Perceptions of nursing workloads and contributing factors, and their impact on implicit care rationing: A Queensland, Australia study.

AIMS: To explore nurses' perceptions of factors affecting workloads and their impact on patient care. BACKGROUND: Fiscal restraints and unpredictable patient illness trajectories challenge the provision of care. Cost containment affects the number of staff employed and the skill-mix for care provision. While organisations may acknowledge explicit rationing of care, implicit rationing takes place at the point of service as nurses are forced to make decisions about what care they can provide. METHOD: A self-report cross sectional study was conducted using an on-line survey with 2,397 nurses in Queensland, Australia. RESULTS: Twenty to forty per cent reported being unable to provide care in the time available; having insufficient staff; and an inadequate skill-mix. The respondents reported workload and skill-mix issues leading to implicit care rationing. Over 60% believed that the processes to address workload issues were inadequate. CONCLUSIONS: Institutional influences on staffing levels and skill-mix are resulting in implicit care rationing. IMPLICATIONS FOR NURSE MANAGERS: Adequate staffing should be based on patient acuity and the skill-mix required for safe care. Managers should be more assertive about adequate clinical workloads, involve staff in decision-making, and adopt a systematic planning approach. Failure to do so results in implicit care rationing impacting on patient safety.

Action research: changing nursing practice.

This article describes action research as a methodology and gives two examples of its application to nursing and health services research. Action research is cyclical in nature and involves the development, evaluation and redefining of an action plan using four basic steps: planning, action, observation and reflection. These cycles of action continue until the research group is satisfied that its objectives have been met. Data generation and analysis are iterative processes that occur continuously throughout the project, which is usually time-limited. Factors that should be taken into account to ensure success include: engaging the community, consideration of 'insider' versus 'outsider' perspectives, competing agendas, expectations not being met and the integrity of the research methodology.

Exploring the meaning of hypoglycaemia to community-dwelling Singaporean Chinese adults living with type 2 diabetes mellitus.

This study aimed to explore how community-dwelling Singaporean Chinese adults diagnosed with type 2 diabetes mellitus experience hypoglycaemia. A qualitative interpretive research design was employed. Semi-structured interviews were conducted with six participants from a Singaporean diabetes specialist outpatient clinic, transcribed verbatim and analysed using qualitative manual thematic analysis. Eight major themes emerged: experiencing symptoms, knowing hypoglycaemia is manageable, using acute measures, using preventative strategies; applying knowledge, identifying causes of hypoglycaemia, forming relationships and working with health-care professionals. Participants underestimated the impact of hypoglycaemia mainly due to their experiencing mild and infrequent episodes, and knowledge deficits. Health-care professionals' roles were limited to information providers, and they were perceived as detached and impersonal. Theimplications are that health-care professionals need to provide more client-focused education, and improve the quality of their interpersonal relationships to ensure shared decision-making with their clients.

Patients' experiences on donation of their residual biological samples and the impact of these experiences on the type of consent given for the future research use of the tissue: a systematic review.

AIM: This review aimed to critically appraise, synthesise and present the best available evidence related to the experiences of patients who have donated their residual biological samples and the impact of this experience on the type of consent given for future research use of these tissues. METHOD: The three-step search strategy aimed to find both published and unpublished studies published in English between 1990 and 2010 in electronic databases (PubMed, CINAHL, Scopus, Embase, PsycINFO, Mednar, PROQUEST). Using the standardised data extraction tool from the Joanna Briggs Institute, the Qualitative Assessment and Review Instrument, 131 findings were extracted from the 18 papers included in this review. These findings generated 19 categories and four synthesised findings. RESULTS: The synthesised findings generated were related to the different stages of the handling of leftover tissue. The first synthesised finding: patient consent to the use of leftover tissue is a complex interaction between many factors and not solely driven by perceptions of benefits to self or others, relates to the collection of the leftover tissue - the initial consent process. The second synthesised finding: healthcare institutions and regulatory authorities must provide clear and transparent safeguards and controls, and communicate these to the patient prior to the consenting process, outlines the issues affecting consent during the processing and storage of the tissues in biobanks or research institutions. The third synthesised finding: views on ownership and rights to the further use of the leftover tissue varies between individual patients and influences their willingness to consent to further use, demonstrates the concerns relating to the safeguards on the collection and storage of leftover tissue. The fourth synthesised finding: patients have opposing views on the use of their leftover tissue for commercial purposes, reflecting the differing community beliefs around using leftover tissue for research which may provide a commercial benefit to some, but not all, the community. CONCLUSION: For leftover tissues to be used, patients must clearly understand: the type of consent they are providing (opt in or opt out); the parameters for the future research use of their leftover tissues; the safeguards put into place to protect the individual and the donated tissue from unethical use; and the commercial implications of their consent. IMPLICATIONS FOR PRACTICE: This review provides information on patient's experiences on the collection, storage, distribution and future use of leftover tissue. These preferences need to be understood when designing a prospective model of consent regimen which respects patient's confidentiality and wishes. The information in this review is especially important for policy-makers designing a prospective model of consent regimen for the use of existing and previously collected biological samples with no consent taken. IMPLICATIONS FOR RESEARCH: Further research is needed to ascertain what factors specifically influence patient's willingness to consent for the use of leftover tissue. Factors for further exploration include the effects of culture, religion and age. Additionally, further research is required to inform the development of specific consent regimes for the use of leftover tissue for commercial, stem cell and genetic research.

The impact of knowledge and beliefs on adherence to cardiac rehabilitation programs in patients with heart failure: A systematic review.

BACKGROUND: Heart failure is a global health problem which affects a large percentage of the older population. Cardiac rehabilitation programs have been implemented to aid patients in successfully managing their heart condition. However, non-adherence to cardiac rehabilitation programs is common in this group of patients. This results in higher morbidity and mortality rates, rehospitalisation and ultimately higher healthcare costs. There is a need to have a better understanding of the impact that knowledge and beliefs have on patients' adherence levels, so that healthcare providers can implement appropriate strategies to promote their adherence. OBJECTIVES: This review aimed to establish the best evidence regarding the impact of knowledge and beliefs on adherence to cardiac rehabilitation programs in patients with heart failure; and to make recommendations for healthcare practice and future research. INCLUSION CRITERIA: Patients above the age of 18, who had been diagnosed with heart failure and had been admitted to a cardiac rehabilitation program in inpatient or outpatient settings.This review considered studies that evaluated the impact of heart failure patients' knowledge and beliefs of their disease, medication, diet, exercise and other lifestyle change recommendations, on their adherence to cardiac rehabilitation programs.Heart failure patients' knowledge, beliefs and adherence toward their medication regime, low-sodium diet, exercise, and other lifestyle change recommendations.Quantitative study designs published in the English language, up to December 2010 were considered for inclusion. SEARCH STRATEGY: Using a three-step search strategy, the following databases were assessed: CINAHL, PubMed, SCOPUS, Web of Science, OvidSP, MDConsult, ScienceDirect, Sociological Abstracts, Mosby's Nursing Consult, Mednar and TRIP. METHODOLOGICAL QUALITY: Two independent reviewers assessed each paper for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute. DATA EXTRACTION: Information was extracted by two independent reviewers, from each paper using the standardised data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS: The findings are presented in narrative form, as statistical pooling was not possible, due to the different instruments used in measuring the outcomes. RESULTS: Twelve quantitative studies were included in this review (one RCT, one pre-test/post-test single group study, and ten descriptive studies). The present findings suggest that the relationship between knowledge and adherence is unclear. However, patient beliefs on medication, symptom monitoring, illness and control were found to have stronger associations of adherence to cardiac rehabilitation programs.Implications for practice Healthcare institutions need to provide adequate support for patients with heart failure; individualise adherence-enhancing interventions to cater for varying patient needs; and work on empowering patients.Implications for research Future quantitative research should be undertaken to investigate the relationship between knowledge and beliefs, determine their combined effect on adherence and examine the effectiveness of strategies used to improve patient knowledge and beliefs. Quantitative and qualitative studies could also be conducted to ascertain the factors correlated with patient knowledge, beliefs, and adherence.

Comprehensive systematic review of healthcare workers' perceptions of risk and use of coping strategies towards emerging respiratory infectious diseases.

AIM: To determine healthcare workers' perceptions of risk from exposure to emerging acute respiratory infectious diseases and the perceived effectiveness of strategies used to facilitate healthy coping in acute hospital and community healthcare settings. METHODS: Electronic databases (Cumulative Index to Nursing and Allied Health Literature, Ovid, PubMed, ScienceDirect, Scopus and Wiley InterScience) were searched using a three-step search strategy to identify the relevant quantitative and qualitative studies published in English from 1997 to 2009. The grey literature was not included in the review. The identified studies were evaluated using the Meta-Analysis of Statistics, Assessment and Review Instrument and the Qualitative Assessment and Review Instrument from the Joanna Briggs Institute. Fourteen quantitative studies were included and the findings included in a narrative summary. The findings from the two qualitative studies were categorised into a meta-synthesis that generated two synthesised findings. RESULTS: Findings indicated that healthcare workers perceived personal and familial health risks and stigmatisation from their exposure to emerging acute respiratory infectious diseases, but the majority were accepting of these risks. Organisational implementation of infection control measures, avoidance of patients and complying with personal protective equipment were identified as risk-mitigating strategies. Demographic, individual and organisational factors were found to influence their risk perceptions and their adoption of strategies to mitigate the risk. CONCLUSIONS: It appears that healthcare workers' risk perceptions can influence their behaviour towards patients with emerging acute respiratory infectious diseases as well as their use of risk-mitigating strategies. Institutions need to ensure that appropriate infection control safeguards are in place to protect workers and their families. Institutions can also offer incentives to encourage healthcare workers to comply with the policies and procedures introduced to mitigate risk. IMPLICATIONS FOR PRACTICE: Institutions and government need to ensure that policies and procedures are communicated and adequate institutional measures (i.e. personal protective equipment; education and training; and personal support) are implemented to safeguard healthcare workers during and after pandemic outbreaks. IMPLICATIONS FOR RESEARCH: Future research needs to examine how perception of risk related to acute emerging respiratory infectious diseases, epidemic or pandemic, and the factors that would influence healthcare workers': decisions to stay within the workforce and provide care or resign from the workforce and compliance with institutional and government policies and procedures, as well as compliance to use of personal protective equipment.

Effectiveness of educational interventions to raise men's awareness of bladder and bowel health.

BACKGROUND: Urinary incontinence is a common health problem with significant medical, psychological and economic burdens. Health education is capable of improving perceptions about and attitudes towards incontinence in turn encouraging them to seek help. AIM: The aim of the present study was to determine the effectiveness of educational interventions at raising men's awareness of bladder and bowel health. INCLUSION CRITERIA: Types of participants. Adult and adolescent men (age 12 years and over) and it was anticipated that some interventions/promotions may be directed at family members or carers of, and health professionals caring for, adult men and therefore these would also be considered for inclusion. Types of intervention. Any intervention, program or action that provided information, or attempted to raise awareness of men's bladder and bowel health. Type of outcome. Any measure defined by included studies such as: bladder and bowel management and treatment, increased knowledge of bladder and bowel health and number of attendees at promotion. Type of studies. Concurrent controls, such as: systematic reviews of concurrently controlled trials, meta-analysis, randomised controlled trials, controlled clinical trials, interrupted time series and controlled before after designs and observational design (cohort, case-control). Search strategy. A search for published and unpublished studies in the English language was undertaken restricted by a publication date of 10 years prior, with the exception of a review of seminal papers before this time. METHODOLOGICAL QUALITY: Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments. DATA COLLECTION AND ANALYSIS: Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. For two studies with similar population types, interventions and outcomes quantitative results were combined into a meta-analysis using Revman 5.0 software. However, the majority of studies were heterogenous and results are presented in a narrative form. RESULTS: With the exception of instruction for pelvic floor muscle exercises for men after prostatectomy, little quantitative research has been performed that establishes the effectiveness of interventions on men's awareness of bladder and bowel health. While numerous interventions have been trialled on mixed gender populations, and these trials suggest that the interventions would be effective, their effectiveness on the male component cannot be definitively established. CONCLUSION: There is little quantitative evidence for the effectiveness of interventions to improve men's awareness of bladder and bowel health therefore few recommendations can be made. Well-designed controlled trials using male sample populations only are needed.

A qualitative systematic review on the experiences of self-management in community-dwelling older women living with chronic illnesses.

BACKGROUND: With the risk of chronic conditions increasing with age, older women are likely to have co-morbid chronic conditions. In addition, they may have to contend with socioeconomic issues unique to their gender which can challenge their self-management. OBJECTIVE: The aim of the systematic review was to determine the best available evidence related to the experiences of self-management among community-dwelling older women with chronic conditions, specifically non-communicable illnesses which include cardiovascular disease, chronic respiratory diseases, diabetes mellitus and arthritis. INCLUSION CRITERIA: Types of participants included all older women with the following characteristics: aged sixty-five years and above; living in their own community dwellings; community setting rural, suburban or urban; living alone or with others; having co-morbidities and having chronic illnesses for a minimum of one year. Phenomenon of interest was experiences of self-management among community-dwelling older women with chronic conditions. Interpretive studies were considered in the review, which included but were not limited to designs like phenomenology, grounded theory, action research, feminist research and ethnography. SEARCH STRATEGY: The search strategy aimed to uncover both published and unpublished studies, in English language only, and was unrestricted by time. The databases searched included CINAHL, MEDLINE, PsycINFO (Ovid), Scopus, Embase, Science Direct, Sociological Abstracts, Social Sciences Citation Index (Web of Science), Proquest and Google Scholar. Preliminary keywords were drawn from the topic of the systematic review. METHODOLOGICAL QUALITY: Each paper was assessed independently by two reviewers for methodological quality. The Joanna Briggs Institute Qualitative Assessment and Review Instrument QARI Critical Appraisal Checklist for Interpretive & Critical Research was used to appraise the methodological quality of all papers. DATA COLLECTION: Qualitative data were extracted from papers included in the review using standardized data extraction tools developed by the Joanna Briggs Institute. DATA SYNTHESIS: Qualitative research findings were synthesized using the Joanna Briggs Institute-Qualitative Assessment and Review Instrument. RESULTS: 88 findings from six studies were aggregated into 22 categories, and then into five synthesized findings. The five synthesized findings are: (i) losing control over a failing body, (ii) maintaining control, (iii) developing self-expertise, (iv) re-defining health, and (v) relying on social support. CONCLUSIONS: For these women, self-management involves reclaiming and maintaining their sense of control over their bodies, which is constantly threatened by their chronic illnesses. In addition, they redefine their meaning of health in the context of illness to maintain their emotional well-being in spite of their illness.Healthcare providers can assist their older female patients in maintaining their sense of control through effective symptom management and practical strategies to manage daily life. Because social support is crucial to self-management by older women, healthcare providers should include, where relevant, family members and other loved ones in patient education. Healthcare providers should also endeavour to build and maintain a positive relationship with their patients through effective communication as the provider-patient relationship is a strong influence on an older woman's experience in self-management.Further research is warranted in older women of other cultural backgrounds as the majority of reviewed studies focused on Caucasians in the United States.

Quality of life in women during and after treatment for breast cancer: a systematic review of qualitative evidence.

EXECUTIVE SUMMARY: Background Breast cancer is the most common cancer in women. With increasing numbers of women surviving breast cancer, there is a need to move beyond the traditional ways of evaluating clinical outcomes and include patient-based outcomes such as the quality of life.Objectives To integrate and summarise the best evidence related to the quality of life of women diagnosed with breast cancer during and up to ten years after treatment for breast cancer. INCLUSION CRITERIA: Types of participants: Adult women (over the age of 18 years) diagnosed with breast cancer who are or have received treatment for breast cancer in the last ten years (i.e. surgery, chemotherapy, radiation therapy and/or hormonal therapy). PHENOMENA OF INTEREST: The quality of life of women diagnosed with breast cancer during and up to ten years after treatment. CONTEXT: Women with breast cancer from both developed and developing countries.Types of studies: Studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory and ethnography, action research and feminist research.Search strategy The search sought to find both published and unpublished studies between 1990 and 2010, limited to the English language. Eleven electronic databases were searched including CINAHL, PubMed, Scopus and PsycArticles.Methodological quality Methodological quality was assessed independently by two reviewers using a standardised critical appraisal instrument from the Joanna Briggs Institute.Data extraction Qualitative data were extracted from the included studies using a standardised data extraction tool from the Joanna Briggs Institute. RESULTS: A total of 42 findings from seven qualitative studies were extracted and rated as unequivocal or credible. Eleven categories were produced. Three synthesised findings were generated based on the meta-aggregation of the categories: (1) "effective care for patients will be achieved if clinicians are aware of the impact of breast cancer and its treatment on the physical and psychosocial domains of women's quality of life"; (2) "for effective patient-centred care, clinicians must be cognisant of the ways breast cancer and its treatment modalities affect social relationships"; (3) "clinicians should be aware that women use religion and spirituality to cope with breast cancer treatment and improve their quality of life". CONCLUSIONS: This review concludes that the breast cancer diagnosis and its treatment can have a significant effect on several domains of women's quality of life. Healthcare providers caring for patients need to be well informed about each individual woman's physical and psychosocial concerns and be cognisant that any attempt to offer support must be targeted to meet the specific challenges faced by each individual woman. IMPLICATIONS FOR PRACTICE: Support and guidance could be provided by healthcare providers through the use of counselling services, psycho-education and organisation of support groups. Elements of counselling and psycho-education should include, when appropriate, joint sessions with the woman's spouse/partner. As spirituality emerged as a coping mechanism, it is important that women be able to nurture their spiritual relationship in an environment which is supportive. IMPLICATIONS FOR RESEARCH: The lack of studies within the Asian context indicates that further research is warranted to examine the impact of breast cancer and its treatment on the quality of life of women from diverse multi-ethnic populations. Further research into self-help strategies to improve the psychosocial well-being of women with breast cancer is warranted.It is noted that when faced with adversity, women seek comfort in religion and spirituality and a study into the relationship between spirituality and quality of life, as well as the effect of culture and religion on the quality of life, is warranted.

The Experience of Hypoglycaemia and Strategies Used For Its Management by Community-Dwelling Adults with Diabetes Mellitus: A Systematic Review.

BACKGROUND: Hypoglycaemia, a common complication of diabetes drug therapy, has been reported to influence therapy adherence and the quality of life of people with diabetes mellitus. No systematic reviews on the experience of hypoglycaemia have been undertaken. The extant literature has taken a medical model perspective focusing on the causes, prevalence, and impact of hypoglycaemia. To understand the meaningfulness of hypoglycaemia and how this condition impacts on a person with diabetes mellitus, a systematic review was undertaken exploring the experiences of hypoglycaemia in community-dwelling people with diabetes mellitus. OBJECTIVE: This review aimed to synthesise evidence on the experience of hypoglycaemia, and the strategies used to control it in community-dwelling adults with type 1 and type 2 diabetes mellitus. INCLUSION CRITERIA: Type of Participants - Community-dwelling adults (18 years of age and over) who had experienced hypoglycaemia from type 1 or type 2 diabetes mellitus and/or who had used self-management strategies for hypoglycaemia were included.Phenomena of Interest - The experiences of hypoglycaemia in community-dwelling adults with diabetes mellitus and the strategies they used to self-manage hypoglycaemia were included.Type of Studies - Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were included. SEARCH STRATEGY: Published and unpublished studies in English from January 2000 to August 2010 were gathered using a three-step search strategy. An initial limited search was conducted in MEDLINE and CINAHL to identify keywords and index terms, which were then used in a second search across the CINAHL, PUBMED, SCOPUS, PsycINFO, PsycARTICLES, Web of Science, JSTOR, EMBASE and MEDNAR databases. Additionally, the reference list of all studies was hand-searched for additional studies. METHODOLOGICAL QUALITY: Two reviewers independently assessed the retrieved studies for methodological validity, using standardised Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI) critical appraisal instruments. Disagreements that arose between the two reviewers were resolved with the help of a third reviewer. DATA COLLECTION: Data, in terms of research findings, were extracted from included studies using the standardised JBI-QARI data extraction tool. DATA SYNTHESIS: These findings were then pooled and assembled into level 1 findings, then level 2 findings (categories), and lastly meta-synthesised to form one level 3 synthesised finding. Meta-aggregation was carried out using JBI-QARI. RESULTS: Six studies were included in the review. Participants who lived independently in the community and attended primary care or outpatient clinics were included. In total, twenty findings were grouped into three categories, which were synthesised into one overall finding - i.e., "People with diabetes mellitus can self-manage their diabetes and thus prevent hypoglycaemic episodes more effectively when health professionals provide psychological, physiological and spiritual support, and an individually targeted education programme". CONCLUSIONS: The review findings revealed patient-identified priorities to maintain normality in blood glucose self-management. There is also evidence that some people lack the knowledge to identify and self-manage hypoglycaemia.To enable community-dwelling adults with diabetes mellitus to self-manage hypoglycaemia, healthcare professionals should provide individualised information and emotional support, and regularly discuss and assess the person's level of knowledge, awareness of hypoglycaemia, and their ability to self-manage.There is a lack of data that capture the person's experience and awareness of hypoglycaemia and how they self-manage the condition, particularly in varying cultural contexts. A mixed-method study could be designed to explore the experiences of hypoglycaemia, and to develop and validate a reliable tool that assesses the level of knowledge and awareness of hypoglycaemia, and the ability to self-manage. This study should include people with diabetes mellitus from different cultures and/or geographical locations.

Patients' experiences towards the donation of their residual biological samples and the impact of these experiences on the type of consent given for secondary use: A systematic review.

EXECUTIVE SUMMARY: Background Residual or leftover clinical tissues are valuable resources for biomedical research. There is on-going discussion about the methodological, legal, and ethical issues on the collection, storage and use of these tissues for future research. This systematic review will consider qualitative studies previously conducted, which report on patients' preferences, experiences and willingness to donate their tissues.Objectives The aim of this review was to critically appraise, synthesize and present the best available evidence related to the experiences of patients toward consent when donating their leftover tissue for research.Search strategy The search strategy aimed to find both published and unpublished studies. A three-step search strategy was utilized. An initial limited search of MEDLINE and CINAHL was undertaken, followed by analysis of text words contained in the title and abstract, and of the index terms used to describe the article. A second search using all identified keywords and index terms was then undertaken across all included databases. Thirdly, the reference lists of all identified reports and articles were searched for additional studies.Data collection & analysis The standardised data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) was used to extract data from each paper. The qualitative research findings were presented as thematic pooling using the JBI-QARI approach in a narrative form. During the analysis, 131 study findings from 18 publications were aggregated into 19 categories to form four synthesized findings.Main results The synthesized findings generated were: (1) Healthcare professionals should be aware that patients' consent to the use of their left-over tissues are influenced by many and varied factors. Primarily these factors included: benefits to self and other and trust in research and researchers; (2) Healthcare institutions and regulatory authorities must provide strict safeguards and controls in order to maintain privacy and confidentiality of the patients; (3) Healthcare professionals should be aware that the views on ownership and rights to the tissues will vary between individual patients; (4) Healthcare professionals, institutions and regulatory authorities should be aware that patients have different views on the commercial use of their tissues.Discussion Patients would prefer that institutions requesting donation of leftover tissues establish a good governance system for the collection and storage of tissues, as well as a system for protecting the rights and confidentiality of patients. Most patients prefer to have an ethical and effective system, which decides the future use of their tissues, especially when a full informed consent is not obtained from the patients at time of donation and subsequent use.Implications for Practice The results from this review can assist researchers and policy makers to understand the experiences of patients and their attitudes and preferences on the collection, storage, distribution and use of their leftover tissue for research. This is especially so when designing a prospective model of consent regimen, to respect patients' needs and make recommendations for the use of existing and previously collected biological samples with no consent taken.Implications for Research Further qualitative research can be undertaken to ascertain patients' expectations when they donate their tissues; the type of consent model to be used; the perceived risks of genetic and stem cells research; and the effects of culture, religion and age on patients' willingness to donate their leftover tissues for future research.

A systematic review on the factors affecting effective communication between registered nurses and oncology adult patients in an inpatient setting.

BACKGROUND: Effective nurse-patient communication is essential in the development of therapeutic relationships and meeting the cognitive and affective needs of oncology patients. However, the emotional load in cancer nursing has made communication additionally challenging. OBJECTIVE: This review aimed to establish the best available evidence regarding the factors affecting effective communication between registered nurses and adult oncology patients in inpatient setting. INCLUSION CRITERIA: Types of participants This review considered studies that included registered nurses and inpatient oncology adults who were more than 21 years of age. This review considered studies carried out in inpatient settings, regardless of ward specialty, whilst active or palliative cancer treatments were administered.Phenomena of interest This review considered the factors affecting effective communication between registered nurses and inpatient oncology adults.Types of studies This review considered both quantitative (randomized controlled trials, non-randomized controlled trials, before and after studies, cohort observational, descriptive survey and mixed method studies) and qualitative (including, but not limited to, phenomenology, grounded theory and ethnography) research studies on the factors affecting effective communication between registered nurses and inpatient oncology adults.Search strategy The search strategy aimed to find studies published in English language and not limited by year of publication. A three-step search strategy was utilized in each component of this review. The grey literature was not included in this review. DATA EXTRACTION: Quantitative data were extracted using standardized data extraction tools adapted from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Qualitative data were extracted using the standardized data extraction tool from the Joanna Briggs Institute-Qualitative Assessment and Review Instrument (JBI-QARI). DATA ANALYSIS: Quantitative data were presented in a narrative summary. Qualitative findings were categorised using JBI-QARI tool to generate synthesised findings. RESULTS: One quantitative, two mixed method and four qualitative studies were included in this review. Combined findings of the narrative summary and meta-synthesis identified promoting and inhibiting factors in the characteristics of nurses, patients, and the environment. Promoting factors in nurses included genuineness, competency and supportive facilitation skills. However, the role of post-basic training in improving communication remained inconsistent. In patients, active participation in their own care and information-seeking behaviour promoted nurse-patient communication. Conversely, inhibiting factors in nurses included task orientation, fear of own death and low self-awareness of own verbal behaviours. Nurses also communicated less effectively during psychological assessments and emotionally-charged situations. For patients, their unwillingness to discuss the disease/feelings, their preference to seek emotional support from family and friends and the use of implicit cues inhibited effective communication. Environmentally, a supportive ward environment increased the use of facilitative behaviour in nurses, whereas the existence of conflict among staff increased the use of blocking behaviours. Cultural norms in the Chinese society also inhibited nurse-patient communication. CONCLUSION: Within the constraints of the study and the few quality papers available, it appears that personal characteristics of patients and nurses are the key influencing factors of effective nurse-patient communication in the oncology setting. Very little evidence exists on the role of environment in effective nurse-patient communication, particularly within an Asian setting. IMPLICATIONS FOR PRACTICE: Using evidence from the quantitative component of the review, nurses need to focus on the mental health status of patients admitted with a recurrence of cancer. Education programs can be implemented to inform nurses about the challenges in communication and develop strategies to counter these obstacles. Using evidence from the qualitative component of the review, nurses should build rapport and encourage active patient participation in their care in order to enhance patient disclosure. Nurses should also be mindful of patients' psychological readiness to communicate and respect their preference as to whom they wish to share their thoughts/emotions with. Institutions need to design ward structures (ward culture and nurses' workload) that support and/or encourage nurses to be person-oriented and take responsibility for providing holistic care to patients. Both the quantitative and qualitative components of the review indicated the need to improve nurses' communication skills and their receptivity to patient cues. IMPLICATIONS FOR RESEARCH: An explorative descriptive study on the effect of the Asian culture on the effective communication in the oncology setting is required to add to the small amount of knowledge in this area. Descriptive or mixed method studies to ascertain the effect of the patient's age and place within the oncology treatment cycle are also warranted. The lack of evidence on the effectiveness of post-basic communication courses would be best gathered by a descriptive study, followed by a before-and-after randomised controlled trial to test different education programs.