Adherence to the distress screening through oncology nurses and integration of screening results into the nursing process to adapt psychosocial nursing care five years after implementation.

PURPOSE: Addressing psychosocial distress is an essential part of cancer care. Therefore, nurses at the University Hospital Zurich have been screening all cancer inpatients with the Distress Thermometer (DT) since 2012. Screening is ineffective without any form of psychosocial intervention. We aimed to identify adherence to the screening protocol and how the reported problems influenced the nursing process. We compared changes in the documentation before and after screening implementation. METHODS: This retrospective descriptive study used screening data and documentation of psychosocial items in the nursing process of inpatients at an oncologic ward. These data were compared with data obtained before screening implementation and were collected from electronic health records. All data were analyzed descriptively. RESULTS: 65% (N = 1111) of the 2166 inpatients were screened. With the implementation, more psycho-oncological referrals were made (4.5% vs. 11.7%) and more psychosocial issues were described in the nursing process (24.6% vs. 51.2%). Inpatients mentioned emotional problems in 37.5% (N = 353) and physical problems in 47.4% (N = 504) of cases. 15.7% (147) had a psychosocial nursing diagnosis. Only 10.7% (N = 26) of patients who noted anxiety, also had a nursing diagnosis of "anxiety". In contrast, 71.1% (N = 202) of patients who noted pain, had a nursing diagnosis of "pain". CONCLUSIONS: Although nurses are more sensitised to psychosocial issues after DT implementation, they do not use screening results to adapt nursing documentation to the psychosocial needs of the patients. Further studies are needed to investigate how distress screening and psychosocial issues can be integrated into nurses' daily work.

Evaluation of the adherence of distress screening with the distress thermometer in cancer patients 4 years after implementation.

PURPOSE: Identifying and assessing psychosocial distress with an appropriate screening instrument is essential when caring for cancer patients. Since 2012, the distress thermometer (DT) has been used by nurses for all cancer inpatients at the Comprehensive Cancer Center Zurich. We wanted to identify nurses' adherence to the screening protocol, differences between screened and not screened patients and the relationship between screening rate and productivity. METHODS: This retrospective descriptive study used screening and referral data as well as socioeconomic and disease-related data of inpatients at the Comprehensive Cancer Center Zurich. This was collected from the electronic patient documentation system. Additionally, data showing the productivity of all wards was used. All data were analyzed descriptive. RESULTS: Since 2012, 40.6% (4541) of the 11,184 patients have been screened. The screening rate was initially significantly lower but settled at 40% after 2 years. There was a higher screening rate among Swiss, married, male, and emergency patients and patients with hematology diseases, brain tumors, or head and neck cancer (p < 0.001). Every fourth patient with a moderate to severe distress level requested referral to a psychosocial service. Significantly more screened patients were referred to the social service (44.7%) than to the psycho-oncology service (9.4%). Only 22.9% of all referrals were made on the day of screening or a day later. There were only two wards of 15 with a significant relationship between productivity and screening rate. CONCLUSIONS: Screening is useful in recognizing distress among patients, but screening practice needs to be reconsidered.

A before and after study of a nurse led comprehensive delirium management programme (DemDel) for older acute care inpatients with cognitive impairment.

BACKGROUND: Studies estimate that approximately one-third of episodes of delirium are preventable and that delirium prevention and management are often suboptimal in practice. While there is no doubt that prevention is desirable, the evidence of the benefits of early intervention and treatment for older hospitalised patients with dementia is unclear. AIM: To determine the effects of DemDel, a comprehensive delirium management programme, in inpatient acute care elders with cognitive impairment. DESIGN AND METHODS: This paper reports the quantitative part of a mixed methods study, comparing an intervention with treatment as usual using validated outcome measures. After training, ward nurses and physicians administered the intervention based on the DemDel algorithm that focused on delirium prevention, including an intensive systematic screening schedule for cognitive impairment and delirium, as well as comprehensive delirium management. The delirium management regimen included timely administration of pro re nata medication. SETTINGS: The study was conducted within four medical wards of an acute care university hospital in urban Switzerland. PARTICIPANTS: A total of 268 patients with cognitive impairment participated in the pre/post comparison study. The intervention and treatment as usual groups consisted of 138 and 130 patients, respectively. RESULTS: Eighty-seven (32.5%) out of 268 patients developed delirium, of whom 51 (58.6%) were of mixed, 10 (11.5%) hyperactive and 26 (29.9%) hypoactive delirium subtypes. Delirium appeared within the first five days after admission in 81.6% of cases. The 44 (31.9%) patients with delirium in the intervention group with systematic delirium management had less severe episodes of delirium and required medication for management than the 43 (33.1%) delirious patients in the control group. Intervention compliance was good on three of the four units. CONCLUSIONS: The DemDel programme was effective with regard to improvement of outcomes associated with delirium in patients with cognitive impairment. The intervention was feasible and possible to be embedded within routine practice on four busy general medical wards.

[Coping with multiple sclerosis in partnerships: a systematic review of the literature]. / Bewältigung der Multiplen Sklerose in der Partnerschaft : Eine systematische Literaturübersicht.

BACKGROUND: As with other chronic diseases, multiple sclerosis (MS) is not only experienced by the persons suffering from the disease but also their partners. OBJECTIVE AND METHOD: To explore the current level of knowledge on dealing with MS in relationships and to obtain indications of factors that have a positive impact on the way of coping with the disease, studies on this topic were sought in the databases of Cinahl, Medline and PsycINFO using the following keywords: multiple sclerosis, spouses, couples, married couple, dyadic system, dyadic systems and dyads. The results were interpreted in the context of "Developmental-contextual model of couples coping with chronic illness across the adult life span". RESULTS: Systematic allocation of the study results found in this way created a comprehensive image of the coping process. The results clearly showed that both partners experience difficult feelings such as uncertainty, fear, depression and distress. Coping in a relationship with the often continuously changing situations and the associated stress is done best by couples who consistently exchange their mutual perceptions, inform one another of the mental and physical strains in open discussions and synchronise their ideas regarding the generation of the meaning and satisfaction with life. CONCLUSION: Targeted support for dyadic coping can lead to stress reduction and higher relationship satisfaction of couples living with MS.

[Understanding needs of people with Multiple Sclerosis. Perspective of patients and significant others in the German-speaking part of Switzerland]. / Bedürfnisse von Menschen, die an Multipler Sklerose leiden: Die Perspektiven von erkrankten Personen und ihren nächsten Angehörigen in der deutschsprachigen Schweiz.

Since there is no data available about the needs of people living with Multiple Sclerosis and significant others in Switzerland a questionnaire based cross sectional study was conducted with 878 patients and 615 family caregivers. This Swiss study used the addresses from the Swiss Multiple Sclerosis Society. The response rate was 35.2 % for patients and 70.1 % for significant others. Data analysis included descriptive and inferential statistics. Results showed that information needs are most important followed by consultation. 42.4 % of patients and 39.2  % of family caregivers need more information about alternative treatment options and 34.4 %, resp. 36.6  % about actual research results. For 39.5  % of patients, the possibility of using of their wheelchair in public is insufficient. Approximately a third of patients need more consultation in order to better manage cognitive impairment and fatigue. 30.9 % of family caregivers need more consultations in order to better manage their feelings of burden. Influencing factors of patients' need for consultation about fatigue are health status, quality of life, and anxiety. Patients' need for consultation about their management of cognitive impairment was influenced by health status, medication, and their ability of dealing with constraints and anxiety. The results showed that an enhancement of the quality of treatment and care based on patients' and family caregivers' needs are urgently needed.

The unspoken disease: symptom experience in women with vulval neoplasia and surgical treatment: a qualitative study.

Women with vulval neoplasia often experience severe post-surgical complications. This study focuses on symptom experience of women during the first 6 months following surgical treatment for vulval neoplasia considering their socio-cultural context. In this qualitative study using a critical hermeneutic approach, narrative interviews were conducted. A purposeful sample of 20 patients was recruited from one Swiss and two German university hospitals. Content analysis was employed to analyse the transcribed interviews considering women's experiences and social perceptions. Narratives showed eight interrelated themes: delayed diagnosis, disclosed disease, disturbed self-image, changed vulva care, experienced wound-related symptoms, evoked emotions, affected interpersonal interactions and feared illness progression. The women experienced a general lack of information pertaining to above themes and all described strategies used to handle their situation, which affected their distress. The communication, assessment and treatment of symptoms were hampered by the society's and the health system's tendency to overlook these symptoms and leave them in the realm of the unspeakable. Health professionals need new strategies to support these women to recognise, assess and evaluate the seriousness of symptoms, and to communicate their symptom experience so that timely medical treatment is sought. This support may minimise potentially preventable complications and symptom-related distress.

Starting or changing therapy - a prospective study exploring antiretroviral decision-making.

BACKGROUND: When to start or change antiretroviral treatment against HIV infection is of major importance. Patients' readiness is considered a major factor influencing such treatment decisions, in particular because no objective, absolute time point when to start antiretroviral therapy exists. We aimed at evaluating patients' readiness to start or change antiretroviral therapy (ART). PATIENTS AND METHODS: HIV-infected patients starting or changing ART between July 2002 and February 2003, treating physicians and nurses participated in this prospective, observational multicenter study. We assessed shared decision-making including qualitative aspects, expected treatment decisions and treatment status after 3 months. RESULTS: 75 patients were included. Of 34 patients for whom starting ART was considered, 27 (79%) indicated that they were willing to start treatment. After 3 months, 21 of 27 (78%) actually started therapy, six did not. Patients with depression were less likely to be ready for ART (p < 0.05). Of 41 patients for whom changing ART was considered, 35 (85%) indicated that they were willing to change treatment. Of the latter 35 patients, 33 (94%) finally changed ART within 3 months. Physicians and nurses were too optimistic in predicting the start or change of ART. The main reason to start or change ART was the sole recommendation of the physician (52% in those starting, 61% in those changing ART). Patients mainly judged the decision as shared and were very satisfied (71%) with the process. Qualitative findings revealed the importance of a dialectic decisionmaking, described with two categories: "dealing with oneself and others"' and "understanding and being understood." CONCLUSION: Patients mainly shared the decision made during consultation. Although physicians have an essential role concerning ART, patients, physicians, and nurses all contribute to the decision. Qualitative findings indicate the importance for health-care providers to include patients' expertise and contributions.

[Developing and establishing an expanded and more comprehensive HIV/AIDS nursing practice]. / Entwicklung und Etablierung einer erweiterten und vertieften HIV/Aids-Pflegepraxis.

Developing and establishing an advanced nursing practice is an essential step toward future-oriented nursing care. An action research process was initiated to establish advanced nursing practice at the HIV clinic of the outpatient department at the University Hospital Basel with the goal to offer advanced nursing care to patients. Participatory action research allows generating knowledge about a social system while at the same time tempts to promote social change. The most important goal is to constantly analyse, improve, and evaluate nursing care for patients and family caregivers. Advanced nursing practice in HIV/AIDS is based on solid knowledge regarding the illness and current therapies. Central concepts are caring, clinical experiences, evidence based practice, and patient preferences. Through a systematic step-by-step process, the nurses at the HIV clinic are being better educated and more experienced in these concepts. An essential aspect of advanced nursing practice is the specialization of each nurse in a self selected topic within HIV/AIDS care. These nurses now offer new services such as medication management and adherence support, health maintenance and prevention, and symptom management. This ongoing process of learning while establishing advanced nursing practice in HIV/AIDS, enables the nurses to face future changes in health care in a proactive way.

[Visions for the future--nursing as a profession in German-speaking Swiss health care]. / Visionen für die Zukunft--Die Pflege als Beruf im Gesundheitswesen der Deutschschweiz.

Social, scholarly, and technical changes and changes in health politics have a lasting influence on the nursing profession. The development of nursing science programs can be seen in this context and institutions, which offer educational programs for nurses, have to orient them toward the new demands of the profession. Up to now in the German-speaking realm, published data, which describe the changes the nursing profession can expect, have not been available, nor have possible future fields of activity of nursing been examined. In order to close this gap, a group of opinion leaders and experts in nursing in German-speaking Switzerland were studied. Eighty-one people were surveyed by means of a questionnaire, and ten people were interviewed in-depth. The results reflect the visions and perspectives of the nursing profession of the future in German-speaking Switzerland. The expectation is that nursing should deal increasingly with sociopolitical changes and that the main issues of nursing with regard to type of client and locations where care is given will change. A re-orientation toward strengthening professional identity is called for in the following areas: involvement in determining and shaping decisions in politics and health politics; taking entrepreneurial initiatives; building clinical practice on caring, patient preferences, and evidence; making professional training and continuing education clinically-oriented as well as the development and the establishment of nursing science. Through a re-orientation, nursing should be better able to meet the challenges, which it faces because of health and social problems in the population. A great discrepancy exists between the expectations for nursing in the future and present reality. The challenge will be to see whether it will be possible to close the gap between visions and reality by means of training, continuing education, and changes in clinical practice.

[HIV/AIDS family care-giving in Switzerland in the context of silence]. / HIV/Aids-familienpflege in der Schweiz im Kontext des Schweigens.

Based on critical hermeneutics, this qualitative study presents insights about care giving experiences of HIV affected families in the German speaking part in Switzerland. Eleven families (12 women, 5 men) were interviewed, and members of different families participated in group-conversations. Critical reflection of the results highlighted that these HIV-families offered family caregiving in a context of silence. Two perspectives of this silence are presented: 1. HIV-families do not share their experiences in their closer and larger environments because of stigmatization, changing family constellations, and traditional images of family care. Instead, HIV-families create silent circles. 2. Professional discourses about family care are almost absent in the Swiss health care system because of its focus on the needs of individual patients with health care providers, in particular nurses, offering no systematic health services tailored to family caregivers. The results highlight, that it is paramount for nurses to take responsibility and to create programs that will better serve HIV-families.

[Families living with HIV and Aids--review of the literature]. / Familien, die mit HIV und Aids leben--Eine Literaturübersicht.

This article presents the current state of the art regarding the concept of families living with HIV and Aids. The literature reflects a comprehensive view including families of origin, families of choice and partnerships. It is evident that family networks of homosexual men are most systematically described in the literature; to a lesser extent families with hemophilia and i.v. drug users and even fewer studies are found regarding families with a heterosexual transmission background and especially female family caregivers. This paper also focuses on the wide range of support offered by these family systems. The acute and mostly terminal infectious disease Aids, as observed in the 80 Dies, has now become a predominantly chronic-progressive illness. Since the mid 90 Dies, the new antiretroviral therapies have further decreased morbidity and mortality, leading to less personal care, high-tech nursing requirements and household support. This development places families in a position of providing more emotional and advocatory support and companionship over a considerably longer time span. The discussion identifies strengths and weaknesses of the current literature in order to define deficits in the Anglo-American as well as in the German speaking area. From a nursing science point of view, the characteristics of HIV/Aids care must be further acknowledged, described and systematically studied, and results must be made accessible. This is important because the knowledge acquired by studying families affected by HIV and Aids is of interest for other family systems dealing with chronically ill family members. Finally, research recommendations are listed regarding family-oriented care and future study designs.

[Becoming partners: the meaning of caring for patients with HIV and AIDS]. / Zu PartnerInnen werden: Die Bedeutung von Caring für Menschen mit HIV und AIDS.

The purpose of this study was to understand and describe what constitutes caring as experienced by persons living with HIV and AIDS (PLWAs) along their illness trajectory. Interpretative phenomenology was employed. Six men and one woman living with HIV or AIDS participated in open-ended interviews. Interviews were analyzed according to Benner (1994) through paradigm cases, thematic analyses, and analyses of examples. Convenience sampling was used to select participants. Two distinct categories were interpreted: Letting go step by step and becoming partners. Letting go step by step encompasses the entire time people are living with HIV/AIDS illness trajectory. Becoming partners describes the relationship and commitments between PLWAs and families, friends, and health care providers. These findings reinforce the need for families, friends, and health care providers to become partners with PLWASs and to work on this partnership along the entire illness trajectory.

Support groups for people living with HIV/AIDS: a review of literature.

For more than a decade, support groups have been proposed as a key intervention for people living with HIV and AIDS (PLWAs). Despite this fact, there are still only a few articles that evaluate and compare outcomes of support groups so as to provide a scientific base for their usefulness and effectiveness. The purpose of this article is to critically review selected published literature on support groups and to assess gaps in research. In general, the reviewed literature evaluated support groups as an effective intervention, which is evident for this widespread support. However, because diverse populations of PLWAs have specific needs, the group and intervention should be designed to meet those needs. Specific recommendations for further research about support groups for PLWAs are offered.

[Bibliographies on Dorothea Orem's nursing theory]. / Bibliographien zur Pflegetheorie von Dorothea Orem.

Bibliography on the subject of Dorothea Orem's nursing theory Dorothea Orem's theory is now well known in Switzerland. In many first level and continuing education courses it is taught, dealt with and critically examined. Various attempts are made to translate it into practice. This compilation shows, in the form of abstracts of various articles, how Orem's self-care-deficit theory is applied, discussed and reflected upon. Part of this paper compares Orem's theory with other nursing theories. This bibliography, like that already published in Pflege, Vol. 7, 1994, Nr. 3, was compiled in the context of the topic "Pain", as part of the Higher Professional Education Course, level 2, of the Advanced School of Nursing, Aarau.

[Admission to a ward for terminal care as a status passage]. / Der Eintritt in eine Sterbeabteilung als Statusübergang.

In the last few years clinics exclusively for patients suffering from AIDS have been developed in Switzerland, specialising in terminal care. The institution in which the research here reported was carried out, admitted drug-dependent patients with AIDS. Admission to the unit, henceforth referred to as unit for the dying, is a very special event, which triggers off a variety of behavioural manifestations. The research shows that it is a case of 'status passage' as described by Glaser and Strauss (1971), which is experienced differently by each individual. In spite of individual differences, similar conditions, similar factors, which influence patients, similar coping mechanisms were observed. To end the paper, concrete suggestions are offered for the care of drug dependent patients suffering from AIDS, suggestions at the level of individual nurses, of the nursing profession and of the structure of the organisation.

[Bibliography on the topic of pain]. / Bibliographien zum Thema Schmerz.

Many books and articles deal with sociological, psychological and other aspects of the subject of pain. They document a variety of approaches in dealing with people who suffer pain. This compilation is a synopsis of articles, almost exclusively related to nursing and nursing research. The articles illuminate a broad spectrum, covering the history of pain research, assessment of pain and the key issues in caring for and nursing patients in pain. The bibliography was produced as part of the course work of the Advanced Nursing Education Programme in Aarau. The purpose was to understand and learn about the largely English language literature on the subject and to prepare an education programme on the concept of pain. This bibliography only partially covers existing publications and consequently is not necessarily representative.