A comparison of aerobic- and resistance-emphasised exercise on cardiometabolic health and quality of life in men receiving androgen deprivation therapy for prostate cancer: Protocol for a feasibility trial.

BACKGROUND: Those with intermediate and high-risk prostate cancer typically receive androgen deprivation therapy (ADT) as part of their treatment. ADT often results in extensive side effects including increased risk of cardiometabolic disease. Many ADT side effects can be influenced by exercise, both resistance and aerobic training. Exercise regimes typically combine aerobic and resistance exercise but the appropriate emphasis for achieving the broadest range of therapeutic benefits has yet to be determined. We propose to determine the feasibility of undertaking a larger trial comparing a resistance- vs an aerobic-emphasised exercise intervention in men with prostate cancer undergoing ADT. The trial will also investigate preliminary evidence of difference between arms for cardiometabolic health and quality of life outcomes. METHODS: This is a 6-month randomised two-armed feasibility trial. Prostate cancer patients undergoing ADT and radiotherapy will be recruited (n = 24) and randomised to either a resistance- or aerobic-emphasised group. Participants will attend twice-weekly supervised individual or small group sessions, with 75% of exercise time in the primary exercise modality. The primary outcome will be feasibility, determined via assessment of recruitment, retention, adherence, safety, and acceptability. Secondary outcomes will include quality of life, body composition, vascular indices, aerobic and muscular fitness and cardiometabolic health blood biomarkers. CONCLUSION: It is envisaged that the trial will provide valuable information and preliminary difference data that will aid in the design of an efficacious larger trial that will adopt a major and minor emphasis approach to the scheduling of resistance and aerobic exercise.

Designing effective exercise intervention trials for prostate cancer cohorts: a qualitative study on experiences and views of exercise oncology researchers.

BACKGROUND: Exercise intervention research has shown promising results in preventing and reversing the side effects caused by prostate cancer and its' treatment. However, there are still unanswered questions and the need for additional research. As the field of exercise oncology in the context of prostate cancer presents unique challenges and complexities, seeking the advice of experienced exercise oncology researchers before initiating a similar trial could help to design more effective and efficient studies and help avoid pitfalls. METHODS: A qualitative descriptive study design and a nonprobability, purposive sampling method was employed. An interview guide was developed and included topics such as recruitment, retention, programme goals, research design, health considerations, treatment considerations, adverse events, exercise prescription and outcome tools. Individual semi-structured interviews were conducted and interviews were transcribed and analysed using thematic analysis. RESULTS: Eight individuals with extensive experience working with prostate cancer patients in exercise oncology research settings were interviewed. Four main themes and seven subthemes were generated and supported by the data. Theme 1 highlighted the critical role of recruitment, with associated subthemes on recruitment barriers and recruitment methods. Theme 2 explored the positives and negatives of home-based programmes. Theme 3 focused on specific health characteristics, exercise prescription and outcome measure factors that must be considered when working with prostate cancer cohorts. Finally, theme 4 centered around the emotional dimensions present in exercise oncology trials, relating to both researchers and study participants. CONCLUSION: Exercise oncology remains a challenging area in which to conduct research. Learning from experienced personnel in the field offers valuable information and guidance that could impact the success of future trials.

A qualitative evaluation of an exercise practitioner in an outpatient child and adolescent mental health service.

BACKGROUND: Physical activity interventions can confer a range of physical and mental health benefits among young people with mental disorders. In some contexts, such as Ireland, integrated physical activity is not easily available within child and adolescent mental health services. Therefore, an interagency pilot intervention was established in a child and adolescent mental health service in Ireland with the integration of a novel exercise practitioner into the multidisciplinary mental health team. OBJECTIVE: A qualitative evaluation was conducted to understand the impact of the pilot intervention and to understand issues of implementation that arose throughout. METHODS: In-depth qualitative interviews with service users' parents/guardians (N = 3) and a single focus group with existing service providers (N = 3), framed by the RE-AIM framework were conducted to evaluate the pilot intervention. Data were analysed using thematic analysis to explore themes. RESULTS: Three overarching themes were identified. These were as follows: (i) Making changes toward healthier physical activity behaviours; (ii) An intervention of therapeutic holism; and (iii) The integrated service delivery. CONCLUSIONS: This research provides insight on the value of a novel integrated exercise practitioner in outpatient young persons' mental health services in Ireland, indicating an enhanced and complimentary therapeutic service. These findings will be helpful for integrating Exercise Practitioners in this setting going forward.

Exploring the Experiences of Physical Activity among Key Stakeholders in Rehabilitation and Recovery Mental Health Services.

Physical activity has therapeutic benefits for mental health service users. To date, there is limited evidence that has brought together the experiences of physical activity for service users and key multi-disciplinary service providers that support activity in outpatient settings, particularly in contexts where activity is not well integrated into policy and care structures. Previous research has relied on homogenous samples of either service users or service providers of a specific discipline, and key stakeholders like peer-support workers are under-represented. This research explored and thematically analysed multi-stakeholder (service users, n = 6; and service providers, n = 8) experiences of physical activity in outpatient mental health service in Ireland using phenomenologically influenced qualitative interviews. Two salient themes were identified; 'The challenges of being physically active in recovery' and 'Physical activity is a tool for recovery'. This research presents an account of the experiences of some of these poorly represented stakeholders such as carers, peer-support workers, doctors and nurse management, in addition to other well represented stakeholders.

Sialorrhoea Management Practices in Residential Older Adults Care Settings: A Qualitative Study.

AIM: The aim of this research was to explore both older adults' and health care professionals' experience and views of sialorrhoea management practices in older adult residential care settings. BACKGROUND: Sialorrhoea is quite a bothersome symptom among patients with certain neurological conditions. The complexity of sialorrhoea and its complications can be quite challenging for health care professionals. In the management of sialorrhoea, a multidisciplinary approach is proposed as an effective way of sialorrhoea management. METHODS: Thematic analysis of collected data via semi-structured qualitative interviews with five focus groups involving 28 multidisciplinary health care members and 1 patient. RESULTS: The older adult and multidisciplinary health care professionals' view of the management of sialorrhoea in residential care settings were established under three main themes: 1) 'Sialorrhoea compromising patient's dignity', 2) 'Ad hoc local management' and 3) 'Further integration of care required'. CONCLUSION: At present, there have been no comprehensive multidisciplinary sialorrhoea management strategies to meet the various needs of older adults with sialorrhoea. IMPLICATION FOR NURSING MANAGEMENT: It is important to minimize the negative impact of sialorrhoea on the patients. The recognition of issues associated with sialorrhoea provides constructive scope for the health care professionals to further investigate and develop more effective integrated sialorrhoea care protocols.

Exercise is more effective than health education in reducing fatigue in fatigued cancer survivors.

INTRODUCTION: Cancer-related fatigue is a most debilitating side effect reported by survivors, often lasting years following treatment. PURPOSE: To determine the effects of a 10-week exercise intervention compared with a health education intervention on fatigue, quality of life outcomes and functional fitness in cancer survivors with documented fatigue. METHODS: This quasi-experimental study allocated 37 post-treatment fatigued cancer survivors (33 female, 30 breast cancer, aged 55 ± 2 years, time since treatment 2.3 ± 0.3 years; mean ± SEM) to an exercise group (EX, n = 19) or health education comparison group (HE, n = 18). The EX intervention emphasised brisk walking with progressive increments, stretching, exercise education and self-efficacy enhancement. The HE intervention emphasised sleep management, nutrition and cognitive behavioural therapy. All participants were evaluated at pre- and post-intervention with EX followed up at 26 W. RESULTS: The intervention effect on fatigue (FACT-F) in EX was greater (p < 0.05) than that in HE, the difference being 4 times the recognised clinically important difference. The intervention also increased (p < 0.05) cognitive function, global quality of life and functional fitness scores. It reduced (p < 0.05) insomnia and fear of physical activity. All intervention effects were maintained to 26 W. The intervention effect on fatigue in EX was largely achieved by week 4. There was 100% retention rate at 10 W and no adverse events reported. CONCLUSIONS: There is a reduction of considerable magnitude in cancer fatigue from group-based exercise training, that is sustainable and attributable to exercise per se. IMPLICATIONS FOR CANCER SURVIVORS: Exercise training is feasible for fatigued cancer survivors and should form part of tailored rehabilitation programmes.

Developing a national undergraduate standardized curriculum for future healthcare professionals on "Making Every Contact Count" for chronic disease prevention in the Republic of Ireland.

This report describes the development of the first national undergraduate interprofessional standardized curriculum in chronic disease prevention for healthcare professionals in the Republic of Ireland. This project brought together for the first time all higher education institutions nationwide in a novel collaboration with the national health service i.e. the Health Service Executive (HSE), to develop a standardized national curriculum for undergraduate health care professions. The curriculum sits within the framework of Making Every Contact Count, the goal of which is to re-orientate health services to embed the ethos of prevention through lifestyle behavior change as part of the routine care of health professionals. The core focus of Making Every Contact Count is chronic disease prevention, targeting four main lifestyle risk factors for chronic disease; tobacco use, alcohol consumption, physical inactivity and unhealthy eating. Making Every Contact Count is a key component of Healthy Ireland, the Irish national framework for health and wellbeing. The aim of the curriculum is to prepare newly qualified health professionals with the skills needed to support patients to achieve lifestyle behavior change delivered as part of routine clinical care.

A systematic review of noninvasive and invasive sialorrhoea management.

AIMS AND OBJECTIVES: To review published literature pertaining to the management of sialorrhoea while also highlighting the significance of the multidisciplinary approach. BACKGROUND: Sialorrhoea is a common and troublesome problem among certain neurological patients. It is distressing for patients and caregivers, and can be challenging for healthcare professionals. Various sialorrhoea management approaches have been documented. However, there is no clear consensus on best management practices. Therefore, it is necessary to systematically review and synthesise various approaches so as to provide an understanding of the efficacy of management approaches. DESIGN: Systematic literature review using PRISMA checklist (see Appendix S1). METHOD: Five databases (ScienceDirect, Wiley Online Library, CINAHL, Cochrane Library and PubMed) were searched (years 2001-2018) following inclusion criteria. Out of 1,294 identified records, 29 studies met the inclusion criteria. RESULTS: Various management approaches identified, ranging from noninvasive, such as speech therapy aiming to enhance swallowing behaviour, to invasive treatment including anticholinergic medication, botulinum toxin injection and surgical techniques. However, in the majority of cases, there is no scientific evidence-based management protocol leading to favourable results, and the evidence base for intervention effectiveness remains weak. CONCLUSIONS: The multifactor nature of sialorrhoea and its associated complications presents challenges for the medical care team. None of the management strategies stand alone as the best modality; therefore, it is proposed that management strategies follow a multidisciplinary approach to meet the diverse needs of patients. RELEVANCE TO CLINICAL PRACTICE: A comprehensive understanding of different sialorrhoea management approaches will enable healthcare professionals to identify the signs and symptoms regarding sialorrhoea, and to assist in effective management implementation. This will help to improve the management of sialorrhoea, hence, to improve quality of life of patients and provide formative scope to the development of an integrated care pathway.

Running on empathy: Relationship of empathy to compassion satisfaction and compassion fatigue in cancer healthcare professionals.

OBJECTIVE: The aim of this study is to examine the relationship of empathy and professional quality of life in cancer healthcare professionals. METHODS: A Professional Quality of Life instrument measuring compassion satisfaction and compassion fatigue, and the Interpersonal Reactivity Index measuring empathy were distributed to healthcare professionals working in cancer care in the Republic of Ireland. Final analysis was conducted on 117 participants. RESULTS: A quarter of participants experience high levels of compassion satisfaction, and a quarter are at risk of compassion fatigue. A positive correlation was found between personal distress and compassion fatigue, and a negative correlation was found between personal distress and compassion satisfaction. A positive correlation was found between empathic concern and secondary traumatic stress. CONCLUSION: These findings suggest that healthcare professionals working in cancer care are at risk of compassion fatigue. Also, healthcare professionals working in cancer care experience personal distress that may impact negatively on professional quality of life. Implications for practice include a need to identify those HCPs who are at risk of compassion fatigue. The implication for further research suggests further exploration of the impact of personal distress felt by cancer healthcare professionals during empathic engagement.

Older adults' views on their person-centred care needs in a long-term care setting in Ireland.

BACKGROUND: person-centred care should be responsive to the needs of older adults in long-term care. It is central to collaborative and high-quality healthcare delivery. AIM: to explore the perceptions of older Irish adults aged 65 years of age or more regarding the person-centred climate of the long-term care setting in which they live. METHOD: a cross-sectional study design using the Person-centered Climate Questionnaire-Patient (PCQ-P) was used to survey 56 older adults in a long-term care setting. RESULTS: overall, residents considered the setting to be hospitable, welcoming, clean and safe; the mean (SD) scale score was 5.39 (0.520). Psychosocial concerns about adapting to living in long-term care environments need to be addressed, particularly among the younger male residents when compared with older male residents (53.8% v 86.7%, P=0.018). CONCLUSION: older people in long-term care may prioritise different facets of person-centredness to staff. Further research of approaches used in Irish older adult long-term person-centred care delivery is warranted.

Electronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review.

AIM: To review the evidence on the effects/impact of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. BACKGROUND: Electronic documentation has been recommended to improve quality care and patient safety. With the gradual move from paper-based to electronic nursing documentation internationally, there is a need to identify interventions that can effectively improve quality care and patient safety. EVALUATION: We conducted a systematic review on the effectiveness of electronic nursing documentation interventions on promoting or improving quality care and/or patient safety in acute hospital settings. KEY ISSUES: Six articles reporting on six individual studies met all eligibility criteria. They were uncontrolled pre/post intervention studies reporting positive impacts on at least one or more outcomes. Most outcomes related to documentation practice and documentation of content. CONCLUSION: Some evidence from our review indicates that implementing electronic nursing documentation in acute hospital settings is time saving, reduces rates of documentation errors, falls and infections. IMPLICATIONS FOR NURSING MANAGEMENT: A planned approach from management over time to allow nurses adapt to new electronic systems of documentation would seem a good investment in terms of efficiency of work time, possibly resulting in more time for clinical care.

Colorectal cancer survivors: an investigation of symptom burden and influencing factors.

BACKGROUND: Colorectal cancer is a significant issue internationally, with over 1.3 million people diagnosed annually. Survival rates are increasing as treatments improve, although physical symptoms can persist despite eradication of the tumour. In order to optimize survivorship care, further research is warranted in relation to symptom burden. Therefore, the objectives of this study are to (i) investigate frequency of physical symptoms in colorectal cancer survivors (ii) identify which symptoms occur together (iii) examine the associations between demographic and clinical variables, and symptoms. METHODS: Participants nine months to three years post diagnosis were identified from the population-based National Cancer Registry Ireland. Respondents completed the EORTC QLQ-C30 and EORTC QLQ-CR29. Reported physical symptom frequencies were transformed into continuous scale variables, which were then analysed using one way analysis of variance, general linear modelling and Spearman rank correlations. RESULTS: There were 496 participants. Fatigue, insomnia and flatulence were the most frequent symptoms, with ≥20% of respondents reporting these to be often present in the previous week. Eight other symptoms were experienced often by 10-20% of respondents. At least one of these eleven most common symptoms was experienced frequently by almost every respondent (99%). 66% of respondents experienced at least two of these symptoms together, and 16% experienced five or more together. Current stoma was the single most common variable associated with increased symptom scores, although statistically significant relationships (p ≤ 0.05) between symptom frequency scores and clinical/demographic variables were generally weak (R-sq value ≤0.08). CONCLUSION: Findings may inform targeted interventions during the nine month to three year post diagnosis timeframe, which would enable supported self-management of symptoms.

An exploration of paediatric nurses' views of caring for infants who have suffered nonaccidental injury.

AIMS AND OBJECTIVES: To explore paediatric nurses' views of caring for infants who have suffered nonaccidental injury. BACKGROUND: Children less than two years of age are at greater risk of serious abuse than those in any other age group. An infant's physical and mental immaturity makes them especially vulnerable. Abuse in this age group is often caused by a parent who does not report the abuse. The experience of caring for abused children is recognised as being both personally and professionally challenging. However, despite the increased risk of serious or fatal injury, caring for these infants who have suffered abuse is relatively unexplored. DESIGN: A qualitative research design using purposive sampling was adopted. The setting for this research was a paediatric unit in Ireland. METHOD: Semi-structured interviews were conducted with 10 paediatric nurses and data were analysed using the framework approach. RESULTS: Paediatric nurses' views of caring for infants who have suffered a nonaccidental injury were established under four main themes: (1) 'Personal impact', (2) 'Professional roles', (3) 'Nurse-client relationship' and (4) 'Resources'. CONCLUSION: Findings highlighted that the experience for the nurse is complex. Personal emotions are evoked and the experience influenced reflection on their own lives. Communication with the parents of the infant is often difficult. Professional relationships were sometimes hindered by poor sharing of information. However, nurses strived to maintain their professionalism and to provide nursing care for the infant and their parents that was holistic. Paediatric nurses relied heavily on each other for support and their nursing experience was a valuable resource for managing nonaccidental injuries. RELEVANCE TO CLINICAL PRACTICE: The general consensus was that a nurse could never fully be prepared to care for an infant who had suffered a nonaccidental injury. However, recommendations for future practice and education are identified and include frequent and practical education sessions.

Barriers to reporting medication errors and near misses among nurses: A systematic review.

OBJECTIVE: To explore barriers to nurses' reporting of medication errors and near misses in hospital settings. DESIGN: Systematic review. DATA SOURCES: Medline, CINAHL, PubMed and Cochrane Library in addition to Google and Google Scholar and reference lists of relevant studies published in English between January 1981 and April 2015 were searched for relevant qualitative, quantitative or mixed methods empirical studies or unpublished PhD theses. Papers with a primary focus on barriers to reporting medication errors and near misses in nursing were included. REVIEW METHODS: The titles and abstracts of the search results were assessed for eligibility and relevance by one of the authors. After retrieval of the full texts, two of the authors independently made decisions concerning the final inclusion and these were validated by the third reviewer. Three authors independently assessed methodological quality of studies. Relevant data were extracted and findings were synthesised using thematic synthesis. RESULTS: From 4038 identified records, 38 studies were included in the synthesis. Findings suggest that organizational barriers such as culture, the reporting system and management behaviour in addition to personal and professional barriers such as fear, accountability and characteristics of nurses are barriers to reporting medication errors. CONCLUSIONS: To overcome reported barriers it is necessary to develop a non-blaming, non-punitive and non-fearful learning culture at unit and organizational level. Anonymous, effective, uncomplicated and efficient reporting systems and supportive management behaviour that provides open feedback to nurses is needed. Nurses are accountable for patients' safety, so they need to be educated and skilled in error management. Lack of research into barriers to reporting of near misses' and low awareness of reporting suggests the need for further research and development of educational and management approaches to overcome these barriers.

Nursing implications: symptom presentation and quality of life in rectal cancer patients.

AIMS AND OBJECTIVES: To determine the changes in symptoms experienced by rectal cancer patients during preoperative chemoradiotherapy, with a specific focus on fatigue and to explore how symptoms impact the quality of life. BACKGROUND: Rectal cancer continues to be a healthcare issue internationally, despite advances in management strategies, which includes the administration of preoperative chemoradiotherapy to improve locoregional control. It is known that this treatment may cause adverse effects; however, there is a paucity of literature that specifically examines fatigue, symptoms and quality of life in this patient cohort. DESIGN: A prospective, quantitative correlational design using purposive sampling was adopted. METHODS: Symptoms and quality of life were measured with validated questionnaires in 35 patients at four time points. RESULTS: Symptoms that changed significantly over time as examined using rm-anova include fatigue, bowel function issues, nutritional issues, pain, dermatological issues and urinary function issues. Findings indicate that fatigue leads to poorer quality of life, with constipation, bloating, stool frequency, appetite loss, weight worry, nausea and vomiting, dry mouth and pain also identified as influencing factors on quality of life. CONCLUSION: Findings have highlighted the importance of thorough symptom assessment and management of patients receiving preoperative chemoradiotherapy, particularly midway through treatment, in order to optimise quality of life and minimise interruptions to treatment. RELEVANCE TO CLINICAL PRACTICE: Close monitoring of symptoms during preoperative chemoradiotherapy, particularly at week 4, will enable the implementation of timely interventions so that interruptions to treatment are prevented and the quality of life is optimised, which may hasten postoperative recovery times.

Predicting radiotherapy-related clinical toxicities in cancer: a literature review.

Assessment of patients receiving radiotherapy for cancer is essential, with the ability to identify those who may be more likely to experience radiotherapy-related side effects noted as an important issue for nurses. Body mass, age, and radiation dose may be predictive factors for the development of such side effects. This review considers these factors and how nurses can use this evidence to inform their care, with results indicating that the dose of radiation, the site treated, and body mass index are predictive of toxicities that may develop. Increased awareness of these predictive factors will aid nurses in identifying patients at greater risk of developing radiation-related side effects. This will assist in guiding nursing interventions, as well as enabling the individualization of patient education, by placing greater emphasis on preventive measures for patients who are more vulnerable to the development of radiation-related toxicities.

Breast cancer in younger women from diverse cultural backgrounds.

Research identifies unique challenges for younger women diagnosed with breast cancer at or before 45 years of age. This paper explores the experiences of younger women from diverse cultural backgrounds with breast cancer to see if there are differing healthcare provision needs across cultures. Sandelowski and Barroso's framework for undertaking a meta-synthesis is used in this paper. Initial searches in academic databases returned 42 papers of interest. Re-reading the papers in the context of the research question identified 12 studies which met the inclusion criteria. Five key themes were identified in these 12 studies. The overarching finding is that, irrespective of cultural background, the confrontation with breast cancer transforms the younger woman's life. It seems that healthcare provision needs do not differ substantially across cultures. Health professionals should address the unique psychosocial effects of cancer in the context of the lifestage of the woman.

Cancer screening in women with intellectual disabilities: an Irish perspective.

In the Republic of Ireland, more than 8000 women with intellectual disabilities (IDs), aged 20 years and over, are registered for service provision. Their health needs challenge preventative health services including breast and cervical cancer screening programmes. This review explores the literature about cancer screening participation rates and issues related to screening for Irish women with IDs. Low cancer screening participation rates are evident in Irish women with IDs; and the women shed light on the barriers they perceive related to the screening experience. These experiences are reflected in the international literature for women with IDs. Further research involving the assessment of the breast and cervical cancer awareness in Irish women with IDs and their participation in cancer screening programmes is recommended. Strategies are required to increase their participation in screening programmes that may lead to the earlier diagnosis with better outcomes.