perceived to have implemented all guideline recommendations (>90%). Adherence to predefined performance indicators (PIs) at ICU level was only above the preset target (>85%) for delirium screening. For all other PIs, the inter-ICU variability was between 34% and 72%. The implementation of delirium guidelines was feasible and successful in resolving the majority of barriers found before the implementation. The improvement was well sustained 6 months after full guideline implementation. Knowledge about delirium was improved (from 61% to 65%). The implementation programme was experienced as very successful. CONCLUSIONS: Multifaceted implementation can improve and sustain adherence to delirium guidelines, is feasible and can largely be performed as planned. However, variability in delirium guideline adherence at individual ICUs remains a challenge, indicating the need for more tailoring at centre level.

Systematic development of CHEMO-SUPPORT, a nursing intervention to support adult patients with cancer in dealing with chemotherapy-related symptoms at home.

BACKGROUND: Given the great symptom burden associated with chemotherapy on the one hand and generally poor self-management of symptoms by cancer patients on the other hand, our aim was to develop a nursing intervention to reduce symptom burden in adult cancer patients treated with chemotherapy and to support them in dealing with their various symptoms at home. METHODS: Development of the intervention was guided by the Intervention Mapping Approach and included following steps: needs assessment, formulation of proximal programme objectives, selection of methods and strategies, production of programme components, and planning for implementation and evaluation of the intervention. A panel of multidisciplinary healthcare professionals (n = 12) and a panel of patients and family caregivers (n = 7) were actively involved developing the intervention at each stage. RESULTS: For the intervention, four patient performance objectives relating to self-management were advanced. Self-efficacy and outcome expectations were selected as key determinants of dealing with chemotherapy-related symptoms. As methods for supporting patients, motivational interviewing and tailoring were found to fit best with the change objectives and determinants. Existing patient information materials were re-designed after panel input to reinforce the new intervention approach. CONCLUSION: The intervention mapping approach, including active involvement of the intervention providers and receivers, informed the design of this nursing intervention with two or more contacts. Further evaluation is needed to gain insight into the potential effects, feasibility and mechanisms of this complex intervention.

A nursing intervention aimed at reducing symptom burden during chemotherapy (CHEMO-SUPPORT): A mixed-methods study of the patient experience.

PURPOSE: CHEMO-SUPPORT is a nursing intervention that supports cancer patients in dealing with chemotherapy-related symptoms at home. The aims of the current study were (1) to determine how patients had experienced the intervention, and (2) to identify and better understand the mechanisms underlying CHEMO-SUPPORT's effects, its essential elements and possible pitfalls. METHODS: All 71 patients who had received the CHEMO-SUPPORT intervention completed a questionnaire, asking their opinion on the helpfulness, strengths, and weaknesses of the individual components of the intervention. Semi-structured interviews were also conducted with a purposeful selection of 9 of the 71 patients to get a deeper understanding of the patient experience. RESULTS: Nurses' caring support, combined with competent care, gave patients a sense of reassurance and made them feel (better) able to deal with their symptoms. The importance patients ascribed to the intervention varied according to the individual symptom experience and coping mechanisms of the patients, and by their experience with regular care. Patients rated the informational brochure component of the intervention most helpful. It served as their 'companion', offering support and expert advice at home. Patients felt that a strength of the brochure was the support they received from the quotes of fellow patients. CONCLUSIONS: The CHEMO-SUPPORT intervention made patients feel more reassured and empowered in dealing with symptoms at home. That the CHEMO-SUPPORT experience was influenced by personal and contextual factors highlights the importance of tailoring the intervention to each patient, as well as improving supportive and competent symptom-management support in daily oncology care.

A Nursing Intervention for Reducing Symptom Burden During Chemotherapy
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OBJECTIVES: To evaluate the efficacy of an individually tailored nursing intervention for reducing chemotherapy-related symptom distress in adult patients with cancer. 
. SAMPLE & SETTING: A control group (n = 71) received usual care and an intervention group (n = 72) received usual care and the CHEMO-SUPPORT intervention, all at the University Hospitals of Leuven in Belgium.
. METHODS & VARIABLES: The intervention effect was evaluated by measuring the difference in outcomes between the two groups. The primary outcome, overall symptom distress, and other symptom-related outcomes were self-reported at the start of treatment (baseline) and at 3, 6, and 12 weeks.
. RESULTS: The CHEMO-SUPPORT intervention showed significantly less worsening of overall symptom distress and severity. Self-efficacy and outcome expectations (measured at six weeks) were significantly higher in the intervention group. Self-care (measured at 12 weeks) was statistically similar between the two groups. The results emphasize the importance of nurses in coaching patients to adequately self-manage their symptoms at home.
. IMPLICATIONS FOR NURSING: Providing goal-directed self-management support using motivational interviewing as well as tailoring are promising areas for reducing chemotherapy-related symptom distress.

Exploring the Range of Lifestyle Interventions Used in Dutch Health Care Practice: A Qualitative Description.

BACKGROUND: The application of evidence-based lifestyle interventions is suboptimal, but little is known what interventions are actually used. This study aimed to explore the range of lifestyle interventions used in Dutch ambulatory health care settings. METHOD: We conducted interviews (n = 67) in purposefully selected hospitals, general practices, and community care organizations. Interviews focused on identifying activities to help patients stop smoking, reduce alcohol consumption, increase physical activity, eat a healthy diet, and lose weight. We also asked who developed the interventions. All reported activities were registered and analyzed. RESULTS: Four categories of health promotion activities emerged: giving advice, making referrals, offering counseling, and providing lifestyle interventions organized separately from the care process. In total, 102 lifestyle interventions were reported. Forty-five interventions were developed by researchers, of which 30 were developed by the Dutch Expert Center on Tobacco Control. Providers did not know the source of 31 interventions. Eighteen interventions were developed by the providers themselves, and eight were based on evidence-based guidelines. CONCLUSIONS: Health promotion activities seemed to be widely present in Dutch health care, in particular smoking cessation interventions. Although health care providers use many different interventions, replacing nontested for evidence-based interventions is required.

Phase-based treatment of a complex severely mentally ill case involving complex posttraumatic stress disorder and psychosis related to Dandy Walker syndrome.

UNLABELLED: For patients with comorbid complex posttraumatic stress disorder (PTSD) and psychotic disorder, trauma-focused therapy may be difficult to endure. Phase-based treatment including (a) stabilization, (b) trauma-focused therapy, and (c) integration of personality with recovery of connection appears to be the treatment of choice. OBJECTIVE: The objective of this article is to describe and evaluate the therapeutic process of a single case from a holistic perspective. METHOD: We present a case report of a 47-year-old woman treated for severe complex PTSD resulting from repeated sexual and physical abuse in early childhood and moderate psychotic symptoms stemming from Dandy Walker Syndrome with hydrocephalus. RESULTS: The patient was treated with quetiapine (600-1,000 mg) and citalopram (40 mg). Stabilization consisted of intensive psychiatric nursing care in the home and stabilizing group treatment for complex PTSD. After stabilization, the following symptom domains showed improvement: self-regulation, self-esteem, assertiveness, avoidance of social activities, and negative cognitions. However, intrusions and arousal persisted and were therefore subsequently treated with prolonged imaginary exposure that also included narrative writing assignments and a final closing ritual. This intensive multidisciplinary, phase-based approach proved effective: All symptoms of complex PTSD were in full remission. Social integration and recovery were promoted with the reduction of polypharmacy and the provision of social skills training and lifestyle training. CONCLUSION: The present case shows a phase-based treatment approach with multidisciplinary collaborative care to be effective for the treatment of a case of complex PTSD with comorbid psychotic disorder stemming from severe neurological impairment. Replication of this promising approach is therefore called for.

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.

BACKGROUND: Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. METHODS: For this observational study, we obtained discharge data for 422,730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26,516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. FINDINGS: An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031-1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886-0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. INTERPRETATION: Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. FUNDING: European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.

Nurse-patient communication in follow-up consultations after head and neck cancer treatment.

BACKGROUND: Adequate provider-patient communication is viewed as an important aspect of good quality (cancer) care, supports patients' stress control, and can positively influence health outcomes. OBJECTIVE: The objective of this study was to describe nurse-patient communication in 2 consecutive follow-up consultations after head and neck cancer, with or without a partner present. METHODS: This was a descriptive observational study of 17 video-recorded, coded, and analyzed consultations of 10 head and neck cancer patients and 6 partners. RESULTS: Nurses adequately responded to about 25% of patients' and partners' emotional cues. In almost 75%, nurses responded to cues using distancing behaviors. The majority of informational questions of both patients and partners were adequately answered. Comparison of consecutive visits showed small differences for patients' and partners' cue-emission and for nurses' responsive behaviors between visits 1 and 2. CONCLUSION: Nurses adequately responded to informational questions from patients and partners. However, they seemed to be less observant of and able to address emotional cues. Communication on nurse-patient-partner interaction deserves further research in a much larger sample and over a longer time period. IMPLICATION FOR PRACTICE: Nurses' awareness of the importance of adequate cue responding is vital, as is the choice to "unlearn" the predominant distancing behaviors. The needs and the role of the patients' partner in consultations and managing consultations require further attention in training and professional practice.

Characteristics and effectiveness of complex nursing interventions aimed at reducing symptom burden in adult patients treated with chemotherapy: a systematic review of randomized controlled trials.

OBJECTIVES: The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy. DESIGN: We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way. RESULTS: We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in common. Although some interventions fail to show significant effects, others significantly reduce aspects of symptom burden by 10-88%. CONCLUSION: Although some complex nursing interventions in this systematic review produce clinically meaningful and statistically relevant reductions in symptom burden, based on the available data it is not possible to make definitive conclusions about the vital parts, circumstances or preferred target population of the interventions. Quality of the studies and modeling and piloting of the interventions are important challenges for future research.

Supportive care in early rehabilitation for advanced-stage radiated head and neck cancer patients.

OBJECTIVE: To investigate the health-related quality of life (HRQoL) and supportive follow-up care needs 1 month posttreatment for patients with advanced-stage (stage III or IV) radiated head and neck cancer (HNC) who were treated with curative intent. STUDY DESIGN: An exploratory, descriptive analysis of HRQoL data obtained from 3 treatment groups: conventional radiotherapy (RT, n = 21), surgery + radiotherapy (SRT, n = 10), and chemoradiation (CRT, n = 21). SETTING: The head and neck oncology center of a university hospital. SUBJECTS AND METHODS: Fifty-two patients completed the EORTC QLQ-C30 and EORTC QLQ H&N35 self-report questionnaires 1 month posttreatment. Descriptive statistics and clinically relevant differences between the groups were analyzed. RESULTS: The HRQoL outcomes between groups differed. Clinically relevant difference was observed in the RT and CRT groups with respect to dry mouth, coughing, feeling ill, use of painkillers, and the use of nutritional supplements. The RT group differed from the other groups with respect to pain and swallowing. The CRT group differed from the other groups regarding role functioning. CONCLUSION: Health-related quality of life differs between RT, SRT, and CRT patients 1 month posttreatment. The RT- and CRT-treated patients reported higher impairment than the patients who were treated with SRT. Nutritional intake and oral function emphasize the importance of providing supportive care to radiated advanced-stage HNC patients throughout the treatment trajectory and the need for continuation during the first few posttreatment months.

Nurse-led follow-up care for head and neck cancer patients: a quasi-experimental prospective trial.

PURPOSE: The aim of this study was to compare conventional medical follow-up with follow-up containing additional nursing consultations regarding the psychosocial adjustment and health-related quality of life (HRQOL) of head and neck cancer patients. METHODS: Using a quasi-experimental design, patients were enrolled consecutively into two groups. Experimental care covered six 30-min bimonthly nursing follow-up consultations during the first year posttreatment. Data were collected at posttreatment months 1 (baseline), 6, and 12 for both groups. RESULTS: The intervention group was significantly worse at baseline, based on two of the seven adjustment scales and on the majority of HRQOL scales. However, their outcome at 6 and 12 months was consistent with that of the group which received conventional follow-up. Thus, the intervention group had a larger improvement in scores, and this was significant for one of the seven adjustment scales and 19 of the 33 HRQOL scales at 6 and 12 months, respectively. Most of the differences in HRQOL scales were clinically relevant at 6 months. CONCLUSION: These results suggest that nurse-led consultations for patients with head and neck cancer have a positive effect, primarily with respect to HRQOL. Nurse-led follow-up leads to a similar psychosocial adjustment as conventional follow-up, even among patients who showed worse performance at the start of follow-up. Thus, nurse-led follow-up may be a cost-effective way to improve follow-up care for this patient group.

A prospective study of bowel preparation for colonoscopy with polyethylene glycol-electrolyte solution versus sodium phosphate in Lynch syndrome: a randomized trial.

Lynch gene carriers undergo regular surveillance colonoscopies. Polyethylene glycol-electrolyte solution (PEG) is routinely prescribed for bowel cleansing, but often poorly tolerated by patients. Sodium phosphate (NaP) may be an alternative. Prospective and random comparison of bowel preparation with PEG and NaP on colon cleansing and patients' acceptance. Patients, who previously underwent a colonoscopy, were invited to participate and randomly assigned to either PEG or NaP. They were asked to fill in a questionnaire about preparation tolerability and future preferences. The endoscopist filled out a report about the quality of colon cleansing. 125 Patients were included in the study. Nine (7%) were excluded because of missing data. The remaining 116 patients (53 PEG and 63 NaP) were included in the analysis. Baseline characteristics did not differ between groups. Before colonoscopy 20 (38%) patients using PEG experienced the preparation almost intolerable, in contrast to 7(11%) of those using NaP (P = 0.001). Eleven patients in the PEG group and 48 in the NaP group would prefer NaP in the future. The colonoscopy was poorly tolerated in 17% of the individuals in both groups (P = 0.963). The endoscopist observed a more than 75% clean colon in 83% of patients on PEG and in 71% of patients on NaP (P = 0.076), however the coecum (P = 0.025) and ascending colon was cleaner after PEG. Lynch patients tolerated NaP better and preferred this formula for future bowel preparation. Colon cleansing was suboptimal with both treatments with a tendency towards a cleaner proximal colon with PEG.

Incidence and short-term consequences of delirium in critically ill patients: A prospective observational cohort study.

BACKGROUND: Delirium is a serious and frequent psycho-organic disorder in critically ill patients. Reported incidence rates vary to a large extent and there is a paucity of data concerning delirium incidence rates for the different subgroups of intensive care unit (ICU) patients and their short-term health consequences. OBJECTIVES: To determine the overall incidence and duration of delirium, per delirium subtype and per ICU admission diagnosis. Furthermore, we determined the short-term consequences of delirium. DESIGN: Prospective observational study. PARTICIPANTS AND SETTING: All adult consecutive patients admitted in one year to the ICU of a university medical centre. METHODS: Delirium was assessed using the Confusion Assessment Method-ICU three times a day. Delirium was divided in three subtypes: hyperactive, hypoactive and mixed subtype. As measures for short-term consequences we registered duration of mechanical ventilation, re-intubations, incidence of unplanned removal of tubes, length of (ICU) stay and in-hospital mortality. RESULTS: 1613 patients were included of which 411 (26%) developed delirium. The incidence rate in the neurosurgical (10%) and cardiac surgery group (12%) was the lowest, incidence was intermediate in medical patients (40%), while patients with a neurological diagnosis had the highest incidence (64%). The mixed subtype occurred the most (53%), while the hyperactive subtype the least (10%). The median delirium duration was two days [IQR 1-7], but significantly longer (P<0.0001) for the mixed subtype. More delirious patients were mechanically ventilated and for a longer period of time, were more likely to remove their tube and catheters, stayed in the ICU and hospital for a longer time, and had a six times higher chance of dying compared to non-delirium ICU patients, even after adjusting for their severity of illness score. Delirium was associated with an extended duration of mechanical ventilation, length of stay in the ICU and in-hospital, as well as with in-hospital mortality. CONCLUSIONS: The delirium incidence in a mixed ICU population is high and differs importantly between ICU admission diagnoses and the subtypes of delirium. Patients with delirium had a significantly higher incidence of short-term health problems, independent from their severity of illness and this was most pronounced in the mixed subtype of delirium. Delirium is significantly associated with worse short-term outcome.

Nursing diagnoses (NANDA-I) in hematology-oncology: a Delphi-study.

PURPOSE: To identify NANDA-I diagnoses that are most relevant to hematology-oncology nursing in Europe. METHODS: In a two-round, electronic, quantitative Delphi study, 28 experts from nine European countries assessed the relevance of NANDA-I diagnoses and health problems. FINDINGS: This study identified 64 relevant diagnoses and three health problems. All experts listed 11 diagnoses: "imbalanced nutrition: less than body requirements,""diarrhea,""fatigue,""risk for bleeding,""risk for infection,""impaired oral mucous membrane,""risk for impaired skin integrity,""impaired skin integrity,""hyperthermia,""nausea,""acute pain," and the health problem "pruritis." CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The "NANDA-I classification 2009-2011" describes, in almost all disease- and treatment-related problems, nursing diagnoses as relevant to the adult patient with hematological malignancy. These diagnoses are therefore recommended.

Discharge advice in cancer patients: posttreatment patients' report.

BACKGROUND: Cancer patients are presented with advice and instructions during treatment and at discharge. Most recommendations aim at relief of physical problems, psychosocial well-being, and patients' health care behaviors. Patients often struggle to incorporate advice into daily life, and this influences symptom relief, quality of life, and even longevity. OBJECTIVE: The aim of this study was to gain insight into the content and form of discharge advice to cancer patients and to determine the factors that hinder or promote the actual adoption of advice by patients. METHODS: Using a descriptive, exploratory research design, data were collected using structured interviews in a convenience sample of 21 head and neck cancer patients who had completed treatment with curative intent 2 to 6 months earlier. Descriptive statistics and a thematic content analysis procedure were used to analyze the data. RESULTS: Findings showed that advice or instructions received by individual patients had a range from 1 to 13, and that 17 out of 21 patients received 4 advices or more. Relevant influencing factors included patient characteristics (cognition, emotion, behavior, and social aspects) and characteristics of health professionals (content and efficacy of advice, professional attitude, behavior, and communication). CONCLUSIONS: Cancer patients try but often struggle to fit the multitude and complexity of advice from health professionals into everyday life. IMPLICATIONS FOR PRACTICE: There seems to be an excellent opportunity for health professionals to support cancer patients by further tailoring of follow-up care. Knowledge and insight into the challenges patients face posttreatment will benefit both professionals and patients.

How to promote healthy behaviours in patients? An overview of evidence for behaviour change techniques.

To identify the evidence for the effectiveness of behaviour change techniques, when used by health-care professionals, in accomplishing health-promoting behaviours in patients. Reviews were used to extract data at a study level. A taxonomy was used to classify behaviour change techniques. We included 23 systematic reviews: 14 on smoking cessation, 6 on physical exercise, and 2 on healthy diets and 1 on both exercise and diets. None of the behaviour change techniques demonstrated clear effects in a convincing majority of the studies in which they were evaluated. Techniques targeting knowledge (n = 210 studies) and facilitation of behaviour (n = 172) were evaluated most frequently. However, self-monitoring of behaviour (positive effects in 56% of the studies), risk communication (52%) and use of social support (50%) were most often identified as effective. Insufficient insight into appropriateness of technique choice and quality of technique delivery hinder precise conclusions. Relatively, however, self-monitoring of behaviour, risk communication and use of social support are most effective. Health professionals should avoid thinking that providing knowledge, materials and professional support will be sufficient for patients to accomplish change and consider alternative strategies which may be more effective.

The effect of the SAFE or SORRY? programme on patient safety knowledge of nurses in hospitals and nursing homes: a cluster randomised trial.

BACKGROUND: Patients in hospitals and nursing homes are at risk for the development of often preventable adverse events. Guidelines for the prevention of many types of adverse events are available, however compliance with these guidelines appears to be lacking. As a result many patients do not receive appropriate care. We developed a patient safety program that allows organisations to implement multiple guidelines simultaneously and therefore facilitates guideline use to improve patient safety. This program was developed for three frequently occurring nursing care related adverse events: pressure ulcers, urinary tract infections and falls. For the implementation of this program we developed educational activities for nurses as a main implementation strategy. OBJECTIVES: The aim of this study is to describe the effect of interactive and tailored education on the knowledge levels of nurses. DESIGN: A cluster randomised trial was conducted between September 2006 and July 2008. SETTINGS: Ten hospital wards and ten nursing home wards participated in this study. Prior to baseline, randomisation of the wards to an intervention or control group was stratified for centre and type of ward. PARTICIPANTS: All nurses from participating wards. METHODS: A knowledge test measured nurses' knowledge on the prevention of pressure ulcers, urinary tract infections and falls, during baseline en follow-up. The results were analysed for hospitals and nursing homes separately. RESULTS: After correction for baseline, the mean difference between the intervention and the control group on hospital nurses' knowledge on the prevention of the three adverse events was 0.19 points on a zero to ten scale (95% CI: -0.03 to 0.42), in favour of the intervention group. There was a statistically significant effect on knowledge of pressure ulcers, with an improved mean mark of 0.45 points (95% CI: 0.10-0.81). For the other two topics there was no statistically significant effect. Nursing home nurses' knowledge did neither improve (0 points, CI: -0.35 to 0.35) overall, nor for the separate subjects. CONCLUSION: The educational intervention improved hospital nurses' knowledge on the prevention of pressure ulcers only. More research on long term improvement of knowledge is needed.

Nurse-patient communication in cancer care: does responding to patient's cues predict patient satisfaction with communication.

OBJECTIVE: The aim is to investigate the relationship between nurses' cue-responding behaviour and patient satisfaction. METHODS: One hundred patient-nurse conversations about present concerns were videotaped and patients' expression of emotional cues and nurses' cue responses were coded using the Medical Interview Aural Rating Scale. Nurses (N=34) and patients (N=100) were recruited from seven oncology inpatient clinics from a University Medical Centre. RESULTS: A mixed-model analysis was conducted to examine whether cue responding was related with patient satisfaction with the conversation, after adjusting for confounding variables and correlation due to repeated measure of each nurse. Nurses' cue responding was independently related to patient satisfaction. Controlling for the level of cue responding, palliatively treated patients were more satisfied with the communication than curatively treated patients. CONCLUSIONS: This study provides evidence that nurses' cue-responding behaviour is appreciated by the patients. Future studies might focus on the effect of improved cue-responding skill on more distal outcome measures, such as identification of concerns, mood and coping behaviour.

A review of quality assessment of the methodology used in guidelines and systematic reviews on oral mucositis.

AIMS AND OBJECTIVES: The objective of this study was to identify and to assess the quality of evidence-based guidelines and systematic reviews we used in the case of oral mucositis, to apply general quality criteria for the prevention and treatment of oral mucositis in patients receiving chemotherapy, radiotherapy or both. DESIGN: Systematic review. METHODS: Literature searches were carried out in several electronic databases and websites. Publications were included if they concerned oral mucositis involving adults treated for cancer and had been published after 1 January 2000. As far as systematic reviews were concerned, the article had to report a search strategy, if the search was minimally conducted in the database PubMed or Medline and the articles included in the review were subjected to some kind of methodological assessment. The Appraisal of Guidelines for Research and Education (AGREE) instrument was used to assess the quality of the guidelines and the Overview Quality Assessment Questionnaire (OQAQ) was used for the quality of systematic reviews. RESULTS: Thirty-one articles met the inclusion criteria of which 11 were guidelines and 20 were systematic reviews. Nine of the 11 guidelines did not explicitly describe how they identified, selected and summarised the available evidence. Reviews suffered from lack of clarity, for instance, in performing a thorough literature search. The quality varied among the different guidelines and reviews. CONCLUSION: Most guidelines and systematic reviews had serious methodological flaws. RELEVANCE TO CLINICAL PRACTICE: There is a need to improve the methodological quality of guidelines and systematic reviews for the prevention and treatment of oral mucositis if they are to be used in clinical practice.

The usefulness of the Staff-Patient Interaction Response Scale for palliative care nursing for measuring the empathetic capacity of nursing students.

In communicating with patients, especially patients receiving palliative care, empathy plays an important role. Little research has as yet been conducted into the development of the empathetic capacity of nursing students at various educational levels. An instrument that may be suitable for such research is the Staff-Patient Interaction Response Scale for Palliative Care Nursing (SPIRS-PCN). The purpose of the article is to determine the validity and reliability of the SPIRS-PCN, an instrument measuring empathy in palliative care. The criterion-related validity, homogeneity, and interrater reliability of the SPIRS-PCN were determined in nursing students (n = 357) who varied in gender, age, religious orientation, educational level, and experience in patient care. The validity of the SPIRS-PCN was underlined by identification of differences for religious orientation and the amount of experience. The variables gender, age, and educational level were not significant in relation to SPIRS-PCN scores. The homogeneity (Cronbach's alpha = .80) and interrater reliability (.74) of the instrument were adequate. We conclude that validity of the SPIRS-PCN was partially supported, whereas reliability was demonstrated. The instrument is feasible in educational situations; we recommend further research into the instrument's validity, especially in the progression of students' scores during the study program.