The role experience of advanced practice nurses in oncology: An interpretative phenomenological study.

AIM(S): To understand the experiences of advanced practice nurses working in cancer care. DESIGN: Phenomenological qualitative study. METHODS: Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. RESULTS: Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. CONCLUSION: Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. IMPLICATIONS FOR THE PROFESSION: These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. REPORTING METHOD: Reporting complied with COREQ criteria for qualitative research. PATIENT OR PUBLIC CONTRIBUTIONS: No patient or public contribution.

Impact of a Nurse-Driven Patient Empowerment Intervention on the Reduction in Patients' Anxiety and Depression During ICU Discharge: A Randomized Clinical Trial.

OBJECTIVES: To assess the impact of a nurse-driven patient empowerment intervention on anxiety and depression of patients during ICU discharge. DESIGN: A prospective, multicenter, randomized clinical trial. SETTING: Three ICUs (1 medical, 1 medical and surgical, and 1 coronary) of three tertiary hospitals. PATIENTS: Adults admitted to the ICU greater than 18 years old for greater than or equal to 48 hours with preserved consciousness, the ability to communicate and without delirium, who were randomized to receive the nurse-driven patient empowerment intervention (NEI) (intervention group [IG] or standard of care [control group (CG)]) before ICU discharge. INTERVENTION: The NEI consisted of an individualized intervention with written information booklets, combined with verbal information, mainly about the ICU process and transition to the ward, aimed at empowering patients in the transition process from the ICU to the general ward. MEASUREMENTS AND RESULTS: Patients completed the Hospital Anxiety and Depression Scale before and after (up to 1 wk) ICU discharge. IG ( n = 91) and CG ( n = 87) patients had similar baseline characteristics. The NEI was associated with a significant reduction in anxiety and depression ( p < 0.001) and the presence of depression ( p = 0.006). Patients with comorbidities and those without family or friends had greater reductions in anxiety and depression after the NEI. After the intervention, women and persons with higher education levels had lower negative outcomes. CONCLUSIONS: We found that a NEI before ICU discharge can decrease anxiety and depression in critically ill survivors. The long-term effect of this intervention should be assessed in future trials. TRIAL REGISTRATION: NCT04527627 ( https://clinicaltrials.gov/ct2/show/NCT04527627 ).

Mixed-method research protocol: Development and evaluation of a nursing intervention in patients discharged from the intensive care unit.

AIM: (a) To understand patients' lived experience at intensive care unit (ICU) discharge and (b) to evaluate the impact of a nursing empowerment intervention (NEI) on patients' anxiety and depression levels at ICU discharge. DESIGN: A mixed-methods approach will be applied. METHODS: In the qualitative phase, the hermeneutic phenomenological method will be used. Participants will be patients from three university hospitals who will be selected by purposive sampling. Data will be gathered through in-depth interviews and analysed using content analysis. The qualitative data obtained will be employed to develop the nursing intervention. Subsequently, a multicenter, parallel-group, experimental pre-test/post-test design with a control group will be used to measure the effectiveness of the nursing empowerment intervention in the quantitative phase by means of the Hospital Anxiety and Depression Scale (HADS). Simple random probabilistic sampling will include 172 patients in this phase.

Carga del cuidador principal informal del paciente crónico complejo y paciente crónico avanzado en dos centros de urgencia de atención primaria de la provincia de Barcelona / Burden of the informal primary caregiver of the chronic complex patient and chronic advanced patient in two emergency primary care centres in the province of Barcelona

OBJETIVO: Determinar el grado de carga del cuidador principal informal (CPI) de pacientes identificados como paciente crónico complejo (PCC) y paciente crónico avanzado (PCA), asistidos en dos centros de urgencias de atención primaria (CUAP) de la provincia de Barcelona. METODOLOGÍA: Estudio descriptivo, observacional, prospectivo, transversal, de tipo exploratorio, de diciembre de 2015 a noviembre de 2016. Muestra formada por 271 CPI del CUAP de Cerdanyola /Ripollet y del CUAP de Sant Fèlix de Sabadell (Barcelona). Para medir la carga del CPI se obtuvieron datos del Test de Zarit y datos descriptivos sobre el CPI y sobre la persona cuidada. RESULTADOS: Parentesco del CPI: 36,5 % (n=99) pareja, 57,6 % (n=156) hijos, 3 % (n=8) hermanos, 1,1 % (n=3) nietos, otros cuidadores (amigos, vecinos,... ) 1,8 % (n=5). Sexo del CPI: 53 % (n=144) mujeres y un 47 % (n=127) hombres. Edad media del CPI: <70 años 19 % (n=52), 71-85 años 61,4 % (n=166), >85 años 19,6 % (n=53). Edad media del PCC/PCA fue de 81 años. Los resultados del Test de Zarit fueron: Media 54 [40-65], presentando una carga intensa del 43 % en el CPI (valores > 56 puntos). Los resultados del Índice Barthel fueron: Media 69 en PCC y Media 54 en PCA, presentando una dependencia severa (24,2 %) en los PCC/PCA (valores entre 21-60). CONCLUSIONES: El estudio ha evaluado la carga del CPI con el Test de Zarit en los PCC/PCA con el objetivo de incorporar un programa de educación que repercuta positivamente sobre su cuidado, mejorar la asistencia recibida, reducir la utilización de servicios sanitarios y conseguir disminuir el grado de carga y la percepción de falta de apoyo social sobre el CPI

OBJECTIVE: To determine the degree of burden of informal primary caregiver (IPC) of patients identified as chronic complex patient (CCP) and chronic advanced patient (CAP), assisted in two emergency primary care centres (EPCC) in the province of Barcelona. METHODOLOGY: Cross-sectional, prospective, observational, descriptive exploratory type from November 2015 to December 2016 study. Sample consisting of 271 IPC in EPCC Cerdanyola /Ripollet and the EPCC St. Fèlix de Sabadell (Barcelona). To measure the burden of IPC, data were obtained by Zarit Burden Inventory and descriptive information about the IPC and careful person. RESULTS: Kinship of the IPC: 36.5% (n = 99) couple, 57.6% (n = 156) children, 3% (n = 8) brothers, 1.1% (n = 3) grandchildren, other caregivers (friends, neighbours,...) 1.8% (n=5). Sex of the IPC: 53% (n = 144) women and 47% (n = 127) men. Average age of the IPC: <70 years 19% (n= 52), 71-85 years 61,4% (n=166), >85 years 19.6% (n = 53). The CCP/CAP average age was 81 years old. The Zarit Burden Inventory results were: average 54 [40-65], presenting an intense load 43% in the IPC (values > 56 points). The Barthel Index results were: average 69 in CCP and average 54 in CAP, presenting a severe dependence (24.2%) in the CCP/CAP (values between 21-60). CONCLUSIONS: The study has evaluated the IPC charge with Zarit Burden Inventory on the CCP/CAP in order to incorporate an educational program that positively impact on their care, improve the assistance received, and reduce the use of health services and get decrease the degree of load and the perceived lack of social support of the IPC

Satisfacción de la carpeta de aprendizaje y agentes que intervienen en la práctica clínica en el grado de enfermería / Satisfaction of the learning portfolio and training staff involved in the clinical practice of a bachelor nursing degree

Objetivo. Evaluar las percepciones de los diferentes agentes que intervenían en la utilización de la carpeta de aprendizaje, y determinar el nivel de satisfacción de los estudiantes durante la práctica clínica. Metodología. Se incluyeron 33 profesores y 185 estudiantes matricula-dos durante el curso 2016-2017 en las asignaturas de Estancias Clínicas I y II, correspondientes al segundo y tercer curso de Grado de Enfermería de la Escuela de Enfermería de la Universidad de Barcelona. Se elaboraron dos cuestionarios ad-hoc: uno para evaluar la percepción de los agentes sobre la carpeta de aprendizaje, con 4 dimensiones relacionadas con el uso de la herramienta, la vinculación competencial, los problemas y las limitaciones en el manejo; y un segundo cuestionario sobre el nivel de satisfacción realizado sólo a los estudiantes. Resultados. Según los estudiantes, la utilidad de la carpeta de aprendizaje fue elevada con un 89% (n = 81) y un 71% (n = 67), en segundo y tercer curso respectivamente, pero esta utilidad disminuyó al asociarla con la ayuda que proporcionaba en la adquisición de sus competencias, 37% (n = 37) y 26% (n = 24). La dificultad en su utilización fue del 41% (n = 37) en segundo curso y del 28% (n=26) en tercero. Respecto a la opinión de los tutores de prácticas, tanto la idonei-dad como la utilidad de la carpeta obtuvieron valores elevados con un 91% (n = 30) y un 94% (n = 31), respectivamente. Conclusiones. La utilidad de la car-peta de aprendizaje es alta tanto para estudiantes como para profesores, pero representó un instrumento complejo en su uso, que nos obligará a unificar diseños en el sistema de evaluación para que el estudiante y tutores optimicen esta herramienta

Objective. To evaluate the perceptions of the students in relation to the usefulness of the Learning Portfolio, and to determine the level of students’ satisfaction during clinical practice. Methodology. 33 assistant professors and 185 students of Clinical Practice I and II at Nursing School in University of Barcelona during the 2016-2017 academic year were enrolled. Two ad-hoc questionnaires were elaborated: the first made reference to the usefulness of the Learning Portfolio related to the use of the tool, the competence liaison, the problems and the limitations in the handling of the same; the second questionnaire was about the level of satisfaction made only to students. Results. According to the students, the usefulness of the learning portfolio was high with 89% (n = 81) and 71% (n = 67), at second and third year, respectively. This utility decreased when portfolio was associated with the help provided in the acquisition of students’ competences, 37% (n = 37) and 26% (n = 24). Difficulty in using Portfolio was 41% (n = 37) in second academic year and 28% (n = 26) in the third. Regarding the tutors, both the suitability and the usefulness of the folder obtained high values with 91% (n = 30) and 94% (n = 31), respectively. Conclusions. The usefulness of the learning portfolio is high for both students and teachers. The portfolio re-presents a complex instrument in its use, an aspect that forces us to unify designs in the evaluation system so that the student and tutors optimize this tool

Medición del incumplimiento terapéutico en el paciente crónico complejo / Measurement of the therapeutic breach in the chronic patient complex and model of attention advanced cronicity in two primary care emergency centers of the province of Barcelona

Objetivo. Determinar la adherencia al tratamiento farmacológico en los pacientes identificados como PCC/MACA en dos centros de urgencias de atención primaria de la provincia de Barcelona durante el año 2016. Metodología. Estudio descriptivo observacional de tipo exploratorio y transversal. Se incluyeron un total de 379 sujetos. Resultados. Edad media 81,8 años; el 52,8% eran mujeres y el resto, hombres. Fueron identificados como PCC el 89,4% y el 10,6%, MACA. Los factores de riesgo predominantes fueron la hipertensión arterial, la obesidad, diabetes y dislipemia. El 98,4% de los pacientes presenta pluripatología. Se obtuvieron unas me-dianas de Índice de Barthel de 85, del Test de Zarit 54, de la probabilidad de ingresos anuales 18,2% y de consumo diario de 11 fármacos. El cumplimiento terapéutico se observó en 274 (72,3%) pacientes, presentando un porcentaje mayor en los MACA respecto de los PCC (p=0,058). El cumplimiento resultó mayor cuando el cuidador era un familiar y menor cuando era institucional o no tenía cuidador (p = 0,008). En cuanto al incumplimiento, se olvidaban más frecuentemente los diabéticos (p = 0,010 ) y los obesos (p=0,013) que el resto de pacientes. La correcta toma de toda la medicación se asocia con un mayor nivel de estudios (p = 0,028). Conclusión. El incumplimiento por olvido es menor en pacientes que tienen el apoyo de los hijos, por lo tanto los pro-gramas deben potenciar la implicación siempre que sea posible de los hijos en los cuidados. En la población de diabéticos es mayor el incumplimiento que en el resto, siendo necesario realizar un seguimiento más exhaustivo de estos pacientes. Las mujeres son más incumplidoras que los hombres y no es por falta de responsabilidad, sino por falta de apoyo

Objective. To determine the adherence to pharmacological treatment in patients identified as PCC / MACA in two primary care emergency centers in the province of Barcelona during 2016.MethOdOlOgy. Observational descriptive study of exploratory and transversal type. A total of 379 subjects were included. Results. Average age 81.8 years of which 52.8% were women and the rest were men. They were identified as PCC 89.4% and 10.6% as MACA. The predominan risk factors were hypertension, followed by obesity, diabetes and dyslipidemia. 98.4% of patients have multiple pathologies. We obtained a median of Barthel Index of 85, of the Zarit Test 54, of the probability of annual income 18.2% and of daily consumption of 11 drugs. Therapeutic compliance was observed in 274 (72.3%) patients, presenting a higher percentage in MACA versus PCC (p = 0.058). Compliance was higher when the caregiver was a family member, and lower when the caregiver was institutionalized or had not caregiver (p = 0.008). In terms of non-compliance, diabetics (p = 0.010) and obese patients (p = 0.013) were more frequently forgotten than the rest of patients. The correct intake of all medication is associated with a higher level of study (p = 0.028). Conclusion. Non-compliance due to forgetfulness is less in patients who have the direct support of children, therefore the programs should enhance the involvement whenever possible of the children in the care of their elders. In the population of diabetics, non-compliance is higher than in the rest of the population, and a more exhaustive follow-up of these patients is necessary. On the other hand, women are more deviant than men and it is not due to lack of responsibility, but rather lack of support

Identifying Coordination and Continuity of Care Indicators for Population-Based Cancer Screening Programs: A Delphi Study.

BACKGROUND: Continuity of care and care coordination are critical issues in virtually all healthcare systems. European guidelines for the quality of screening programs for breast and colorectal cancer describe process, structure, and outcome indicators, but none specifically evaluate coordination and continuity of care during the cancer screening process. OBJECTIVE: The aim of this study was to identify indicators reflecting care coordination and continuity in population-based breast and colorectal cancer screening program. METHODS: A two-round Delphi study was conducted in a sample of 30 cancer screening nurses to identify quality indicators. RESULTS: The final Delphi consensus resulted in six core indicators for the cancer screening program: adequacy of the referral of the target population from the screening program to other health services, waiting time for referral to other health services, understanding of the screening program by professionals involved in the process, effective information flow between professionals involved in the process, participants' perception of the screening program, and, finally, participants' understanding of information about the program. CONCLUSION: The evaluation of indicators is crucial for quality improvement and should allow a measuring system to be established that would allow a comparison of outcomes for all population-based cancer screening programs.

La narrativa como estrategia didáctica para una aproximación al proceso de la muerte / Narrative strategy for an approach to the process of death

Objetivos: Explorar, a partir de una experiencia didáctica basada en la práctica reflexiva, la narrativa sobre una experiencia personal vivida en torno a la muerte, de estudiantes de 2º curso de Grado en enfermería. Comprender el proceso en torno a la muerte y su transcendencia en la práctica de los cuidados enfermeros. Métodos: Estudio cualitativo con un enfoque fenomenológico hermenéutico. Los participantes de este estudio fueron estudiantes de "Comunicación terapéutica" de 2º curso de Grado en enfermería, reclutados en el aula, en la 2ª sesión de la asignatura. Su participación fue voluntaria ya que el estudiante pudo elegir entre 4 temas distintos. Los datos fueron colectados a través de escritura reflexiva. Se analizaron los textos mediante análisis de contenido cualitativo semántico. Resultados: Se identificaron unidades de significado que revelaron la estructura del fenómeno de estudio. Posteriormente, se agruparon en 8 categorías de las que emergieron 6 temas: Impacto de la noticia; Despedida; Evocación; Afrontamiento; Creencias y valores; Crecimiento personal. Conclusiones: Tomar consciencia de la propia vivencia en torno a la muerte permite precisar aspectos significativos que pueden enriquecer los cuidados profesionales. Reconocer las conductas observadas durante el proceso de duelo contribuye al acompañamiento sensible de las personas en procesos en torno a la muerte. El relato pedagógico, como estrategia didáctica, es útil en la formación enfermera ya que posibilita la comprensión de significados y del impacto ante situaciones complejas. La reflexión sobre las experiencias vividas y el contraste con la literatura permite guiar el proceso del cuidado comprensivo (AU)

Objectives: Based on teaching experience of reflective practice, we aim to explore the description about personal experiences around death in second degree nursing students. We intend to understand the environment process of death, and its importance in nursing care. Methods: Qualitative study with a hermeneutic phenomenological approach. Participants in this study were students of "Therapeutic communication" recruited in the classroom, during the 2nd lesson of the subject. Participation was voluntary and each student could choose between 4 different topics. Data was collected using reflective writing. The texts were analyzed using qualitative content analysis with semantic approach. Results: Several units of meaning were identified and subsequently grouped in 8 categories where 6 different topics emerged: Impact of the notice; Farewell; Evocation; Coping; Beliefs and values; Personal growth. Conclusions: Raising awareness of own experiences in the process of death can help to define relevant aspects that may improve professional care. The recognition of the behaviors observed during the grieving process contributes to optimize the sensitive accompaniment of people in processes around death. The pedagogical chronicle, as a teaching strategy, is useful in nursing education given that allows the comprehension of the significance and impact of complex situations. Reflection on the lived experiences and contrasting them with the literature allows guiding the process of comprehensive (AU)

A specific nursing educational program in patients with Cushing's syndrome.

Cushing's syndrome (CS) is a rare endocrine disease, due to cortisol hypersecretion. CS patients have comorbidities, often still present after biochemical cure. Specific nursing healthcare programs to address this disease and achieve improved health related quality of life (HRQoL) are lacking. Thus, an educational nursing intervention, through the development and promotion of specific educational tools, appears to be justified. The objective of this study is to assess the effectiveness of an educational nursing program in CS patients on HRQoL, clinical parameters, level of pain and physical activity, patterns of rest, and use of health resources. A prospective, randomized study was conducted in two reference hospitals for CS. Sixty-one patients (mean age 47 ± 12.7 years, 83.6 % females) were enrolled and divided into 2 groups: an "intervention" group where educational sessions were performed over 9 months and a "control" group, without these sessions. Specific questionnaires were used at the beginning and end of the study. After educational sessions, the intervention group had a better score in the CushingQoL questionnaire (p < 0.01), reduced level of pain (p < 0.05), improved physical activity (p < 0.01) and healthy lifestyle (p < 0.001) compared to the control group. A correlation between the CushingQoL score and reduced pain (r = 0.46, p < 0.05), improved physical activity (r = 0.89, p < 0.01), and sleep (r = 0.53, p = 0.01) was observed. This educational nursing program improved physical activity, healthy lifestyle, better sleep patterns, and reduced pain in CS patients, influencing HRQoL and reducing consumption of health resources. Moreover, the brief nature of the program suggests it as a good candidate to be used in CS patients.

Cardiovascular risk and white matter lesions after endocrine control of Cushing's syndrome.

OBJECTIVE: Cushing's syndrome (CS) is associated with high cardiovascular risk. White matter lesions (WML) are common on brain magnetic resonance imaging (MRI) in patients with increased cardiovascular risk. AIM: To investigate the relationship between cardiovascular risk, WML, neuropsychological performance and brain volume in CS. DESIGN/METHODS: Thirty-eight patients with CS (23 in remission, 15 active) and 38 controls sex-, age- and education-level matched underwent a neuropsychological and clinical evaluation, blood and urine tests and 3Tesla brain MRI. WML were analysed with the Scheltens scale. Ten-year cardiovascular risk (10CVR) and vascular age (VA) were calculated according to an algorithm based on the Framingham heart study. RESULTS: Patients in remission had a higher degree of WML than controls and active patients (P<0.001 and P=0.008 respectively), which did not correlate with cognitive performance in any group. WML severity positively correlated with diastolic blood pressure (r=0.659, P=0.001) and duration of hypertension (r=0.478, P=0.021) in patients in remission. Both patient groups (active and in remission) had higher 10CVR (P=0.030, P=0.041) and VA than controls (P=0.013, P=0.039). Neither the 10CVR nor the VA correlated with WML, although both negatively correlated with cognitive function and brain volume in patients in remission (P<0.05). Total brain volume and grey matter volume in both CS patient groups were reduced compared to controls (total volume: active P=0.006, in remission P=0.012; grey matter: active P=0.001, in remission P=0.003), with no differences in white matter volume between groups. CONCLUSIONS: Patients in remission of Cushing's syndrome (but not active patients) have more severe white matter lesions than controls, positively correlated with diastolic pressure and duration of hypertension. Ten-year cardiovascular risk and vascular age appear to be negatively correlated with the cognitive function and brain volume in patients in remission of Cushing's syndrome.

Small cerebellar cortex volume in patients with active Cushing's syndrome.

OBJECTIVE: Cushing's syndrome (CS) is associated with neuropsychological deficits. As the cerebellum plays a key role in neuropsychological functions it may be affected in CS. The aim of this study was to investigate whether patients with CS have a smaller cerebellar volume than healthy controls, and to analyse whether cerebellar volume is associated with neuropsychological performance and clinical parameters. DESIGN: A cross-sectional study was performed. METHODS: Thirty-six CS patients (15 with active CS and 21 with CS in remission) and 36 controls matched for age, sex, and education underwent neuropsychological testing, quality of life assessment, clinical evaluation, and magnetic resonance imaging brain scan. Cerebellar volumes (white matter and cortex, bilateral) were calculated using FreeSurfer Software. RESULTS: Patients with active CS showed smaller bilateral cerebellar cortex volumes than controls (left, P=0.035 and right, P=0.034), as well as a trend toward smaller right cerebellar cortex volumes than patients in remission CS (P=0.051). No differences were observed in the volume of cerebellar white matter between the three groups. Both right and left cerebellar cortex volumes correlated negatively with triglyceride levels (right: r=-0.358, P=0.002 and left: r=-0.317, P=0.005) and age at diagnosis (right: r=-0.433, P=0.008 and left: r=-0.457, P=0.005). Left cerebellar cortex volume also correlated positively with visual memory performance (r=0.245, P=0.038). Right cerebellar cortex volume positively correlated with quality-of-life scores (r=0.468, P=0.004). CONCLUSIONS: The cerebellar cortex volume is smaller in active CS patients than in controls. This finding is associated with poor visual memory and quality of life and is mostly pronounced in patients with higher triglyceride levels and older age at diagnosis.