Needs-focused interventions for family caregivers of older adults with cancer: a descriptive interpretive study.

PURPOSE: Although family caregivers (FCs) of older adults with cancer (OACs) provide invaluable assistance by fulfilling multiple tasks along the cancer trajectory, evidence suggests that their needs are poorly assessed, and there is a scarcity of supportive interventions that influence their well-being. Viewing these issues as opportunities for improvement, we conducted this qualitative study to understand FCs' needs and identify promising needs-focused interventions. METHODS: This descriptive interpretive qualitative study was conducted in Quebec, Canada, in a French Canadian Oncology Clinic. Participants were FCs who were spouses or adult children (n = 25) of OACs aged 70 years or older. Data were collected via focus groups and were analyzed using an ongoing analytic process following each interview. RESULTS: Three types of needs were of particular importance: information, relationships between FC and others, and care for oneself. The need for information was described in terms of the content, timeliness, and modalities in which information should be verbalized and delivered. The need for relationships specifically targeted health care providers (HCPs), family members, and OACs. The need to care for oneself was recognized as important throughout the cancer trajectory but also represented a challenge. Participants proposed innovative ideas for interventions, resources, and strategies for each type of need. CONCLUSIONS: According to our results, HCPs should systematically include FCs into OACs' care plan through the use of concrete actions such as the "family systems approach" suggested by Duhamel, and integrate a systematic FC's needs assessment.

Learning theories and tools for the assessment of core nursing competencies in simulation: A theoretical review.

AIM: To identify the theories used to explain learning in simulation and to examine how these theories guided the assessment of learning outcomes related to core competencies in undergraduate nursing students. BACKGROUND: Nurse educators face the challenge of making explicit the outcomes of competency-based education, especially when competencies are conceptualized as holistic and context dependent. DESIGN: Theoretical review. DATA SOURCES: Research papers (N = 182) published between 1999-2015 describing simulation in nursing education. REVIEW METHODS: Two members of the research team extracted data from the papers, including theories used to explain how simulation could engender learning and tools used to assess simulation outcomes. Contingency tables were created to examine the associations between theories, outcomes and tools. RESULTS: Some papers (N = 79) did not provide an explicit theory. The 103 remaining papers identified one or more learning or teaching theories; the most frequent were the National League for Nursing/Jeffries Simulation Framework, Kolb's theory of experiential learning and Bandura's social cognitive theory and concept of self-efficacy. Students' perceptions of simulation, knowledge and self-confidence were the most frequently assessed, mainly via scales designed for the study where they were used. Core competencies were mostly assessed with an observational approach. CONCLUSION: This review highlighted the fact that few studies examined the use of simulation in nursing education through learning theories and via assessment of core competencies. It also identified observational tools used to assess competencies in action, as holistic and context-dependent constructs.

Translation and Validation of the Toronto Pain Management Index, French-Canadian Version.

Background To provide effective pain management, nurses must have sufficient knowledge and adequate beliefs about pain management. In Quebec, however, nurses seem to be generally uninvolved in pain management, and there is little significant evidence shedding light on nurses' pain management knowledge and beliefs in postoperative settings. To perform such studies, a valid questionnaire in French to assess nurses' knowledge and beliefs is required. Some valid questionnaires are available in English, but none are available in French. Purpose This article describes the process of translation, adaptation, and preliminary validation of the Toronto Pain Management Index into French. Results For temporal stability of the Toronto Pain Management Index, French-Canadian version, the result of intraclass correlation coefficient for the total score of this questionnaire is 0.59 (CI: 0.44-0.72). Conclusion Following this process, the French version of this questionnaire has suitable face and content validity and can be used to evaluate nurses' knowledge and beliefs about pain management in postoperative settings.

Once upon a time: Storytelling as a knowledge translation strategy for qualitative researchers.

Qualitative research should strive for knowledge translation toward the goal of closing the gap between knowledge and practice. However, it is often a challenge in nursing to identify knowledge translation strategies able to illustrate the usefulness of qualitative results in any given context. This article defines storytelling and uses pragmatism to examine storytelling as a strategy to promote the knowledge translation of qualitative results. Pragmatism posits that usefulness is defined by the people affected by the problem and that usefulness is promoted by modalities, like storytelling, that increase sensitivity to an experience. Indeed, stories have the power to give meaning to human behaviors and to trigger emotions, and in doing so bring many advantages. For example, by contextualizing research results and appealing to both the reason and the emotions of audiences, storytelling can help us grasp the usefulness of these research results. Various strategies exist to create stories that will produce an emotional experience capable of influencing readers' or listeners' actions. To illustrate the potential of storytelling as a knowledge translation strategy in health care, we will use our story of discovering this strategy during a qualitative study in a nursing home as an example.

Involuntary Hospitalisation in France: Major Evolution of Legal Aspects.

Involuntary hospitalisation has been legal in France since 1838. The first reform took place in 1990. However, critics postulated that this first reform did not adequately respect the rights of patients. Consequently, further reforms were introduced in 1990. In 2011 further reforms rendered involuntary hospitalisation consistent with European requirements, introducing systematic control by the Juge des Libertés et de la Détention (Judge of Freedoms and Detention) for each patient hospitalised without consent. The purpose of this article is to provide a qualitative description of the evolution of the legal concerns surrounding involuntary hospitalisation in France.

Decisional Needs Assessment to Help Patients with Advanced Chronic Kidney Disease Make Better Dialysis Choices.

Patients with advanced chronic kidney disease (CKD) face many choices regarding future dialysis modalities. Decision-making is difficult for patients. The objective of this study was to describe the decision-making needs from the perspectives of patients with advanced CKD, professionals, and others involved in the decision. Guided by a shared decision-making model, this qualitative study was conducted using interviews with key informants (17 patients, two peer helpers, and eight health professionals) and a focus group (five nurses). The results revealed evolving decisional needs in five-stage through the decision making journey: 1) Progress toward acceptance of dialysis, 2) Receive information, 3) Take some time for personal reflection, 4) Seek opinion and support of other, and 5) Re-evaluate one's choice. As we anticipate decisional needs, we will be able to develop decision support interventions that are stage-matched.

Evaluation of the preliminary effectiveness of hand massage therapy on postoperative pain of adults in the intensive care unit after cardiac surgery: a pilot randomized controlled trial.

Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

Relationship Between Empathy and Well-Being Among Emergency Nurses.

INTRODUCTION: A large number of patients who are in pain upon arriving at the emergency department are still in pain when they are discharged. It is suggested that nurses' personal traits and their level of empathy can explain in part this issue in pain management. The purpose of this study was to better understand the shortfalls in pain management provided by emergency nurses by considering nurses' characteristics. METHODS: A cross-sectional descriptive correlational design was used for this pilot study. French validated self-administrated questionnaires (sociodemographic characteristics, empathy, psychological distress, and well-being) were presented to 40 emergency nurses. Thirty emergency nurses completed all questionnaires during work hours. Descriptive statistics, group comparisons, and correlation analyses were used for the data analysis. RESULTS: Emergency nurses appear to have low levels of empathy. High levels of psychological distress and low levels of well-being were also observed in our sample. Among these variables, only empathy and well-being appear to be related, because we found higher empathy scores in nurses with higher well-being. DISCUSSION: The poor mental health we found among emergency nurses is alarming. A clear need exists for supportive interventions for nurses. Finally, well-being was the only variable related to empathy. To our knowledge, this is the first study to report this relationship in nurses.

[Impact of standing order prescriptions on the joint follow-up of diabetics in primary care: a case study]. / Retombées des ordonnances collectives dans le suivi diabétique conjoint en soins primaires: une étude de cas.

The burden of chronic disease requires a new organization of medical care and services. Enhancing collaboration among front-line care givers facilitates access to care and optimizes follow-up. As a result, a new organizational structure has been gradually deployed in Quebec since 2003. Family Medicine Groups (FMGs) use a new type of standing order, prescribing details of care. Among 52 FMGs surveyed, an exemplarygroup was identified that most successfully instituted more and higher-impact standing orders. This single case study explored the impact of standing orders used for diabetes follow-up on professional practices, physician-nurse-patient interactions and patient self-management. The data collected and analyzed were derived from more than 200 documents, 15 hours of observation in the clinic, and individual interviews of ten patients, three nurses and eight doctors. Standing ordersformalizing thejointfollow-up ofdiabetic patients both increased professional collaboration and improved patient-professional interactions. As professionals and patients achieved a better consensus, patient self-management was improved. Ultimately, for professionals, standing orders facilitate a better match between the use of their time and skills, and their aspirationsfor practice. Patients are reassured and empowered by ready access to care and their progress in self-management skills. Concrete measures, such as standing orders, modify care delivery by reinforcing professional collaboration, and facilitate patient self-care, in accordance with the Chronic Care Model (CCM).

Nurses' evaluations of the CPOT use at 12-month post-implementation in the intensive care unit.

BACKGROUND: Performing routine pain assessments with all intensive care unit (ICU) patients is strongly recommended in clinical practice guidelines. As many ICU patients are unable to self-report, the Critical-Care Pain Observation Tool (CPOT) is one of the two behavioural pain scales suggested for clinical use. Still, no study has described the evaluations of its use in ICU daily practice. OBJECTIVE: To describe the nurses' evaluation of the feasibility, clinical relevance and satisfaction with the CPOT use 12 months after its implementation in the ICU. METHOD: A descriptive design was used. It was conducted in the medical-surgical ICU of a university affiliated setting at Greenfield Park (Québec, Canada). A self-administered evaluation questionnaire including four sections (i.e. feasibility, clinical relevance, satisfaction and socio-demographic information) was completed by ICU nurses who were all trained to use the CPOT. The questionnaires were completed anonymously. RESULTS: A total of 38 ICU nurses returned their completed questionnaire (63% participation rate). Regarding its feasibility, the majority rated the CPOT as quick to use, simple to understand and easy to complete (92-100%). According to clinical relevance, close to 70% of ICU nurses acknowledged that the CPOT had influenced their practice, but lower results (<50%) were found for effective communication of pain assessment findings with the physicians and other health professionals. More than 80% of ICU nurses were satisfied with its daily use. CONCLUSION: The CPOT use was deemed feasible and relevant in daily practice as per the nurses' evaluations but did not allow an effective communication with other ICU care team members. RELEVANCE TO CLINICAL PRACTICE: Training should be offered to all members of the ICU care team, and other implementation strategies should be explored as well to ensure optimal uptake of a pain assessment approach which impacts on their decision-making process for pain management.

Patients and ICU nurses' perspectives of non-pharmacological interventions for pain management.

BACKGROUND: Pain is a major stressor for critically ill patients. To maximize pain relief, non-pharmacological interventions are an interesting avenue to explore. AIMS AND OBJECTIVES: The study aim was to describe the perspectives of patients/family members and nurses about the usefulness, relevance and feasibility of non-pharmacological interventions for pain management in the intensive care unit (ICU). DESIGN: A qualitative descriptive design was used. METHODS: Patients/family members (n = 6) with a previous experience of ICU hospitalization and ICU nurses (n = 32) were recruited. Using a semi-structured discussion guide, participants were asked to share their perspective about non-pharmacological interventions that they found useful, relevant and feasible for pain management in the ICU. Interventions were clustered into five categories: a) cognitive-behavioural, b) physical, c) emotional support, d) helping with activities of daily living and, e) creating a comfortable environment. RESULTS: A total of eight focus groups (FGs) with patients/family members (two FGs) and ICU nurses (six FGs) were conducted. Overall, 33 non-pharmacological interventions were discussed. The top four non-pharmacological interventions found to be useful, relevant and feasible in at least half of the FGs were music therapy and distraction (cognitive-behavioural category), simple massage (physical category) and family presence facilitation (emotional support category). Interestingly, patients/family members and nurses showed different interests towards some interventions. For instance, patients discussed more about active listening/reality orientation, while nurses talked mostly about teaching/positioning. CONCLUSIONS: Four non-pharmacological interventions reached consensus in patients and nurses' FGs to be useful, relevant and feasible for pain management in the ICU. Other interventions seemed to be influenced by personal experience or professional role of the participants. RELEVANCE TO CLINICAL PRACTICE: While more evidence is required to conclude to their effectiveness, ICU nurses can use non-pharmacological interventions complementary to pharmacological treatment of pain as they are low cost and safe.

[Good palliative care in the intensive care unit]. / Conditions facilitant les "bons soins" palliatifs aux soins intensifs selon la perspective infirmière.

UNLABELLED: The aging population, the complexity and irreversibility of certain conditions lead to the deaths of 20% of patients admitted to intensive care units (ICU). However, in Quebec, as elsewhere in America, few of them currently receive palliative care. METHOD: inspired by a conceptual model considering nursing as a moral practice, this phenomenological study was conducted in four phases: focus groups (n = 6) observation sessions (n = 6) followed by individual interviews and group validation activities (n = 5). In its first part, this study shows that through several caring behaviours, "good palliative care" in the ICU is manifested by the consideration of six dimensions of the person, physical, relational, psychological, moral, social and spiritual. This article presents the second part of this study and reveals three main themes summarizing the conditions facilitating "good the palliative care" according to ICU nurses: Sharing a common vision enhanced by a collective and specific palliative care knowledge, an informed and concerted decision-making process in a favourable organisational and physical environment.

Predictive validity and psychiatric nursing staff's perception of the clinical usefulness of the French version of the Dynamic Appraisal of Situational Aggression.

This study seeks to evaluate the predictive validity of the French version of the Dynamic Appraisal of Situational Aggression (DASAfr) and psychiatric nurses' perceptions of the clinical usefulness of the scale. The study was conducted in a 12-bed psychiatric intensive care unit in a large adult general psychiatric hospital. We found that the total score on the DASAfr has acceptable predictive accuracy for aggression against others and against staff and for seclusion with restraints; predictive accuracy was poorer for aggression against objects. Moreover, the nurses though the scale would be useful to their practice; and, indeed, the team still uses the DASAfr.

[Improvement in perception of nurse's competence in screening for delirium: a quasi-experimental study]. / Amélioration du sentiment de compétence des infirmières pour le dépistage du délirium en médecine générale: une étude quasi-expérimentale.

INTRODUCTION: Up to 60% of elderly will develop delirium during the course of their hospitalization. Less than 50% of nurses can screen for delirium, although it is a medical emergency and that the evaluation of mental state constitutes one of their responsibilities. OBJECTIVE: Evaluate the effect of a training program on screening for delirium on the competence perception of nurses in a medicine unit. METHODOLOGY: Quasi experimental, comparing two groups of nurses working on medicine units, in two different hospitals. The independent variable, an active training taking into account experience and knowledge of nurses, did include a tool based on the "confusion assessment method". The dependent variable, the perception of competence, was measured before training and 6 months later with a pre-tested self-administered questionnaire. RESULTS: Response rate was higher than 90% at time 1 and 2. There was no difference in the perception of competence between groups before training. The experimental group improved statistically but not the comparison group. CONCLUSION: This study suggests a significant improvement in perception of competence following an active training hopefully enhancing screening of delirium, thus the well-being of hospitalized elderly.

Evaluation of the effectiveness of arsenic screening promotion in private wells: a quasi-experimental study.

The Eastern Townships (ETR) is a region in Québec (Canada) where the soil is naturally rich in arsenic (As). About a third of the people in the ETR obtain their water from a private well. A quasi-experimental design was used to compare two campaigns designed to promote As screening in well water: a mass-media campaign (MMC) followed or not by a community-based intervention (CBI). The MMC is based on a press release issued for the ETR, along with a leaflet on As made available on the Internet, and in strategic places. The CBI, formulated according to the factors of the Precede-Proceed model, was aimed at mobilizing local authorities and small media. It targets only one municipality; the intervention community (IC). Using a separate pre-post samples design, two population-based cross-sectional (pre-CBI and post-CBI) surveys were conducted by phone at 6-month intervals, by means of random samples. The samples counted, for the IC and the ETR, respectively, 87 and 156 well owners in pre-CBI, and 106 and 190 in post-CBI. The results in post-CBI showed that the proportion of well owners who had their water test increased by four times in the IC after (16% p = 0.004). When adjusting for age and gender among all the post-CBI respondents, As screening is related with intervention status (exposed to MMC and CBI; p ≤ 0.001) and on previous microbiological water analysis behavior (p ≤ 0.05), but is not related to knowledge. This study demonstrates the superiority of a community-based campaign over a MMC when environmental health is concerned.

Developing a decision support intervention regarding choice of dialysis modality.

UNLABELLED: Predialysis nurses have an important role in supporting patients who must make decisions when renal replacement therapy is needed. However, no effective interventions have been established for nurses who provide this decision support. The Ottawa Decision Support Framework provides a structure to develop such interventions, which include a patient decision aid and decision coaching. GOAL: To propose a method for developing and implementing a decision support intervention. METHOD AND RESULTS: Guided by this model, a mixed method design is proposed to develop and evaluate the intervention. The intervention includes a decision aid intended for patients and their families and training in decision coaching intended for nurses. Its development requires knowledge synthesis and a decisional needs assessment with key informants. The development of decision coaching competencies for nurses will include an interactive skill building workshop. A constructivist evaluation approach will be used to evaluate the intervention. CONCLUSION: This study proposes an innovative approach to develop interventions and should contribute to improving the quality of decision-making regarding dialysis modality and to developing nurses' skills in providing decision support.

[The experience of clinical assessment as lived by surgical nurses in the context of best practice guidelines' implementation]. / L'expérience d'evaluation clinique vécue par des infir- mières de chirurgie lors de l'implantation de pratiques exemplaires.

The purpose of this hermeneutic phenomenological study (Benner, 1994) was to understand the meaning of the experience of clinical assessment of surgery nurses in a context of implementation of best practices guidelines. The study was held in an affiliated university hospital (Québec, Canada) with nine registered nurses. Data were collected through an observation period of nursing assessment and semi-structured individual interviews. The results revealed four subthemes which, combined, compose this main theme: In a context of the implementation of best practices guidelines in nursing care, clinical assessment carried out by surgery nurses is an implicit, tactful, adapted and ongoing process, facilitated by the nurse's commitment to know the patient, his history and its future in order to promote positive outcomes.

[Good palliative care in the intensive care unit: for nurses, a way to prospect]. / De "bons soins" palliatifs aux soins intensifs: une perspective infirmière.

Caring for dying patients is part of daily practice for the nurses working in intensive care unit (ICU). Few studies have documented what nurses consider to be "good palliative care" in this context. This phenomenological study was conducted in four phases and was designed to understand how the provision of "good palliative care" is expressed according to nurses' perspectives. Data were collected through group interviews, observation sessions followed by individual interviews and group validation sessions. "good palliative care" is expressed by the consideration of six dimensions of the person, as proposed by Gastmans et al. (1998), namely: physical, relational, psychological, moral, social and spiritual.

[The nursing practice informed by research: leader training in health organizations, a promising path]. / La pratique infirmière informée par des résultats de recherche: la formation de leaders dans les organisations de santé, une avenue prometteuse.

PROBLEM: Despite the recognition by nurses of the importance of supporting their experiential knowledge on scientific data, evidence-based nursing research is seldom integrated in their practice. An important limitation is the nurses' general lack of basic abilities to use research to better inform their clinical decision making. The objective of this pilot study was to evaluate a leader training intervention on research results integration in nursing practice. INTERVENTION: Seven advanced practice nurses and 12 clinical nurses from six care specialties jointly participated to training activities on knowledge transfer and exchange. METHOD: Nineteen nurses went through a 20-day training internship and 14 participated to two interviews, before and after the intervention. RESULTS AND CONCLUSION: Overall, nurses were very positive about their participation to the training. Difficulties encountered during the internship and the prior negative perception about the research process, were largely offset by the acquired capabilities and the clinical results of the intervention. Furthermore, the beginning of change in the organization and in relations with some health professionals were noted and seen as positive.