An Innovation in Cancer Nursing Education Across Europe: A Pilot Evaluation.

The European Oncology Nursing Society (EONS) is a pan-European not for profit society involving approximately 28,000 cancer nurses from 32 countries in the region. The European College of Cancer Nursing (ECCN) exists under the umbrella of EONS and was established in 2020 with a strategic priority to develop, promote and deliver educational opportunities for nurses across Europe. ECCN introduced a pilot on-line education programme for 20 nurses in January 2023. This study evaluated participating nurses' views and experience of learning on the pilot programme. The study adopted a mixed method approach guided by the four levels of the Kirkpatrick theoretical framework. A dominant focus on qualitative data was used with supplementary quantitative data. The Standards for Reporting Qualitative Research (SRQR) was followed. Eleven nurses completed the pre-pilot online questionnaire (response rate 65%) and seven (n = 7) completed the post-pilot questionnaire (41% response rate). Five (n = 5) nurses participated in two focus group interviews. Data analysis resulted in the development of four overarching themes: A wider world of cancer nursing; Shapeless mentorship; Impact on Practice; Learning online and what now? On commencement of online education programmes, nurses value a structured timetable and support from nursing management to maximise engagement with the learning materials.

Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis.

BACKGROUND: The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES: To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA: We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS: We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS: We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS: This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.

Student nurses' experiences of remote learning during Covid-19 pandemic: A qualitative evidence synthesis.

AIM: To systematically synthesize undergraduate student nurses' experience of online, blended or distance learning during Covid-19 pandemic. DESIGN: A qualitative evidence synthesis (QES). REVIEW METHODS: A QES. Themes were organized using the 'best fit' framework approach. Methodological limitations and confidence in the review findings were informed by GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research). DATA SOURCES: Qualitative literature from five databases including CINAHL, PubMed, Medline, Education Full Text (H.W. Wilson) and ERIC were searched from March 2020 to November 2021. RESULTS: Nine qualitative and two mixed method studies were included in this 'best fit' framework using Chickering and Gamson's Seven Principles for Good Practice in Undergraduate Education. Importance of the social presence of the teacher through effective communication and interpersonal relationships is highlighted. Clinical placement and in-person practical skills training are needed for effective nursing education. CONCLUSIONS: This review highlighted that online content can be developed into efficient and high-quality learner-centred education within blended undergraduate nursing programmes incorporating essential face-to-face and practical components. Various supporting measures are required for both students and faculty. We suggest an adaptation of a 'Blending with Purpose: The Multimodal Model' with key considerations for undergraduate nursing programmes where pedagogical objectives and activities drive the approaches to achieve intended learning outcomes and student satisfaction. IMPLICATIONS FOR THE PROFESSION: Well-designed online programmes using digital tools that support interaction and teamwork are required for undergraduate nursing education. IMPACT: Blended learning approaches offer more flexibility than online learning alone which leads to improved student engagement. Clinical placement and in-person practical skills training are needed for effective nursing education. REPORTING METHOD: 'Enhancing transparency in reporting the synthesis of qualitative research' (ENTREQ) for QES. NO PATIENT OR PUBLIC CONTRIBUTION: No Patient or Public Contribution.

Breast cancer genetic mutation: Synthesis of women's experience.

AIMS AND OBJECTIVES: To systematically identify and synthesise the experiences reported by women with a breast cancer mutation who do not have cancer as reported in qualitative research published between 2013 and 2020. BACKGROUND: Women carrying a BReast CAncer (BRC) genetic mutation have an increased risk for breast and ovarian cancer. They must engage in emotional decision-making regarding risk management strategies to prevent cancer, including risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy. DESIGN AND METHODS: The ENTREQ statement guided this review. Eight databases were systematically searched (CINAHL, Pubmed, Embase, Psychinfo [Ovid], Web of Science, Scopus, Proquest and Lenus). Synthesis was guided by "best fit" framework. The Critical Appraisal Skills Programme guided assessment of methodological limitations and confidence in the review findings was informed by GRADE-CERQual. RESULTS: Twenty studies met the inclusion criteria for synthesis. Six themes were synthesised from the included studies (anxiety; family planning; it's a family affair; empowerment; actions; pragmatic adjustments). CONCLUSIONS: The multidimensional experiences of women living with a BRCA1/2 mutation require an individualised response based on women's needs at their life stages. A decision coaching model adopted during consultations could support women to guide decision-making regarding cancer risk-reducing strategies.

Development and Implementation of an Online Education Program on Advanced Breast Cancer for European Cancer Nurses: ABC4Nurses Project: a Brief Report.

Breast cancer is now the most commonly diagnosed cancer worldwide. Approximately 30% of those who present with early breast cancer later develop advanced breast cancer (ABC). Additionally, approximately 6% have advanced breast cancer at diagnosis. New treatment options result in an extended lifespan dominated by cycles of deterioration and stable disease. Specialist nurse knowledge is key to multidisciplinary care of people with ABC; however, access to education on ABC for nurses is not universally available in Europe. This paper describes the development and implementation of an online bespoke program on ABC care for specialist and generalist nurses in Europe. The project team is affiliated with the European Oncology Nurses Society (EONS) and comprises specialist breast cancer nurses, oncology nurse academics and breast cancer advocates associated with EUROPA DONNA Turkey, an independent non-profit European breast cancer organisation. The program development involved (1) a systematic review of ABC educational resources for cancer nurses; (2) a modified four-round Delphi study to seek agreement on curriculum content and (3) curriculum development, conversion to an interactive online platform and translation into four European languages. The program evaluation will be guided by Kirkpatrick's framework. The phases described in this short report could guide others involved in developing bespoke cancer education programs.

The 'inbetweeners': living on a watch and wait approach for chronic lymphocytic leukaemia - a qualitative study.

BACKGROUND: Chronic lymphocytic leukaemia (CLL) is an incurable disease; many people with the condition do not require active treatment and are monitored using a watch and wait approach. AIM: The aim of this study was to explore the experiences of people living with a diagnosis of CLL and on watch and wait. METHODS: Using a descriptive qualitative approach, seven participants on the watch and wait approach were interviewed. Data analysis was guided by systematic text condensation. FINDINGS: Participants reported anxiety, referring to 'wait and worry'. Their information needs were not met, and they resorted to seeking information on possible future treatments themselves. They also experienced feeling like an imposter because they were not receiving active treatment like other patients with cancer. CONCLUSIONS: A greater understanding of how information provision affects levels of anxiety and worry among people living with CLL on watch and wait is needed. In addition, clinical nurse specialists could deliver education on the watch and wait approach, supplemented by video-based educational materials developed by the haematology team.

Advances in the management of myeloma: an update.

Myeloma is an aggressive B-cell malignancy resulting from an uncontrolled production of plasma cells in the bone marrow. A multitude of drugs and combinations of drugs are now approved for use to treat this complex disease and nurses require knowledge and skills in recognising and managing new side effects associated with these treatments. This article presents an overview of some of the newer and recently approved drugs and the important side effects that have been associated with them. Clinical nurse specialists and advanced nurse practitioners are at the forefront of patients' treatment journeys and play a central role in supporting patients and families to manage side effects. Through this support, patients can continue the treatments for as long as possible with the aim of maintaining a good quality of life.

Psychosocial vulnerability among carers of persons living with a chronic illness: A scoping review.

AIMS: To outline and examine evidence related to the meaning of 'psychosocial vulnerability' among caregivers of persons with chronic illnesses. BACKGROUND: The number of informal caregivers continues to rise globally. Their risk of psychosocial vulnerability is frequently overlooked, but understanding their psychosocial vulnerability may offer insights into meeting their needs. DESIGN: Scoping review following the PRISMA 2020 extension guidelines. DATA SOURCES: The databases CINAHL, Embase, Medline/Pubmed, Cochrane Library, PsycINFO, Web of Science, Google Scholar, Lenus and ProQuest were systematically searched to identify original research. No date limit was set, and 23 studies were included. REVIEW METHODS: A five-step approach using the Arksey and O'Malley framework. Thematic analysis guided data analysis. RESULTS: Carers' psychosocial vulnerability occurs when they experience barriers to resources while access and use of supports reduce risk. Antecedents of psychosocial vulnerability include a carer's age and sex, socioeconomic status and their health and wellbeing. Psychosocial vulnerability affects carers' relationships and causes personal losses. CONCLUSIONS: The concept of carers' psychosocial vulnerability is complex. Recognition of carers at risk for psychosocial vulnerability would help nurses direct relevant support and information to carers who need it most.

Women's fertility decision-making with a diagnosis of breast cancer: A qualitative evidence synthesis.

AIM: To synthesize qualitative evidence of premenopausal women's experiences of fertility decision-making with a diagnosis of breast cancer. BACKGROUND: Breast cancer is increasingly more common in premenopausal women who may have not yet considered starting a family or have completed their families. DESIGN: Qualitative evidence synthesis guided by Thomas and Harden's three-stage approach to thematic analysis. DATA SOURCES: Twelve electronic databases were searched: CINAHL, Embase, Pubmed, Proquest, PsychINFO, Lenus, Scopus, Web of Science, Rian.ie, Medline, EThOS e-theses online and DART Europe. No year limit was set. REVIEW METHODS: The 'Enhancing transparency in reporting the synthesis of qualitative research guidelines' (ENTREQ) statement was followed. RESULTS: Fifteen qualitative studies were included in the synthesis. Seven review findings under four major themes were identified: (1) first comes survival, (2) making decisions 'under the gun', (3) health-care professionals should not make assumptions and (4) we want accurate, detailed information and we want it early. High confidence in six of the review findings was agreed. CONCLUSION: Most women experienced rushed fertility preservation decision-making at a time when they also faced cancer treatment decisions. Women want detailed, clear information on fertility preservation early after their diagnosis.

Factors that impact on recruitment to randomised trials in health care: a qualitative evidence synthesis.

BACKGROUND: Randomised trials (also referred to as 'randomised controlled trials' or 'trials') are the optimal way to minimise bias in evaluating the effects of competing treatments, therapies and innovations in health care. It is important to achieve the required sample size for a trial, otherwise trialists may not be able to draw conclusive results leading to research waste and raising ethical questions about trial participation. The reasons why potential participants may accept or decline participation are multifaceted. Yet, the evidence of effectiveness of interventions to improve recruitment to trials is not substantial and fails to recognise these individual decision-making processes. It is important to synthesise the experiences and perceptions of those invited to participate in randomised trials to better inform recruitment strategies. OBJECTIVES: To explore potential trial participants' views and experiences of the recruitment process for participation. The specific objectives are to describe potential participants' perceptions and experiences of accepting or declining to participate in trials, to explore barriers and facilitators to trial participation, and to explore to what extent barriers and facilitators identified are addressed by strategies to improve recruitment evaluated in previous reviews of the effects of interventions including a Cochrane Methodology Review. SEARCH METHODS: We searched the Cochrane Library, Medline, Embase, CINAHL, Epistemonikos, LILACS, PsycINFO, ORRCA, and grey literature sources. We ran the most recent set of searches for which the results were incorporated into the review in July 2017. SELECTION CRITERIA: We included qualitative and mixed-methods studies (with an identifiable qualitative component) that explored potential trial participants' experiences and perceptions of being invited to participate in a trial. We excluded studies that focused only on recruiters' perspectives, and trials solely involving children under 18 years, or adults who were assessed as having impaired mental capacity. DATA COLLECTION AND ANALYSIS: Five review authors independently assessed the titles, abstracts and full texts identified by the search. We used the CART (completeness, accuracy, relevance, timeliness) criteria to exclude studies that had limited focus on the phenomenon of interest. We used QSR NVivo to extract and manage the data. We assessed methodological limitations using the Critical Skills Appraisal Programme (CASP) tool. We used thematic synthesis to analyse and synthesise the evidence. This provided analytical themes and a conceptual model. We used the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach to assess our confidence in each finding. Our findings were integrated with two previous intervention effectiveness reviews by juxtaposing the quantitative and qualitative findings in a matrix. MAIN RESULTS: We included 29 studies (published in 30 papers) in our synthesis. Twenty-two key findings were produced under three broad themes (with six subthemes) to capture the experience of being invited to participate in a trial and making the decision whether to participate. Most of these findings had moderate to high confidence. We identified factors from the trial itself that influenced participation. These included how trial information was communicated, and elements of the trial such as the time commitment that might be considered burdensome. The second theme related to personal factors such as how other people can influence the individual's decision; and how a personal understanding of potential harms and benefits could impact on the decision. Finally, the potential benefits of participation were found to be key to the decision to participate, namely personal benefits such as access to new treatments, but also the chance to make a difference and help others. The conceptual model we developed presents the decision-making process as a gauge and the factors that influence whether the person will, or will not, take part. AUTHORS' CONCLUSIONS: This qualitative evidence synthesis has provided comprehensive insight into the complexity of factors that influence a person's decision whether to participate in a trial. We developed key questions that trialists can ask when developing their recruitment strategy. In addition, our conceptual model emphasises the need for participant-centred approaches to recruitment. We demonstrated moderate to high level confidence in our findings, which in some way can be attributed to the large volume of highly relevant studies in this field. We recommend that these insights be used to direct or influence or underpin future recruitment strategies that are developed in a participant-driven way that ultimately improves trial conduct and reduces research waste.

A qualitative study of the factors influencing recruitment to a pilot trial on the prevention of striae gravidarum.

BACKGROUND: Striae gravidarum are a common occurrence in pregnancy and many women use a topical product to prevent their development or lessen their appearance if they do develop. There is a lack of evidence on the effectiveness of many of the products used by women. This study arose from challenges in recruitment to a pilot randomised trial (ISRCTN trial registration number:76992326) designed to evaluate the feasibility of a definitive trial to compare a moisturising oil to no treatment in the prevention and reduction in severity of striae gravidarum. The study reported here explored the factors influencing recruitment to that pilot trial. METHODS: A qualitative descriptive study was undertaken involving primigravid women attending an Irish maternity hospital. Data were collected by semi-structured telephone interviews over a four-week period and analysed using the framework method of analysis. Fifteen interview transcripts were included in the analysis. RESULTS: Four main themes consisting of twelve categories were identified from the interview data. The themes focused on women's prevention of stretch marks and their choice of anti-stretch mark product, who and what influenced that choice and influences on trial participation. In relation to influences on trial participation, the possibility of being randomised to the non- intervention or control group was a deterrent for many women. CONCLUSIONS: The prevention of stretch marks is important to pregnant women, as is their choice of product to prevent them. Offering women the opportunity to be part of a trial that would be of low burden and would test a well-known product may optimise recruitment. However, reluctance to be randomised because of the possibility of being allocated to the non-intervention control group suggests that further work is needed in this field on how best to communicate uncertainty to potential participants.

A qualitative evidence synthesis of healthcare professionals' experiences and views of palliative care for patients with a haematological malignancy.

INTRODUCTION: Patients with haematological malignancies may not be receiving appropriate referrals to palliative care and continuing to have treatments in the end stages of their disease. This systematic review of qualitative research aimed to synthesise healthcare professionals' (HCPs) views and experiences of palliative care for adult patients with a haematologic malignancy. METHODS: A systematic search strategy was undertaken across eight databases. Thomas and Harden's approach to thematic analysis guided synthesis on the seventeen included studies. GRADE-GRADEQual guided assessment of confidence in the synthesised findings. RESULTS: Three analytic themes were identified: (a) "Maybe we can pull another 'rabbit out of the hat'," represents doctors' therapeutic optimism, (b) "To tell or not to tell?" explores doctors' decision-making around introducing palliative care, and (c) "Hospice, home or hospital?" describes HCPs concerns about challenges faced by haematology patients at end of life in terms of transfusion support and risk of catastrophic bleeds. CONCLUSION: Haematologists value the importance of integrated palliative care but prefer the term "supportive care." Early integration of supportive care alongside active curative treatment should be the model of choice in haematology settings in order to achieve the best outcomes and improved quality of life.

Barriers and facilitators to seasonal influenza vaccination uptake among nurses: A mixed methods study.

AIM: To identify the barriers and facilitators to seasonal influenza vaccination uptake among nurses. BACKGROUND: Seasonal influenza causes significant mortality and morbidity among older people and high-risk groups. Vaccinating nurses against influenza is an essential public health measure to reduce the burden of disease. Yet despite annual recommendations, nurses' influenza vaccine uptake rates remain low. DESIGN: An explanatory sequential mixed methods study design. DATA SOURCES: Qualified nurses attending mandatory training in two large acute hospitals in Ireland. METHODS: A paper-based questionnaire assessing nurses' knowledge, risk perception, health beliefs and influenza vaccination practices was distributed to a convenience sample of qualified nurses (N = 462) between September 2017 - February 2018. A self-selected sample of 35 nurses who completed the questionnaire participated in five focus groups to explore in depth the barriers and facilitating factors associated with their vaccination practices between September 2018 - October 2018. The questionnaire data were analysed statistically and thematic analysis was applied to the qualitative data. The quantitative and qualitative findings were integrated using the Pillar Integration Process. RESULTS: Seven themes emerged: (a) the influence of nurses' knowledge on vaccine uptake; (b) dissemination of information; (c) vaccine fears and concerns; (d) protection, risk and vulnerability: self and others; (e) influencers; (f) accessibility; and (g) organizational pressure. CONCLUSION: Achieving high vaccine uptake rates among nurses through voluntary vaccination programmes remains a challenge. Multi-faceted influenza campaigns based on the HBM should be prioritized to address dissemination of evidence-based knowledge, accessibility, and external cues to action. IMPACT: Low influenza vaccine uptake among nurses compromises patient safety and contributes to a significant burden on health services. This study identified factors associated with vaccine practices among nurses and will inform the development of specific tailored interventions for nurses.

Clinical research nurses' expectations and realities of their role: A qualitative evidence synthesis.

AIMS: To synthesise the available body of qualitative studies relating to clinical research nurses' experiences of their role. METHODS: A systematic search of the literature in five databases was undertaken: CINAHL, MEDLINE, EMBASE, PubMed and ProQuest. Thomas and Harden's three-stage approach to thematic analysis was followed using the ENTREQ statement for reporting. RESULTS: Nineteen studies reported in 20 papers (with a total of 232 nurses) were included in the synthesis. Three analytical themes with six subthemes were identified as follows: "identity"; "meeting targets"; and "patient advocate." CONCLUSIONS: Clinical research nurses experience isolation, and contributing to this is their perception of nonresearch nurses' lack of understanding for their role. This can result in difficulties when recruiting study participants. Clinical research nurses can experience internal conflict between being a patient advocate and adhering to a trial protocol. RELEVANCE TO CLINICAL PRACTICE: Training is needed to help research nurses develop skills to face challenges in order to ensure safe and ethical care is provided to research participants while also ensuring high-quality data collected for the study.

Mandatory vaccination for seasonal influenza: what are nurses' views?

BACKGROUND: Preventing seasonal influenza is a public health priority but, although the benefits of vaccinating healthcare workers (HCWs) are emphasised, seasonal influenza vaccine uptake rates remain low. Voluntary vaccination policies have been less successful in achieving high vaccine uptake when compared to mandatory policies and the persistently low vaccine uptake among HCWs has fuelled debate on whether mandatory vaccination programmes should be implemented in the interest of patient safety. AIM: This study explored nurses' views on mandatory vaccination policy for seasonal influenza. METHODS: A self-selected sample (n=35) of qualified nurses working in two large hospital sites in Ireland participated in five focus groups. Data were analysed using Braun and Clarke's framework. FINDINGS: Two themes were identified: (1) mixed views on mandatory vaccination and (2) leave nurses to make their own choice on vaccination. CONCLUSION: This study provides an understanding of nurses' views regarding mandatory vaccination policy for seasonal influenza and highlights that individual choice and autonomy are crucial for vaccine acceptance.

Implementing an initiative promote evidence-informed practice: part 2-healthcare professionals' perspectives of the evidence rounds programme.

BACKGROUND: The translation of research into clinical practice is a key component of evidence-informed decision making. We implemented a multi-component dissemination and implementation strategy for healthcare professionals (HCPs) called Evidence Rounds. We report the findings of focus groups and interviews with HCPs to explore their perceptions of Evidence Rounds and help inform the implementation of future similar initiatives. This is the second paper in a two-part series. METHODS: We employed total population, purposive sampling by targeting all of the health care professionals who attended or presented at group sessions exploring the evidence on clinical questions or topics chosen and presented by the HCPs. We conducted and audio-recorded in-person focus groups and one-to-one interviews, which were then transcribed verbatim. Two authors independently coded transcripts. NVivo software was used to collate the primary data and codes. We analysed data guided by the five steps involved in framework analysis; 1) familiarization 2) identifying a thematic framework 3) indexing 4) charting 5) mapping and interpretation. RESULTS: Thirteen HCPs participated, of which 6 were medical doctors an d 7 were nursing or midwifery staff. We identified the following key domains; organisational readiness for change, barriers and facilitators to attendance, barriers and facilitators to presenting, communication and dissemination of information, and sustainability. During focus groups and interviews HCPs reported that Evidence Rounds had a positive impact on their continuing education and clinical practice. They also provided insights into how future initiatives could be optimised to support and enable them to narrow the gap between research evidence and practice. CONCLUSIONS: Individual, departmental and organisational level contextual factors can play a major role in implementation within complex health services. HCPs highlighted how in combination with clinical guideline development, implementation of evidence could be increased. Further research after a longer period of implementation could investigate how initiatives might be optimised to promote the uptake of evidence, improve implementation and expedite behaviour change.

Implementing an initiative to promote evidence-informed practice: part 1 - a description of the Evidence Rounds programme.

BACKGROUND: Evidence-informed practice is fundamental to the delivery of high quality health care. Delays and gaps in the translation of research into practice can impact negatively on patient care. Previous studies have reported that problems facing health care professionals such as information overload, underdeveloped critical appraisal skills, lack of time and other individual, organisational and system-level contextual factors are barriers to the uptake of evidence. Health services research in this area has been restricted largely to the evaluation of program outcomes. This paper aims to describe the implementation process of an educational initiative for health care professionals working in midwifery, neonatology or obstetrics aimed at disseminating evidence and enhancing evidence-informed clinical care. METHODS: We designed and implemented an educational initiative called Evidence Rounds for health care professionals working in the women and children's division of an urban hospital in Ireland. It consisted of three core components: (1) group educational sessions examining evidence on topics chosen by staff (2) a dedicated website and (3) facilitation, enablement and support from a knowledge translation professional. We evaluated user engagement in the educational program by monitoring attendance figures and website analytics. We followed up with staff at 3, 16 and 21-month intervals after the last educational session to find out whether evidence had been implemented. We use Lavis's organising framework for knowledge transfer and the Template for Intervention Description and Replication (TIDieR) checklist to describe the educational program and document the implementation process. RESULTS: Six educational sessions presented by 18 health care professionals took place over a nine month period with 148 attendances of which 85 were unique (individuals who attended at least one session). During the period spanning from one month before, during and one month after the running of the group sessions, 188 unique visitors, 331 visits and 862 page views were recorded on our website. CONCLUSIONS: Audit and feedback processes can provide quantitative data to track practice outcomes. Achieving sustainable educational programs can be challenging without dedicated resources such as staffing and funding.

Lymphoma survivors' experiences at the end of treatment.

AIMS AND OBJECTIVES: To explore lymphoma survivors' experiences on their end of treatment and follow-up care at a large urban haematology centre in Ireland. METHODS: This was a qualitative study using semistructured interviews with lymphoma patients post-treatment (n = 14). Thematic analysis guided the analysis of interview data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines. FINDINGS: Five main themes were identified following analysis of the interview data: dealing with uncertainty, changed relationships, returning to work, extended recovery time and concerns for the future. Findings of note were that some participants were unaware that their treatment had ended, many experienced recurrent infections which prolonged recovery time, and many had no recall of discussions on healthy lifestyle behaviours or recommended screening programmes at their follow-up visits. CONCLUSIONS: The findings suggest that the period of transition from active treatment to survivorship can be challenging for lymphoma survivors, and they experience ongoing needs. While the challenges of survivorship in lymphoma mirror those of other cancers, this cohort of patients require focused preparation for the end of active treatment and the transition to follow-up care. Moreover, this patient group requires repeated specific education on late effects and second cancers, education with regards to identifying the signs of cancer recurrence and promotion of healthy lifestyle practices. RELEVANCE TO CLINICAL PRACTICE: This study highlights the importance of a dedicated end of treatment visit with the clinical nurse specialist to confirm the completion of active treatment with lymphoma patients and focus on health promotion.

How do nurses use the early warning score in their practice? A case study from an acute medical unit.

AIMS AND OBJECTIVES: This study aimed to describe how nurses use the early warning score (EWS) in an acute medical ward and their compliance with the EWS and explore their views and experiences of the EWS. BACKGROUND: early warning score systems have been implemented in response to upward trends in mortality rates. Nurses play a central role in the use of EWS systems. However, barriers to their use have been identified and include behavioural, cultural and organisational approaches to adherence. Improvement strategies including education and training and electronic devices have assisted in compliance with the system. DESIGN: A holistic single descriptive case study design was used. METHODS: Data triangulation was used including non-participant observation, semi-structured interviews with nurses and document analysis. Nurses were observed using EWS and were subsequently interviewed. Data analysis was guided by systematic text condensation (STC), an approach underpinned by Giorgi's phenomenological method, where meaning units and themes are identified. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines. RESULTS: Three themes with associated meaning units were found. Protocol Adherence vs. Clinical Judgement addresses nurses' knowledge, skill and experience and patient assessment. Parameter Adjustment and Escalation included parameters not being adjusted or reviewed, junior doctors not being authorised to set parameters and escalation. The final theme Culture highlighted a task-driven approach and deficient communication processes. CONCLUSION: This study highlights the need for ongoing training, behavioural change and a cultural shift by healthcare professionals and organisations to ensure adherence with EWS escalation protocols. RELEVANCE TO CLINICAL PRACTICE: Improvements in education and training into recognition, management and communication of a deteriorating patient are required. Also, a cultural shift is needed to improve compliance and adherence with EWS practice. The potential use of electronic data should be explored.

Critical care nurses' experiences of providing care for adults in a highly technological environment: A qualitative evidence synthesis.

AIMS AND OBJECTIVES: To synthesise the available body of qualitative evidence relating to nurses' perceptions and experiences of care provision in adult critical care environments. METHODS: The study adhered to ENTREQ (Confidence in Evidence of Reviews of Qualitative Research) guidelines. See Appendix S1. A systematic search of the literature in nine databases was undertaken: CINAHL, Web of Science, MEDLINE, EMBASE, PsycINFO, Campbell Collaboration, ProQuest A & I, DART and Lenus. Blind screening to select relevant studies was undertaken, and each selected study was assessed for quality using the Critical Appraisal Skills Programme framework. Guided by Thomas and Harden's three-stage approach to thematic analysis, line-by-line coding of participants' verbatim accounts and the researchers' interpretations in the selected studies' findings was undertaken and then organised into higher order analytical themes. Confidence in the findings was reviewed using GRADE-CERQual. RESULTS: Twelve studies reported in thirteen papers, including 122 nurses, were selected in the final sample for synthesis. Three analytical themes were identified: (a) sometimes machines get all the attention, (b) with experience the patient becomes the focus and (c) technology can't save everybody. CONCLUSIONS: Providing care for adult patients in a highly technological environment is challenging particularly for novice nurses, who face the potential of technology drawing all their attention. Experienced critical care nurses learn to keep technology in abeyance and deliver person-centred care within the bounds of a technological environment. RELEVANCE TO CLINICAL PRACTICE: The review supports Locsin's theory of technological competence and highlights that providing care in critical care requires nurses to actively balance attention for the person while managing machines. Experienced nurses achieve this balance and can offer support to novice nurses. Critical care nurse orientation programmes should be underpinned by a holistic approach which addresses the dualism of technology and care.