Effectiveness of resilience interventions among cancer patients - A systematic review, meta-analysis, and meta-regression of randomised controlled trials.

PURPOSE: This systematic review, meta-analysis and meta-regression aimed to (1) evaluate the effects of resilience interventions on cancer patients' resilience and posttraumatic growth and (2) identify essential contents and features of resilience interventions. METHODS: A systematic review, meta-analysis, and meta-regression analyses were conducted. Published and unpublished randomised controlled trials evaluating the effects of resilience interventions among cancer patients were retrieved from nine databases, trial registries, and grey literature. The mean and standard deviation scores were used to compute the effect sizes. RESULTS: 23 randomised controlled trials comprising 3287 cancer patients were included. The random effects model found that resilience interventions had beneficial impacts on patients' resilience, posttraumatic growth, quality of life, anxiety, and depressive symptoms with moderate to large effects. The subgroup analyses concluded that theoretically guided interventions that adopted synchronous communication delivered physically had greater effect sizes. Interventions comprising skills that promote patients' cognitive flexibility, self-efficacy, self-esteem, self-regulation, and coping had greater effect in comparison with interventions lacking these components. The meta-regression analyses revealed that sample size has a significant effect on posttraumatic growth scores. More well-designed trials are needed to confirm the effects of resilience interventions. CONCLUSIONS: There is merit in utilizing resilience interventions to improve cancer patients' resilience and psychological well-being. Resilience interventions should be incorporated into the routine care for cancer patients and survivors.

The global prevalence of overweight and obesity among nurses: A systematic review and meta-analyses.

BACKGROUND: Several studies have reported the prevalence of overweight and obesity in various countries but the global prevalence of nurses with overweight and obesity remains unclear. A consolidation of figures globally can help stakeholders worldwide improve workforce development and healthcare service delivery. OBJECTIVE: To investigate the global prevalence of overweight and obesity among nurses. DESIGN: Systematic review with meta-analysis. SETTING: 29 different countries across the WHO-classified geographical region. PARTICIPANTS: Nurses. METHODS: Eight electronic databases were searched for articles published from inception to January 2023. Two independent reviewers performed the article screening, methodological appraisal and data extraction. Methodological appraisal was conducted using Newcastle-Ottawa Scale (NOS). Inter-rater agreement was measured using Cohen's Kappa. Meta-analyses were conducted to pool the effect sizes on overweight, obesity and waist circumference using random effects model and adjusted using generalised linear mixed models and Hartung-Knapp method. Logit transformation was employed to stabilise the prevalence variance. Subgroup analyses were performed based on methodological quality and geographical regions. Heterogeneity was assessed using the I2 statistic. RESULTS: Among 10,587 studies, 83 studies representing 158,775 nurses across 29 countries were included. Based on BMI, the global prevalence of overweight and obesity were 31.2% (n = 55, 95% CI: 29%-33.5%; p < .01) and 16.3% (n = 76, 95% CI: 13.7%-19.3%, p < .01), respectively. Subgroup analyses indicated that the highest prevalence of overweight was in Eastern Mediterranean (n = 9, 37.2%, 95% CI: 33.1%-41.4%) and that of obesity was in South-East Asia (n = 5, 26.4%, 95% CI: 5.3%-69.9%). NOS classification, NOS scores, sample size and the year of data collected were not significant moderators. CONCLUSIONS: This review indicated the global prevalence of overweight and obesity among nurses along with the differences between regions. Healthcare organisations and policymakers should appreciate this increased risk and improve working conditions and environments for nurses to better maintain their metabolic health. PATIENT OR PUBLIC CONTRIBUTION: Not applicable as this is a systematic review. REGISTRATION: PROSPERO (ref: CRD42023403785) https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=403785. TWEETABLE ABSTRACT: High prevalence of overweight and obesity among nurses worldwide.

Experiences of simulation-based learning among undergraduate nursing students: A systematic review and meta-synthesis.

OBJECTIVES: We aimed to examine the experiences of simulation-based learning (SBL) among undergraduate nursing students. DESIGN: We conducted a systematic review and meta-synthesis on the experiences among undergraduate nursing studies who received SBL. DATA SOURCES: We searched through six databases namely PubMed, CINAHL, Scopus, Web of Science, Embase, ProQuest, for qualitative studies published from January 2011 to January 2022. REVIEW METHODS: A meta-synthesis was conducted according to the three-stage framework outlined by Thomas and Harden (2008). Critical appraisal was performed using the Critical Appraisal Skills Program (CASP) checklist. A standardised data extraction form was developed with reference from JBI Qualitative Assessment and Review Instrument Data Extraction Tools for Qualitative Research (JBI-QARI) checklist for data extraction. RESULTS: Fifteen studies were included, and four themes emerged from the synthesis: (1) acquiring knowledge and skills through SBL; (2) positive experiences of using high-fidelity simulation (HFS) and virtual reality simulation (VRS) methods; (3) challenges encountered while using SBL methods and (4) drawing parallels between simulation and real clinical settings. CONCLUSION: SBL allowed undergraduate nursing students to gain knowledge, acquire skills and have a positive SBL experiences. However, the provision of innovative strategies and resources for nursing students to overcome SBL-based challenges are still needed.

The perspectives of health professionals and patients on racism in healthcare: A qualitative systematic review.

OBJECTIVE: To understand racial bias in clinical settings from the perspectives of minority patients and healthcare providers to inspire changes in the way healthcare providers interact with their patients. METHODS: Articles on racial bias were searched on Medline, CINAHL, PsycINFO, Web of Science. Full text review and quality appraisal was conducted, before data was synthesized and analytically themed using the Thomas and Harden methodology. RESULTS: 23 articles were included, involving 1,006 participants. From minority patients' perspectives, two themes were generated: 1) alienation of minorities due to racial supremacism and lack of empathy, resulting in inadequate medical treatment; 2) labelling of minority patients who were stereotyped as belonging to a lower socio-economic class and having negative behaviors. From providers' perspectives, one theme recurred: the perpetuation of racial fault lines by providers. However, some patients and providers denied racism in the healthcare setting. CONCLUSION: Implicit racial bias is pervasive and manifests in patient-provider interactions, exacerbating health disparities in minorities. Beyond targeted anti-racism measures in healthcare settings, wider national measures to reduce housing, education and income inequality may mitigate racism in healthcare and improve minority patient care.

The unspoken reality of gender bias in surgery: A qualitative systematic review.

OBJECTIVE: This study was conducted to better understand the pervasive gender barriers obstructing the progression of women in surgery by synthesising the perspectives of both female surgical trainees and surgeons. METHODS: Five electronic databases, including Medline, Embase, PsycINFO, CINAHL and Web of Science Core Collection, were searched for relevant articles. Following a full-text review by three authors, qualitative data was synthesized thematically according to the Thomas and Harden methodology and quality assessment was conducted by two authors reaching a consensus. RESULTS: Fourteen articles were included, with unfavorable work environments, male-dominated culture and societal pressures being major themes. Females in surgery lacked support, faced harassment, and had unequal opportunities, which were often exacerbated by sex-blindness by their male counterparts. Mothers were especially affected, struggling to achieve a work-life balance while facing strong criticism. However, with increasing recognition of the unique professional traits of female surgeons, there is progress towards gender quality which requires continued and sustained efforts. CONCLUSION: This systematic review sheds light on the numerous gender barriers that continue to stand in the way of female surgeons despite progress towards gender equality over the years. As the global agenda towards equality progresses, this review serves as a call-to-action to increase collective effort towards gender inclusivity which will significantly improve future health outcomes.

Nursing Home's Measures during the COVID-19 Pandemic: A Critical Reflection.

This study examined the pandemic measures taken by nursing leaders to cope with COVID-19 at a nursing home in Singapore. The pandemic has affected over 215 countries, sparking a series of containment and pandemic measures by governments and healthcare organizations worldwide. Long-term care facilities are especially vulnerable to the pandemic, but little has been reported about the nursing homes' measures in handling the pandemic. The present study used Morley's (2014) three-stage critical reflection method to review meeting minutes, organizational emails, and government advisories on the COVID-19 pandemic measures undertaken by nursing leaders at a nursing home in Singapore between January and June 2020. The pandemic measures were broadly classified into four groups: (1) infection surveillance and containment measures; (2) ensuring continuity in clinical care and operational support; (3) resource and administrative coordination; and (4) staff training and development. Nurses have played a vital role in the fight against COVID-19 by ensuring continuity in patient care and demonstrating clinical leadership in pandemic efforts. This study proposes a useful nursing pandemic structure that outlines a set of functions and measures required for handling a pandemic and that can be applied to various medical emergencies and contingencies.

Nurses' communication difficulties when providing end-of-life care in the oncology setting: a cross-sectional study.

PURPOSE: To (1) examine the communication difficulties nurses experience when providing end-of-life (EOL) care, (2) establish the correlation between communication difficulties across various stakeholders and (3) determine the impact sociodemographic factors has on the communication difficulties experienced. METHODS: 124/178 (69.7%) nurses from oncology wards of a tertiary hospital were recruited. Sociodemographic survey and three validated subscales: Communication with Patient and Family (CPF), Explanation to Family (EF) and Reassessment of Current Treatment and Nursing Care (RCTNC) were used to collect the data. Data were analysed with Independent Samples T test, One-Way Analysis of Variance and Pearson's correlation coefficient. RESULTS: Mean score was highest for CPF (8.75 ± 2.24) and lowest for RCTNC (6.32 ± 2.26). Positive correlations were found between CPF with EF (r = 0.613, p < 0.001), CPF with RCTNC (r = 0.243, p = 0.007) and EF with RCTNC (r = 0.370, p < 0.001). Age (p = 0.048), years of experience (p = 0.001), religion (p = 0.034) and EOL care training received (p = 0.040) were significant factors for CPF subscale while age (p = 0.011), years of experience (p = 0.001), educational qualification (p = 0.003) and EOL care training received (p = 0.026) were the significant factors for EF subscale. CONCLUSION: Nurses experienced more communication difficulties with patients and families than with the healthcare team. When nurses experience communication difficulties with the healthcare team, they also tend to experience communication difficulties with patients and families and when providing explanations to families. Nurses experienced greater communication difficulties when they are younger, are non-graduates, have less years of experience, adopted a religion or did not receive training in EOL care. TRIAL REGISTRATION: Clinical Trials.gov Identifier: 2019/00680 (Domain Specific Review Board).

Evolving perspectives on stool testing for colorectal cancer: a qualitative systematic review.

OBJECTIVES: Colorectal cancer is one of the leading causes of cancer-related deaths globally. A multitude of screening methods has been devised for early diagnosis, including the faecal immunochemical test (FIT). This qualitative review aims to discover the barriers and facilitators to the utility of the FIT from the general population's perspective. METHODS: Authors searched five electronic bases (Medline, Embase, CINAHL, PsycINFO and Web of Science) till December 2019. The search was conducted using key search terms and qualitative and mixed-method studies were included. Two independent reviewers screened articles and conducted quality appraisal. Data were synthesised thematically. RESULTS: A total of 11 articles that reported users' views on FIT kits were included. Three themes were generated from the included articles: FIT kit factors, patients' perception of colorectal cancer screening, and social health support system. The nature of the test and the supplementary information was found to affect the utilisation of the test. User's awareness and perspectives towards cancer and screening were found to have impacted the adoption of the FIT kit. Social support and local healthcare systems were also found to have influenced the use of FIT. CONCLUSION: This systematic review focuses on addressing and understanding the perception of FIT from first-hand accounts. Since its inception, FIT screening has increased colorectal cancer screening uptake due to its increased reliability and the simplicity of the test. However, there is a need to increase the uptake of FIT kits through increasing accessibility of the screening process and considering the holistic patient experience.

Multidisciplinary team approach to diabetes. An outlook on providers' and patients' perspectives.

OBJECTIVE/BACKGROUND: This study sought to uncover the perspectives of various stakeholders towards multidisciplinary team (MDT) care, discover new understandings and help inform current practice on MDT care for diabetic patients. METHODS: 5 electronic databases were searched for articles that evaluated patients' and providers' perspectives on type 2 Diabetes Mellitus (T2DM) MDT management. Articles retrieved were sieved, coded and findings were analytically themed together in accordance to Thomas and Harden methodology. RESULTS: 15 articles were identified with three common themes: interactions between healthcare providers, benefits to patients and constraints and facilitators of the healthcare system. Trust and synergistic teamwork are important factors in promoting effective care. Patients commended MDT's improved accessibility and convenience and felt more welcomed. Often plagued by poor support, lack of manpower and resources, MDTs are less efficient and incapable of realizing their full potential. CONCLUSION: This review illustrates that the MDT model does improve diabetes treatment outcome, help prevent or reduce complications. Nevertheless, the MDT model can be a double-edged sword as poor interactions between HCPs can hamper quality patient care. The current MDT model is also based on available resources of the health system. More effort is needed to modify the MDT model to meet the changing needs of patients.

Difficulties Faced by General Surgery Residents. A Qualitative Systematic Review.

BACKGROUND: General surgery residency training is academically rigorous, taxing and involves complex operative procedures. These trainings are synonymous with alarming burnout rates, high incidence of mistreatment reports and lower job satisfaction. Moreover, the established association between residents' levels of well-being and their capacity for empathy and patient care, emphasises the urgency to mitigate the negative connotations relating to surgical training. This systematic review aims to circumnavigate the multitude of problems faced by general surgical residents in training. STUDY DESIGN: Literature searches were conducted on electronic databases Medline, PsycINFO, Embase, CINAHL, and Web of Science Core Collection using specific search criteria. Studies that analyzed the difficulties faced by General Surgery residents were eligible for inclusion Qualitative analysis involved the derivation of analytical themes and grouping data extracted from the papers accordingly. RESULTS: After review of the full study texts, 19 studies met the inclusion criteria. The 3 main analytical themes identified were Problems regarding the Residency Programme, Work Associated Challenges, and Personal Concerns. Problems Regarding Residency Training was associated with residents' lack of experience. Work Associated Challenges highlighted problems with peer interactions, autocratic relationships, and communication with patients. Personal Concerns includes work-life balance, personal well-being and gender biases. CONCLUSION: This systematic review delves into several prevalent difficulties that general surgical residents face, ranging from work related issues to personal difficulties. The results of this review can be used to provide complementary supportive measures for general surgical residents.

A Clinical Teaching Blended Learning Program to Enhance Registered Nurse Preceptors' Teaching Competencies: Pretest and Posttest Study.

BACKGROUND: Clinical nursing education provides opportunities for students to learn in multiple patient care settings, receive appropriate guidance, and foster the development of clinical competence and professionalism. Nurse preceptors guide students to integrate theory into practice, teach clinical skills, assess clinical competencies, and enhance problem-solving and critical thinking skills. Previous research has indicated that the teaching competencies of nurse preceptors can be transferred to students' clinical learning to enhance their clinical competencies. OBJECTIVE: This study aimed to develop a clinical teaching blended learning (CTBL) program with the aid of web-based clinical pedagogy (WCP) and case-based learning for nurse preceptors and to examine the effectiveness of the CTBL program on nurse preceptors' clinical teaching competencies, self-efficacies, attitudes toward web-based learning, and blended learning outcomes. METHODS: A quasi-experimental single-group pretest and posttest design was adopted. A total of 150 nurse preceptors participated in the CTBL program, which was conducted from September 2019 to December 2019. A set of questionnaires, including the clinical teaching competence inventory, preceptor self-efficacy questionnaire, attitudes toward web-based continuing learning survey, and e-learning experience questionnaire, was used to assess the outcomes before and after the CTBL program. RESULTS: Compared with the baseline, the participants had significantly higher total mean scores and subdomain scores for clinical teaching competence (mean 129.95, SD 16.38; P<.001), self-efficacy (mean 70.40, SD 9.35; P<.001), attitudes toward web-based continuing learning (mean 84.68, SD 14.76; P<.001), and blended learning outcomes (mean 122.13, SD 14.86; P<.001) after the CTBL program. CONCLUSIONS: The CTBL program provides a comprehensive coverage of clinical teaching pedagogy and assessment strategies. The combination of the WCP and case-based approach provides a variety of learning modes to fit into the diverse learning needs of the preceptors. The CTBL program allows the preceptors to receive direct feedback from the facilitators during face-to-face sessions. Preceptors also gave feedback that the web-based workload is manageable. This study provides evidence that the CTBL program increases the clinical teaching competencies and self-efficacies of the preceptors and promotes positive attitudes toward web-based learning and better blended learning outcomes. The health care organization can consider the integration of flexible learning and intellect platforms for preceptorship education.

A web-based clinical pedagogy program to enhance registered nurse preceptors' teaching competencies - An innovative process of development and pilot program evaluation.

BACKGROUND: Registered Nurse Preceptors guide students to integrate theory into practice, assess clinical competencies, and enhance problem-solving skills. Researches have indicated that the teaching competencies of nurse preceptors can be transferred to students' clinical learning. OBJECTIVES: The aims of the study are to develop a web-based clinical pedagogy (WCP) program for Registered Nurse Preceptors and conduct pilot program evaluation. DESIGN: A three-step process was applied to integrate the theoretical framework, evidence from the systematic review, and content validity by the experts and pilot test with the Registered Nurse Preceptors in the content and technical development of the program. The WCP program has unique features including use of dashboard, interactive videos, consultation with experts, discussion forum and backend data analysis. RESULTS: A committee of six content experts evaluated the comprehensiveness, appropriateness, and relevancy of the program. The item-Content Validity Index (CVI) score ranged from 0.83 to 1.00 and the scale-CVI score was 0.87, which indicated that the WCP program had a strong content validity. Ten nurse preceptors were invited to use the WCP program. Preceptors shared that the website was easy to use and navigate. They commented that the videos in each module are beneficial for nurses to understand the real situation in the clinical setting. This feature also makes the website more interactive. Feedback from preceptors was subsequently used to further refine the program. DISCUSSION AND CONCLUSION: The WCP program is an evidence-based program that provides a comprehensive coverage on clinical teaching pedagogy and assessment strategies. The unique web-based technology and interactive features provide a platform for nurse preceptors to discuss clinical encounters with peers and consult experts. The flexible and resource-rich nature of web-based learning encourages nurses to use it for continuing education.

Spiritual Experiences of Women with Breast Cancer in Singapore: a Qualitative Study.

OBJECTIVE: Although there has been increasing emphasis on the importance of spirituality in patients with cancer, few studies have examined the spiritual experiences of an ethnically diverse sample of Asian women with breast cancer. The objective of this study was to examine the spiritual experiences of Singaporean women with breast cancer in the first year of diagnosis. METHODS: A qualitative exploratory study design was used and data were gathered using individual semi-structured interviews. Purposive sampling selected the participants and data saturation sample size was reached after interviews with 28 participants. Data were analyzed using Braun and Clarke's thematic approach. RESULTS: The participants were aged between 28 and 64 years and included women from the three major ethnic groups. The three themes that emerged from the data included transcendental experiences, meaning and purpose, and changing perspectives. CONCLUSIONS: This study informs that while spiritual needs are common, Singaporean women in their first year of the breast cancer diagnosis express spirituality in culturally specific ways. The clinical implications of the study emphasize the importance of addressing women's spiritual concerns, with attention to cultural differences so as to render holistic patient-centered care.

The Progression and Future of Nursing in Singapore: A Descriptive Qualitative Study.

Introduction: Nursing professionalism and nursing identity are important for retention of nurses. Despite of much attention on nurses in Singapore, there is still a shortage of nurses. This study aims to understand the perceptions of the progression and future of the nursing profession in Singapore. Methodology: A descriptive qualitative study design was used. The participants were 20 nurse educators, clinical nurses, and student nurses. Data were collected through focus group and online interviews and analyzed thematically. Results: Nurses felt a need to bridge the theory-practice gap and various factors to the underlying cause of the shortage of nurses were highlighted. Nurses shared their desires to see greater autonomy among nurses and a greater focus on community nursing in the future. Discussion: Collaboration between nurse academics and clinical nurses may bridge the theory-practice gap. To reduce the issue of the shortage of nurses, efforts to promote nursing professionalism are required.

Blended learning pedagogy designed for communication module among undergraduate nursing students: A quasi-experimental study.

BACKGROUND: Effective communication is important for nurse and patient outcomes. Nursing students often feel unprepared to communicate effectively with patients and other healthcare workers within the clinical environment. Blended learning pedagogy-based communication skills training can provide an alternative to traditional methods of teaching to enhance students' satisfaction and self-efficacy levels in communicating with others. OBJECTIVES: To examine the effectiveness of blended learning pedagogy in a redesigned communication module among nursing undergraduates in enhancing their satisfaction levels and attitudes towards learning communication module as well as self-efficacy in communication. DESIGN: A single group pre-test and post-test quasi-experimental design was adopted. SETTINGS AND PARTICIPANTS: Data were collected from August 2016 to November 2016 from 124 nursing undergraduates from a leading nursing school. METHODS: Blended learning pedagogy was adopted to redesign a communication module that offered a wide array of learning opportunities via face-to-face classroom and online sessions. Validated and reliable instruments were used to measure satisfaction levels with blended learning pedagogy, attitudes towards learning communication, and communication self-efficacy. Descriptive and inferential statistics were used to analyze the data. RESULTS: Participants had enhanced satisfaction levels with blended learning pedagogy, better attitudes in learning communication skills, and improved communication self-efficacies at posttest (week 13 of the semester) when compared with their pre-test scores (week one of the semester). Participants scored higher in the Blended Learning Satisfaction Scale, the Communication Skills Attitude Scale, and the communication skills subscale of the Nursing Students Self-Efficacy Scale. CONCLUSIONS: Blended learning pedagogy can be effectively used in facilitating communication modules and enhancing student outcomes among nursing undergraduates. The long-term effectiveness of using blended learning pedagogy in facilitating communication modules should be evaluated from students' and patients' perspectives. Additionally, the technology should be constantly improved by incorporating more interactive functions and should be tested to accommodate the learners' needs.

Factors affecting life expectancy: evidence from 1980-2009 data in Singapore, Malaysia, and Thailand.

The authors aim to examine the impact of demographic changes, socioeconomic inequality, and the availability of health care resources on life expectancy in Singapore, Malaysia, and Thailand. This is a cross-country study collecting annual data from 3 Southeast Asian countries from 1980 to 2008. Life expectancy is the dependent variable with demographics, socioeconomic status, and health care resources as the 3 main determinants. A structural equation model is used, and results show that the availability of more health care resources and higher levels of socioeconomic advantages are more likely to increase life expectancy. In contrast, demographic changes are more likely to increase life expectancy by way of health care resources. The authors suggest that more effort should be taken to expand and improve the coverage of health care programs to alleviate regional differences in health care use and improve the overall health status of people in these 3 Southeast Asian countries.

Systematic review on the relationship between the nursing shortage and job satisfaction, stress and burnout levels among nurses in oncology/haematology settings.

AIM: To establish the best available evidence regarding the relationship between the nursing shortage and nurses' job satisfaction, stress and burnout levels in oncology/haematology settings. METHODS: Electronic databases (CINAHL, Medline, Scopus, ScienceDirect, PsycInfo, PsycArticles, Web of Science, The Cochrane Library, Proquest and Mednar) were searched using a three-step strategy in order to identify published and unpublished studies conducted between 1990 and 2010. Grey literature was excluded in the review. The identified studies were evaluated using standardised critical appraisal instruments from the Joanna Briggs Institute-Meta Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). A total of seven descriptive and descriptive-correlational studies published in English were included and data were presented in a narrative summary. RESULTS: Findings revealed a positive bidirectional relationship between the nursing shortage and oncology registered nurses' (RNs') job dissatisfaction, stress and burnout. The extent of the job dissatisfaction, stress and burnout experienced by the oncology RNs and their perception of staffing inadequacy differed according to their demography and work settings. Particularly, nurses who had higher qualifications and positions, who worked full-time and who worked in inpatient settings and non-Magnet hospitals were more likely to attribute staffing inadequacy as one of the main contributing factors for their job dissatisfaction, stress and burnout. This led to a rise in the number of oncology RNs leaving the speciality. CONCLUSION: Within the constraints of the study and the few quality papers available, it appears that oncology RNs who worked in substandard staffing units often express job dissatisfaction, stress and burnout, which prompt them to seek new employment out of the oncology specialty. This entails a pressing need for organisations to ensure sufficient staffing in oncology/haematology settings, in order to ensure that quality patient care is provided. Limited studies that examine the relationship between the nursing shortage and oncology RNs' stress and burnout have been conducted. Also, no studies in the Asian context have previously been conducted. IMPLICATIONS FOR PRACTICE: Organizations need to customize their strategies for the recruitment and retention of oncology nurses. The strategies should take into consideration the specific demographic characteristics of oncology nurses or those of work settings that are experiencing staffing inadequacy and negative nursing outcomes. The strategies should also aim to replicate features of other institutions that are attractive to oncology nurses, and also include training that help oncology nurses better manage their emotions. IMPLICATIONS FOR RESEARCH: Future research needs to examine the relationship between the nursing shortage and oncology nurses' job satisfaction, stress and burnout in bone marrow transplant units, paediatric oncology settings and Asian oncology settings. The characteristics of oncology nurses or workplaces that are more likely to experience negative nursing outcomes due the nursing shortage should also be identified.

Anxiety in women with breast cancer undergoing treatment: a systematic review.

BACKGROUND: Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidity that is inevitable. Many researchers have investigated the prevalence and detrimental effects of anxiety in breast cancer treatment, but little is known about differences in anxiety level among women receiving different breast cancer treatments. A systematic review of all available literature was needed to attain better understanding of anxiety in patients undergoing treatment for breast cancer. AIM: This review aimed to determine the best available evidence on the level of anxiety among women with breast cancer who were undergoing cancer treatment(s), and the factor(s) contributing to anxiety in various treatment modalities. METHODS: The search sought to gather data from published and unpublished studies conducted between 1990 and 2010. An initial search on CINAHL and Medline was done to identify relevant search terms. A search strategy was then developed, using MeSH headings and key words. The following databases were searched: CINAHL, PubMed, ScienceDirect, PsycINFO, Cochrane Database of Systematic Review, Scopus, Wiley InterScience and PsycARTICLES. All papers are quantitative papers (randomised controlled trials and descriptive studies) that examined anxiety level in women with breast cancer of stage 0 to stage IIIA, over and equal to 21 and below 65 years of age, who were undergoing/had undergone treatment restricted to chemotherapy, radiotherapy and/or surgery, and these quantitative papers have made correlations between women's anxiety levels and contributing factors. The Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were the two tools most frequently used by these papers to quantify the anxiety level. Two reviewers independently assessed the eligibility of the papers for inclusion. Eighteen papers were selected based on relevance, and assessed for methodological quality using MAStARI. Ten research papers that met our methodological standard were included in the review. Both reviewers agreed on the papers to be included and excluded. Due to the methodological heterogeneity of the included papers, a meta-analysis was not possible. The studies were hence presented in narrative summary. RESULTS: Anxiety seems to be ubiquitous, presenting itself in all treatment types for breast cancer. Anxiety level in women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. Radiotherapy regimes did not affect anxiety level in radiotherapy-treated patients, and most research concluded that anxiety level was higher among women who underwent mastectomy than those who underwent breast conservation therapy. CONCLUSIONS: The prevalence and intensity of anxiety have been shown to be pronounced among breast cancer women who were undergoing/had undergone one or more of the three treatments. Chemotherapy, as compared to other treatments, is shown to be associated with a higher anxiety level. With the prevalence, intensity and correlated factors of anxiety identified through this review, future research may investigate the interventions that could help alleviate anxiety among these patients. Anxiety is prevalent in women with breast cancer undergoing treatment, especially those undergoing chemotherapy. Healthcare professionals should pay greater attention to identify signs of anxiety in patients and design interventions to help alleviate it earlier.

Anxiety in patients with breast cancer undergoing treatment: a systematic review.

BACKGROUND: Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidity that is inevitable. Many researchers have investigated its prevalence and detrimental effects, yet little is known when comparing the different breast cancer treatments. A systematic review of all available literature was indicated to encourage better understanding of anxiety in patients undergoing treatment for breast cancer. OBJECTIVES: This review aimed to determine the best available evidence on the level of anxiety among women with breast cancer undergoing/had undergone cancer treatment(s), and factor(s) contributing to anxiety in these treatment modalities. INCLUSION CRITERIA: Types of participants Women with breast cancer of stage 0 to stage IIIA breast cancer, over and equal to 21 and below the age of 65 years of age.Types of intervention Women who were undergoing/had undergone cancer treatment restricted to chemotherapy, radiotherapy, surgery or combined treatments, and were without other medical co morbidities.Types of outcomes A variety of outcome measures were used to assess anxiety in the included papers. Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were mostly used.Types of studies This review considered quantitative papers (randomized control trials, descriptive studies and systematic review) that fulfilled both requirements: SEARCH STRATEGY: The search sought to gather data from published and unpublished studies conducted between 1990 and 2010. An initial search on CINAHL and Medline was done to identify relevant search terms. A search strategy was then developed, using MeSH headings and keywords. Following databases were searched: CINAHL; PubMed; ScienceDirect; PsycINFO; Cochrane Database of Systematic Review; Scopus; Wiley Interscience and PsycARTICLES. DATA COLLECTION/EXTRACTION: Two reviewers independently assessed the eligibility of the papers for inclusion. Eighteen papers were selected based on relevance, and underwent assessment for methodological quality using MAStARI. Eleven research papers that met the level of methodological standard were included into the review. Both reviewers came to the same consensus on the included and excluded papers. DATA ANALYSIS: Due to the methodological heterogeneity of the included papers, a meta-analysis was not possible. The studies were hence presented in narrative summary. RESULTS: Anxiety seems to be ubiquitous, presenting itself in all treatment types for breast cancer. Anxiety level in breast cancer women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. Radiotherapy regimes did not affect anxiety level in radiotherapy-treated patients, and most research concluded that anxiety level was higher among women who underwent mastectomy than breast conservation therapy. When compared, patients who underwent chemotherapy were more anxious. CONCLUSIONS: The prevalence and intensity of anxiety has been shown to be pronounced among the three treatments. Chemotherapy, as compared to other treatments, has shown to be associated with a higher anxiety level. IMPLICATIONS FOR RESEARCH: With the prevalence, intensity and correlated factors of anxiety identified through this review, future research may investigate the interventions that could help alleviate anxiety among these patients. IMPLICATIONS FOR PRACTICE: Anxiety is prevalent in women with breast cancer undergoing treatment, especially those undergoing chemotherapy. Healthcare professionals should pay greater attention to identify cues of anxiety in patients and prevent/alleviate it.