The value of preventing constipation in patients treated with peritoneal dialysis: an advanced practice nursing study / Intérêt de la prévention de la constipation des patients traités par la dialyse péritonéale : une recherche de pratique infirmière avancée

Introduction: In 1989, experts developed the Rome criteria classification coupled with the use of the Bristol scale, to objectify the condition of functional constipation.Background Nowadays, little is documented in the literature about transit disorders in patients with End-Stage Chronic Renal Failure treated with peritoneal dialysis, even though this causes non-negligible complications on the patient’s morbidity, comfort and quality of life. Objective: The main objective of our study was to evaluate the prevalence of constipation in CKD patients. Material and method: We conducted a retrospective multicenter data-driven study. Results: 74 patient records were analyzed. We found a prevalence of constipation of 58 % in patients with CKD. Discussion: Our results showed that the prevalence of constipation is frequent in patients with CKD. It leads to a significant discomfort for the patient, an additional cost in terms of care and technical procedures and a failure of the peritoneal dialysis technique. Conclusion: Thus, the prevention of constipation in CKD patients would be relevant to limit complications and ensure a better quality of life.

Introduction: En 1989, des experts ont mis au point la classification des critères de Rome couplée à l'utilisation de l'échelle de Bristol, afin d'objectiver l'état de constipation fonctionnelle. Contexte: Aujourd'hui, la littérature documente peu les troubles du transit des patients en Insuffisance rénale chronique terminale (IRCT) traités par la Dialyse péritonéale (DP), alors même que cela engendre des complications non négligeables sur la morbidité, le confort et la qualité de vie du patient. Objectif: L'objectif principal de notre étude était d'évaluer la prévalence de la constipation des patients en IRCT. Matériel et méthode: Nous avons réalisé une étude rétrospective multicentrique sur données. Résultats: 74 dossiers patients ont été analysés. Nous avons mis en évidence une prévalence de la constipation de 58 % chez des patients atteints d'une IRCT. Discussion: Nos résultats ont démontré que la prévalence de la constipation est fréquente chez les patients atteints d'une IRCT. Elle entraîne un inconfort notable chez le patient, un surcoût au niveau des soins et des actes techniques, et un échec de la technique de dialyse péritonéale. Conclusion: Ainsi, la prévention de la constipation des patients en IRCT serait pertinente pour limiter les complications et leur assurer une meilleure qualité de vie.

The value of preventing constipation in patients treated with peritoneal dialysis: An advanced practice nursing study / Intérêt de la prévention de la constipation des patients traités par la dialyse péritonéale : une recherche de pratique infirmière avancée

Introduction: In 1989, experts developed the Rome criteria classification coupled with the use of the Bristol scale, to objectify the condition of functional constipation. Background: Nowadays, little is documented in the literature about transit disorders in patients with End-Stage Chronic Renal Failure treated with peritoneal dialysis, even though this causes non-negligible complications on the patient's morbidityÌ, comfort and quality of life. Objective: The main objective of our study was to evaluate the prevalence of constipation in CKD patients. Material and method: We conducted a retrospective multicenter data-driven study. Results: 74 patient records were analyzed. We found a prevalence of constipation of 58% in patients with CKD. Discussion: Our results showed that the prevalence of constipation is frequent in patients with CKD. It leads to a significant discomfort for the patient, an additional cost in terms of care and technical procedures and a failure of the peritoneal dialysis technique. Conclusion: Thus, the prevention of constipation in CKD patients would be relevant to limit complications and ensure a better quality of life.

Introduction: En 1989, des experts ont mis au point la classification des critères de Rome couplée à l'utilisation de l'échelle de Bristol, afin d'objectiver l'état de constipation fonctionnelle. Contexte: Aujourd'hui, la littérature documente peu les troubles du transit des patients en Insuffisance rénale chronique terminale (IRCT) traités par la Dialyse péritonéale (DP), alors même que cela engendre des complications non négligeables sur la morbidité, le confort et la qualité de vie du patient. Objectif: L'objectif principal de notre étude était d'évaluer la prévalence de la constipation des patients en IRCT. Matériel et méthode: Nous avons réalisé une étude rétrospective multicentrique sur données. Résultats: 74 dossiers patients ont été analysés. Nous avons mis en évidence une prévalence de la constipation de 58 % chez des patients atteints d'une IRCT. Discussion: Nos résultats ont démontré que la prévalence de la constipation est fréquente chez les patients atteints d'une IRCT. Elle entraîne un inconfort notable chez le patient, un surcoût au niveau des soins et des actes techniques, et un échec de la technique de dialyse péritonéale. Conclusion: Ainsi, la prévention de la constipation des patients en IRCT serait pertinente pour limiter les complications et leur assurer une meilleure qualité de vie.

[Impact of a program encouraging prevention in primary care on a daily and opportunistic basis]. / Impact d'un programme encourageant la prévention en soins primaires au quotidien et de façon opportuniste.

In France, clinical preventive practices are still underdeveloped and formalized, notably due to a lack of guidelines, despite the fact that a proactive and systematic prevention and health promotion strategy involving all healthcare professionals seems essential. The P3C program aims to encourage preventive clinical practices among healthcare professionals, and thus contribute to the emergence of a common culture of prevention.

[IPAs mentioning PCS mobilize a care model based on patient partnership]. / Mobilisation par des IPA d'un modèle de soin portant sur le partenariat patient.

The Impact program aims to structure the care provided by advanced practice nurses (APNs) for people with chronic illnesses, based on the humanistic health partnership model. This model, based on patient partnership, is enriched by measurement tools that take into account four determinants of adaptation to chronic illness. Impact aims to improve patient partnership, individualize care and integrate IPAs into a research dynamic.

Impact of horticultural therapy on patients admitted to psychiatric wards, a randomised, controlled and open trial.

Psychiatric inpatients often endure anxiety. This randomized trial assessed the impact of horticultural therapy on anxiety in adult psychiatric inpatients over four weeks, compared to standard care. Recruiting 211 inpatients from six units were randomized into control (n = 105) and experimental (n = 106) groups. Control received usual care; the experimental group had horticultural therapy alongside usual care. Anxiety, measured using HADS-A scale at four weeks, aimed to establish horticultural therapy's superiority. After four weeks, horticultural therapy significantly reduced anxiety compared to standard care (P < 0.001). These results argue in favor of integrating horticultural therapy into psychiatric nursing practices.Trial registration: No Clinical Trail: NCT02666339 (1st registration: 28/01/2016).

Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study.

BACKGROUND: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-Étienne (February 2021), we performed a survey of the general population. OBJECTIVE: We evaluated, on the scale of a city's population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. METHODS: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. RESULTS: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted ß coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted ß coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ≥60 years (adjusted ß coefficient=0.25, 95% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted ß coefficient=0.10, 95% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted ß coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted ß coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ≥60 years (adjusted ß coefficient=0.25, 95% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase-polymerase chain reaction) positivity (adjusted odds ratio 0.80, 95% CI 0.69-0.94; corrected P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20% on average. CONCLUSIONS: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city's population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens' behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health.

Glossary of healthcare pathways: a methodological approach involving a transdisciplinary team in public health.

Introduction: The healthcare pathway is at the heart of public health organization concerns, but communication between the various players can be an obstacle. This work, produced by a French transdisciplinary team, offers a methodological approach based on formalized consensus to elaborate a glossary of healthcare pathways. A two-steps procedure was elaborated, including a double rounded Delphi method to formalize expert consensus, and two groups of experts: a workgroup and a review group. Methods: The workgroup provided a list of words or expressions that, in their opinion, described, evaluated or compared the healthcare pathways for patients, caregivers or regulators. The review group checked this list and added or deleted words or expressions. Then, definitions were added by the workgroup based into account three dimensions: official, academic and from the field. The review group validated the definitions and provided complementary proposals if needed. Results: After pooling the list of words proposed by each of the six members of the working group, 417 words/expressions were ranked. After the two rounds of evaluation, 294 words/expressions were rated "appropriate" and were analyzed by the review group. This group, after two rounds of evaluation, agreed on 263 words/expressions that were transmitted to the working group who defined them. These definitions were rated by the review group. The first round of evaluation established 195 definitions as being appropriated whereas 68 definitions were amended by the review group. Conclusion: This glossary supports transdisciplinary communication, reduces the extent of variations in practice and optimizes decision-making. International debate on all aspects might be strengthened by an improved understanding of the concept of health pathway.

Nurses' and auxiliary nurses' beliefs and attitudes regarding the sexual health of patients with severe mental illness: A qualitative study.

INTRODUCTION: Sexual health is essential to the overall health. People suffering from severe mental illness (SMI) experience a deterioration in their sexual health. These patients and their caregivers seem unwilling to engage in a dialogue concerning sexual health within the context of mental health care. AIM: The study investigated nurses' and care assistants' beliefs and attitudes regarding the sexual health of people with SMI on the psychiatric care pathway. METHODS: Twenty semi-structured interviews were conducted with nurses and care assistants. Data were subject to a thematic analysis. RESULTS: Three main themes emerged: (1) The formalization of the care approach towards people with a SMI in hospitals; (2) the place given to sexual health in psychiatry units; (3) nurses and care assistants are not equipped to deal with patients' sexual health. DISCUSSION: Caregivers consider that sexual health is a fundamental right and an indicator of good health. They nevertheless believe that the psychiatric hospital remains a place of acute care where sexual health is not considered. IMPLICATION FOR PRACTICE: This research justifies that it is necessary to question the representations of nurses and care assistants before implementing a tailored intervention that integrates the consideration of sexual health into the holistic care of the patient on the psychiatric care pathway.

Supporting health education policies: translation, cross-cultural adaptation and validation of a health literacy instrument, in French.

Background: Oral health is a fundamental human right and is inseparable and indivisible from overall health and well-being. Oral Health Literacy (OHL) has been proved to be fundamental to promoting oral health and reducing oral health inequalities. To our knowledge, no OHL instrument to evaluate OHL level is currently validated in French language despite the fact it is the fifth most widely spoken languages on the planet. The Oral health literacy Instrument (OHLI) appears to be the most interesting OHL instrument to adapt into French because it is already available in English, Spanish, Russian, Malaysian, and it contains both reading comprehension and numeracy sections. Its psychometric properties have been rated as adequate. Objective: The aim of this study was to translate and adapt cross-culturally the OHLI into French, to evaluate its psychometric properties and to compare its results to oral health knowledge. Method: This study followed and applied well-established processes of translation, cross-cultural adaptation and validation, based on the recommendations of the World Health Organization guidelines and on the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) study design checklist for patient-reported outcomes. Two psychometric assessments were planned, the comparison of OHLI-F scores according to education level and frequency of dental visits, and the test-retest reliability of the OHLI-F. Results: A total of 284 participants answered the OHLI-F. The OHLI-F scores were significantly different between participants with different levels of education and frequency of dental visits (p < 0.001). Participants with an education level lower than the baccalaureate, and those who never visit the dentist or only in case of pain, had significantly lower OHLI-F scores. Internal consistency was excellent (Cronbach's alpha = 0.881-0.914). Test-retest reliability was very high (intraclass correlation = 0.985 to 0.996). Conclusion: The OHLI-F has demonstrated adequate psychometric properties and can therefore be used to measure oral health literacy in French-speaking populations.

Development and Validation of the COVID-19 Knowledges and Behavior Questionnaire in a French Population (CoVQuest-CC).

BACKGROUND: The SARS-CoV-2 pandemic has led most countries to take restrictive measures affecting social activities and individual freedoms to limit viral transmission. It was shown that practical, motivational and social barriers impact on adherence to the isolation and social distancing measures advocated by the health authorities. The purpose of this study was to develop and validate a COVID-19 Knowledges and Behavior Questionnaire adapted to a teenager and adult French population. METHODS: CoVQuest-CC was developed by a multidisciplinary team made of infectious diseases physicians, medical virologist, specialists of infectious control, experts of the questionnaires methodology, experts in public health and prevention, and statisticians. CoVQuest-CC was responded to by a big cohort from the general population during their participation in a massive SARS-CoV-2 screening campaign in 2021 in Saint-Etienne, France. RESULTS: The confirmatory factorial analysis yielded good results (CFI = 0.94, TLI = 0.94, RMSEA = 0.04), and confirmed the five-dimensional structure of the questionnaire. Each dimension had a satisfying internal consistency, with Cronbach alphas of 0.83, 0.71, 0.65, 0.72 and 0.83 for transmission knowledge, barrier gesture respect, tests acceptability, home isolation possibility and test practicability, respectively. CONCLUSIONS: According to our knowledge, CoVQuest-CC is the first validated, consistent and reliable self-administrated French-specific questionnaire investigating the general population's knowledge and attitudes towards COVID-19. It shows acceptable psychometric properties and can be use by Public Health teams or caregivers for public health and research purposes. TRIAL REGISTRATION: The study protocol was approved by the IRB ILE-DE-FRANCE 1 (No. IRB: I ORG0009918). All participants were given written and verbal information about the study and gave informed consent to participate. CLINICALTRIALS: gov identifier (NCT number): NCT04859023.

Alcohol Consumption in the Specific Socio-Professional Context of the French Public Service: Qualitative Study Protocol.

Alcohol, a psychoactive substance with addictive potential, has major consequences on the population and public health. In France, alcohol use disorder affects approximately 3.5 million people, and 41,000 persons died in 2015. Alcohol consumption is significantly correlated to the workplace. Thus, the workplace is an area of opportunity to change risky behaviors and must play a key role in the prevention of alcohol misuse. To do this, it is essential to understand the consumption framework and to identify specific environmental risk factors. This qualitative study aims to describe the framework of alcohol consumption in the French public service. A focus group will be organized in France from November to January 2023. The participants will be: (i) representatives of the Local Health Insurance; (ii) over 18 years old; (iii) active or retired civil servants; (iv) mutualist activists; and (v) representatives of the Union of Health Prevention for the Obligatory System of the Public Service. The exclusion criteria for the study will be: (i) lack of consent form; (ii) inability to participate in the focus group, and (iii) early departure during the focus group. The focus groups will be supervised by two researchers following an interview guide. The data will be analyzed using the methodological framework, which consists in carrying out a thematic analysis. This will allow for an understanding of the sources of usage behaviors, and the identification of the most appropriate intervention functions for suitable prevention actions in order to reduce the risk of a transition to alcohol use disorder.

Current perceptions of cancer nurses in France about their role and the evolution of nursing practices: Findings and perspectives.

BACKGROUND: Florence Nightingale lamented that nurses were seen as merely obedient and devoted. Our two previous oncology studies demonstrated the continuum of strictly curative care and paternalistic care practices among healthcare professionals. At a time when France has just formalized the nursing sciences, this article seeks to shed light on the specifics of the nursing role in oncology and the evolution of standard nursing practices in a rapidly changing environment. METHODS: We performed a secondary qualitative analysis, on the same dataset, focusing only on the nursing population (n = 20), to answer a question not excavated through the two previous studies. The COREQ guidelines were used to ensure the rigorous reporting of this study. FINDINGS: The data analysis show that the inherent role and application of medical directives characterise the profession of nursing in oncology. The former is essentially an intermediary role, whereby the nurse directs the patient to a professional specialist for a problem identified through clinical nursing expertise. The latter is expressed through the application of various medical instructions. The results highlight a minor evolution in nursing practices, despite an evolving environment. Oncology nurses do not seem to authorise themselves to become agents of change. CONCLUSION: Various reforms and studies of the nursing profession, as well as public funding of programmes dedicated to nursing research were designed to facilitate the integration of Evidence Based Practice to encourage the autonomy of nurses in their practices. Education in research is fundamental to awakening critical thinking and considering scientific validity as vital. Continuing education and leadership by advanced practice nurses are two strong levers to acculturate registered nurses to gaining empowerment, improving their ability to question practices, helping them adapt to increasing the quality of care and making oncology nursing care more efficient. For cancer nurses in France, research education is the challenge to be met.

Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version.

BACKGROUND: The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient's needs, with nursing care adapting accordingly. OBJECTIVE: The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. METHODS: This study will follow the "Reach, Effectiveness, Adoption, Implementation, and Maintenance" framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the "Capability, Opportunity, Motivation, and Behavior" model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient's anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient's enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. RESULTS: This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. CONCLUSIONS: This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. TRIAL REGISTRATION: ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17485.

Managing unresolved issues of addiction during cancer treatment: A qualitative study about cancer care providers' representations.

OBJECTIVE: Five French oncology institutions had participated in a funded study aiming at implementing an Evidence-Based Practice tool (PAM-13), which allowed nurses to measure the level of activation of the patient to support his or her own empowerment in the cancer care pathway. The purpose of this ancillary study is to (i) describe the caregivers' perceptions of addictions and their management concurrently with cancer treatment, (ii) explore the role that Motivational Interviewing techniques can play. METHODS: 15 individual semi-structured interviews of caregivers were performed, using the Theoretical Domains Framework for the interview guide. Qualitative data were analyzed inductively, in a thematic analysis. The COREQ guided the reporting of this qualitative study. RESULTS: Views on addictions influence the way caregivers manage patients suffering from unresolved issues of addiction. Care is mainly focused on the pathology (cancer-centered) and strictly curative. When practiced, Motivational Interviewing is patient-centered, fostering the patient's empowerment on the cancer care pathway. CONCLUSIONS: The dissemination of Motivational Interviewing techniques in current practices in oncology, both in terms of doctors and nursing teams, would enable improvement to the management of addictions on the cancer care pathway, by deploying a patient-centered approach. This new paradigm of care would support the empowerment of patients enrolled in the cancer care pathway and promote better communication between caregivers and patients. Hence, a paradigm shift is essential. Motivational Interviewing techniques could provide a caring approach that promotes communication between the patient and the caregiver and also supports the former's empowerment. This research suggests the need to adapt the cancer care pathway in order to integrate the necessary care for patients who concomitantly suffer from unresolved addictive disorders. TRIAL REGISTRATION: NCT03706937.

Conditions for the Implementation of a Patient Education Program Dedicated to Cancer Patients Treated by Oral Anticancer Therapy.

INTRODUCTION: A patient education program has been developed in the field of cancer for supporting cancer patients undergoing oral anticancer therapies. Its implementation was tested in 3 different settings. The objectives of this study were to 1) identify barriers and facilitators for implementing the patient education program, 2) identify practices encouraging or hindering implementation and 3) produce recommendations for its dissemination. METHODS: Twenty semi-structured interviews were conducted with caregivers from all three establishments. RESULTS: The main factors associated with successful implementation were as follows: prescribers' representations on patient education, considered of low value; on oral anticancer therapies, considered too dangerous to be handled by the patient him/herself, the indefinite legitimacy of certain professions in charge of patient education programs; patients' engagement in their care pathway and provision of caregivers. CONCLUSION: Recommendations include developing patient education culture within the environment of the medical doctors' curriculum, to consider contextual, pre-existing cooperative units for implementing patient education, to systematically send patients to patient education programs without practicing triage. Successful implementation of patient education critically depends on the prescribing physicians' perceived value of patient education. Patient education should become mandatory, integrated as part of the cancer care pathway. Physicians lack the necessary time and/or means to assess patients' capacity for engagement, without adequate strategies for their support. Therefore, physicians should systematically refer all patients to patient education, where nurses can tailor their coaching of cancer patients. TRIAL REGISTRATION: The study protocol was approved by the IRB SUD EST I (N° EudraCT: 2016-A00113-48). All participants were given written and verbal information about the study and gave informed consent to participate.