Factors influencing job satisfaction of oncology nurses over time.

In this study, we tested a structural equation model to examine work environment factors related to changes in job satisfaction of oncology nurses between 2004 and 2006. Relational leadership and good physician/nurse relationships consistently influenced perceptions of enough RNs to provide quality care, and freedom to make patient care decisions, which, in turn, directly influenced nurses' job satisfaction over time. Supervisor support in resolving conflict and the ability to influence patient care outcomes were significant influences on job satisfaction in 2004, whereas, in 2006, a clear philosophy of nursing had a greater significant influence. Several factors that influence job satisfaction of oncology nurses in Canada have changed over time, which may reflect changes in work environments and work life. These findings suggest opportunities to modify work conditions that could improve nurses' job satisfaction and work life.

Core domains for a person-focused outcome measurement system in cancer (PROMS-Cancer Core) for routine care: a scoping review and Canadian Delphi Consensus.

OBJECTIVES: The objectives of this scoping review study were 1) to identify core domains and dimensions for inclusion in a person-focused and self-reported outcome measurement system for cancer and 2) to reach consensus among key stakeholders including cancer survivors on the relevance, acceptability, and feasibility of a core outcome set for collection in routine clinical care. METHODS: Following a scoping review of the literature, a Rand Delphi consensus method was used to engage key interdisciplinary decision makers, clinicians, and cancer survivors in reaching consensus on a core patient-reported outcome domain taxonomy and outcome measures. RESULTS: Of the 21,900 citations identified in the scoping review, 1,503 citations were included in the full article review (380 conceptual articles, 461 psychometric evaluation articles, and 662 intervention studies) and subjected to data abstraction and mapping. Final consensus was reached on 20 domains, related subdimensions, and 45 self-report measures considered relevant and feasible for routine collection in cancer by the Delphi panel (PROMS-Cancer Core). CONCLUSIONS: Standardization of patient-reported outcome data collection is key to assessing the impact of cancer and treatment on the person for population comparison and monitoring the quality of clinical care. The PROMS-Cancer Core taxonomy of domains and outcome measures can be used to guide the development of a patient-reported outcome information system for cancer.

The context of oncology nursing practice: an integrative review.

BACKGROUND: In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. OBJECTIVE: The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how "context" has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. METHODS: The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. RESULTS: Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses' work, and interactions and relationships) of oncology nursing practice settings. CONCLUSIONS: The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. IMPLICATIONS FOR PRACTICE: The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.

Managing symptoms during cancer treatments: evaluating the implementation of evidence-informed remote support protocols.

BACKGROUND: Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments. METHODS: A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses' use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses' barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings. DISCUSSION: Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home.

Canadian oncology nurse work environments: part II.

In the aftermath of healthcare restructuring, it is important to pay attention to nurses' perceptions of workplace and professional practice factors that attract nurses and influence their retention. Continuing constraints on cancer care systems make the issue of health human resources an ongoing priority. This paper presents the findings of a follow-up study of a cohort of Canadian oncology nurses that aimed to compare nurses' perceptions of their work environment, job satisfaction and retention over a two-year period. Participants of the follow-up survey represented 65% (397/615) of the initial cohort. Many similar perceptions about the work environment were found over two years; however, at follow-up a larger proportion of nurses reported an absence of enough RNs to provide quality care and a lack of support for innovative ideas. With respect to career status, only 6% (25/397) of the follow-up sample had left oncology nursing. However, the proportion of nurses declaring an intention to leave their current job increased from 6.4% (39/615) on the initial survey to 26% (102/397) on the follow-up survey. Findings suggest that decision-makers need to use both the growing body of workplace knowledge and the input from staff nurses to implement changes that positively influence nurse recruitment and retention. Future research should focus on the implementation and evaluation of strategies that address workplace issues such as nurse staffing adequacy, leadership and organizational commitment.

Evaluation of an intervention designed to recruit Canadian women to mammography screening.

Mammography screenings have the potential to reduce mortality; unfortunately, participation rates remain below federally established targets. To increase screening, the Ontario Breast Screening Program (OBSP) implemented a mammography recruitment intervention that involved a locally designed postcard. The first phase of this descriptive study involved the distribution of a questionnaire to determine how attendees became aware of the OBSP. Semistructured telephone interviews were conducted in the study's second phase to describe breast screening attendees' perceptions of the postcard campaign. Although the participants positively appraised the postcard initiative, it played a minor role in comparison to typical OBSP recruitment methods.

Characteristics of unsafe undergraduate nursing students in clinical practice: an integrative literature review.

Providing quality clinical experiences for nursing students is vital to the development of safe and competent professional nurses. However, clinical educators often have difficulty identifying and coping with students whose performance is unsatisfactory. The purposes of this integrative review were to examine the extent and quality of the literature focusing on unsafe nursing students in clinical settings and to describe the characteristics of nursing students considered unsafe in clinical settings. A structured literature search yielded 11 relevant articles: five theoretical articles and six research studies. Analysis of findings revealed three themes: ineffective interpersonal interactions, knowledge and skill incompetence, and unprofessional image. The themes reflected the attitudes, actions, and behaviors that influenced students' ability to develop a safe milieu for client care. The findings provide clarity for early identification of students in need of increased support and facilitate clinical educators in meeting students' learning needs to ensure patient safety.

The fatigue pictogram: psychometric evaluation of a new clinical tool.

Fatigue is one of the most prevalent side effects of cancer, yet clinicians may not focus on it during busy clinic appointments. The purpose of this project was to evaluate the psychometric properties of a new two-item instrument designed to quickly identify patients experiencing difficulties with fatigue. The evaluation was conducted with 190 lung cancer patients attending ambulatory clinics. The Fatigue Pictogram had good reliability for test-retest over a 24-hour period (Weighted Kappa 0.71 for Question 1 and 0.72 for Question 2) and for equivalence of method (in person versus phone) (Weighted Kappa 0.64 for Question 1 and 0.65 for Question 2). Validity was assessed by comparing results of the new tool against the Multidimensional Fatigue Inventory and the SF-36. Overall, patients who indicated high fatigue levels did so on all respective scales. The new Fatigue Pictogram was easy to administer and score in a busy clinical setting. It provides a standardized reliable and valid instrument to identify patients experiencing difficulty with fatigue.

Canadian cancer nurses' views on recruitment and retention.

AIM: The purpose of this study was to explore oncology nurses' perceptions about recruitment and retention. BACKGROUND: Competition among healthcare organizations to recruit and retain qualified nurses is a real-life challenge. Focusing attention on human resource planning in oncology is highlighted by both the worsening nursing shortage and cancer incidence. METHODS: A participatory action research approach was used and 12 focus groups with 91 cancer nurses were conducted across Canada to collect data about strategies that could improve recruitment and retention. RESULTS: Four themes emerged reflecting oncology nurses' beliefs and values about organizational practices that attract and retain nurses and they are as follows: (1) recognizing oncology as a specialty, (2) tacit knowledge no longer enough, (3) gratification as a retaining factor, and (4) relationship dependent on environment. CONCLUSIONS: Participants highlighted leadership, recognition and professional and continuing education opportunities as critical to job satisfaction and organizational commitment. IMPLICATIONS FOR NURSING MANAGEMENT: Recruitment and retention were viewed as a continuum where organizational investment begins with a well-developed orientation and ongoing mentorship to ensure knowledge development. The challenge for nurse leaders is to use the evidence generated from this study and previous studies to develop professional practice environments that facilitate the cultural changes needed to build and sustain a quality nursing workforce.

Nurse autonomy in cancer care.

BACKGROUND: The concept of autonomy is regarded as an essential element for gaining professional status. Yet, it remains poorly defined and understood. To date, there is little research that has focused on exploring how nurses in different specialty areas perceive autonomy. OBJECTIVE: The purpose of this research was to explore oncology nurses' perceptions of autonomy and understand how they develop and exhibit autonomy in their everyday practice. METHODS: Using Leininger's ethnonursing method, data were collected from 15 oncology nurses using semistructured interviews. Participant observation was also carried out through job shadowing to complement interview data. RESULTS: Three themes emerged from the findings: autonomy is an unspoken opportunity in the workplace; autonomy is developed through professional and personal growth acquired over time; and demonstrating autonomous behaviors is a conscious choice. CONCLUSION: The findings provide insight into how oncology nurses perceive, develop, and exhibit autonomy in everyday practice and how autonomous and collaborative clinical decision making contributes to quality cancer care. IMPLICATIONS FOR PRACTICE: Descriptions of the meaning of autonomy and its explication in a nursing specialty practice can add to nursing knowledge by clarifying nurse autonomy and its relevance to nurses' work life. Descriptive studies can identify nurse behaviors and attitudes related to autonomy that may be measurable and relevant to real life.

Canadian oncology nurse work environments: part I.

The global nursing shortage and statistics indicating a steady increase in the cancer patient workload suggest that the recruitment and retention of oncology nurses is and will be a serious problem. The purpose of this research study was to examine oncology nursing work environments in Canada and to determine the presence of workplace and professional practice factors. A total of 615 oncology nurses responded to a national survey in 2004. The majority of nurses indicated that positive nurse-physician relations and autonomy in clinical decision-making were factors that contributed to job satisfaction and the desire to remain in oncology nursing. However, the findings identified that nurse staffing, the lack of nursing leadership and inadequate opportunities to participate in policy decisions were areas of concern. Differences in work environment perceptions were seen most often when responses were compared across provincial regions. While the findings support previous research reports that the key to the nursing shortage is attention to nursing work environments, they also emphasize the need for organizations to act now. A follow-up survey was conducted in 2006; analysis of these data will be presented in a future report on nurses' perceptions of their work environments and job satisfaction over time.

The relationship between nursing leadership and nurses' job satisfaction in Canadian oncology work environments.

BACKGROUND: Current Canadian oncology work environments are challenged by the same workforce statistics as other nursing specialties: nurses are among the most overworked, stressed and sick workers, and more than 8% of the nursing workforce is absent each week due to illness. AIM: To develop and estimate a theoretical model of work environment factors affecting oncology nurses' job satisfaction. METHODS: The sample consisted of 515 registered nurses working in oncology settings across Canada. The theoretical model was tested as a structural equation model using LISREL 8.54. RESULTS: The final model fitted the data acceptably (chi(2) = 58.0, d.f. = 44, P = 0.08). Relational leadership and physician/nurse relationships significantly influenced opportunities for staff development, RN staffing adequacy, nurse autonomy, participation in policy decisions, support for innovative ideas and supervisor support in managing conflict, which in turn increased nurses' job satisfaction. CONCLUSIONS: These findings suggest that relational leadership and positive relationships among nurses, managers and physicians play an important role in quality oncology nursing environments and nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Oncology nursing work environments can be improved by focusing on modifiable factors such as leadership, staff development and staffing resources, leading to better job satisfaction and hopefully retention of nurses.

Oncology nursing: Finding the balance in a changing health care system.

Health care restructuring has resulted in significant changes in the workload and work environment for oncology nurses. While recent studies describe the impact of these changes on the general nursing workforce in several countries, there have been no published studies that have focused on worklife issues of Canadian oncology nurses. Therefore, a qualitative study was conducted to gain insight about how oncology nursing has changed over the past decade and how Canadian oncology nurses are managing these changes. Analysis of telephone interviews with 51 practising oncology nurses employed across Canada revealed three major themes. The first theme, "health care milieu", portrayed a picture of the cancer care environment and patient and professional changes that occurred over the past decade. The second theme, "conflicting demands", reflects how the elements of change and social forces have challenged professional oncology nursing practice. The third theme, "finding the way", describes the patterns of behaviour that nurses used to manage the changing health care environment and make meaning out of nurses' work in cancer care. Overall, the findings portray a picture of Canadian oncology nurses in "survival mode". They face many workplace challenges, but are able to keep going "for now" because they find ways to balance their responsibilities on a daily basis and because they know and believe that their specialized nursing knowledge and skills make a difference in patient care.

Assessing the reliability and validity of the revised WCCNR stomatitis staging system for cancer therapy-induced stomatitis.

Before developing interventions for stomatitis, nurses require a simple, valid and reliable approach to staging severity. The eight-item WCCNR(R) was previously validated for chemotherapy-induced stomatitis. In this study, the validity and reliability of the WCCNR(R), a shorter three-item tool for staging stomatitis caused by chemotherapy, radiotherapy, or both, was assessed. Pairs of data collectors evaluated 207 patients from 10 Canadian cancer centres. The WCCNR(R) correlated well with the MacDibbs Mouth Assessment (r = 0.44, p = 0.0002 to r = 0.54, p < 0.0001), a standardized tool for staging radiotherapy-induced stomatitis. Agreement between data collectors at five sites was acceptable (kappa = 0.75); three additional sites were close to this target. Findings indicate that the WCCNR is a valid and reasonably reliable tool for staging stomatitis due to cancer therapy.

Blood pressure monitoring. Older adults' perceptions.

The purpose of this article is to report the qualitative findings on older adults' perceptions of blood pressure measurement and its meaning to their health. The convenience sample consisted of 51 community-dwelling older adults who were recruited from either wellness clinics or a senior citizens' club. Data were collected through in-depth audiotaped interviews. Participants' responses were analyzed by identifying topics, patterns, and themes. The following three themes emerged: provision of reassurance, decision-making leading to self-care activities, and reliance on health care professionals. These findings can be used by community health nurses, especially those in gerontology to gain insight into how a sample of older adults perceived blood pressure monitoring. In addition, the findings can serve as guidelines for nurses in the provision of effective hypertension management with older adults.