Transition experience of patients with cancer undergoing surgical insertion of an implantable venous access device: An exploratory study / Expérience de transition vécue par les patients avec une maladie oncologique lors de la pose d'un dispositif d'accès veineux implantable : une recherche exploratoire

Introduction: Patients experience a transition between health and a serious disease when they receive a diagnosis of cancer or of its recurrence. Context: The implantation of a venous access device often takes places shortly after the diagnosis and is an additional stress factor. Aim: Explore the unmet needs and expectations of patients after a venous access device has been implanted in order to offer specialized nursing care. Method: An exploratory descriptive qualitative approach with deductive content analysis was used. Afaf Meleis' transitions theory was the framework that guided the analysis. Data was collected from interviews with twelve patients. Results: The results showed the vulnerability of patients during venous access device implantation. Personal, interpersonal, and organizational dimensions were found to hinder or facilitate the transition, influencing the quality of patients' experience. Several coping strategies were used by patients to diminish their emotional distress. Discussion: Support for self-care strategies, advance preparation, and adequate pain management help to reduce anxiety and insecurity. Conclusion: Nurses must offer transition care in order to facilitate a positive experience of venous access device implantation.

Introduction: À l'annonce d'un diagnostic de cancer ou d'une récidive, les patients vivent une transition de type maladie. Contexte: La pose d'un dispositif d'accès veineux implantable (DAVI) survient souvent juste après l'annonce ; il est un facteur de perturbation supplémentaire à leur équilibre. Objectif: Explorer les besoins non comblés et les attentes des patients en interrogeant leur expérience vécue de la pose du DAVI pour proposer des interventions de soins adaptées. Méthode: Une méthode d'analyse de contenu déductive a été réalisée, ainsi qu'une analyse à la lumière de la théorie de la transition de Meleis. Douze entretiens ont été réalisés. Résultats: Les résultats montrent la vulnérabilité des patients lors de la pose du DAVI. Des conditions entravantes et facilitantes de la transition, de nature personnelle, interpersonnelle et organisationnelle, influencent la qualité de l'expérience vécue. Différentes stratégies de coping sont utilisées par les patients pour diminuer leur détresse émotionnelle. Discussion: La préparation anticipée, le soutien au développement des capacités d'autosoins, la gestion de la douleur contribuent à diminuer l'anxiété et l'insécurité. Conclusion: Les infirmières se doivent d'offrir des soins transitionnels pour favoriser une expérience positive de la pose du DAVI.

Risk assessment scale for pressure ulcers in pediatric patients: French translation, internal consistency, convergent validity, feasibility, and clinical utility of the Braden QD Scale / Échelle d'évaluation des risques d'escarres en pédiatrie : traduction en langue française, cohérence interne, validité convergente, faisabilité et utilité clinique de l'échelle Braden QD

Introduction: Pediatric patients are particularly vulnerable to pressure ulcers. Structured evaluation with a risk assessment tool is recommended in order to identify patients at risk. The Braden QD Scale integrates the risks of both immobility-related and medical device-related pressure ulcers in pediatric patients. Objectives: To translate and pretest the Braden QD Scale into French (Swiss-French version), and to evaluate its consistency, convergent validity, feasibility, and clinical utility. Method: Over five prevalence surveys, the Braden QD Scale was used on all hospitalized pediatric patients. Convergent validity and internal consistency were tested. A self-administered questionnaire on feasibility and clinical utility was completed by nurses. Results: The translated version of the Braden QD Scale was pretested on 352 children. The prevalence surveys showed that 5.1% were at risk of developing pressure ulcers. Medical devices were present in 85.8% of cases. A Cronbach's alpha of 0.710 and a high convergent validity were measured. High scores of feasibility and clinical utility were found. Discussion and conclusion: This study suggests that the Swiss-French version of the Braden QD Scale is reliable, valid, feasible, and has clinical utility.

Introduction: La population pédiatrique est particulièrement vulnérable aux escarres. Afin d'identifier les patients à risques, une évaluation structurée est recommandée. L'utilisation de l'échelle Braden QD permet d'intégrer les risques liés à l'immobilité et à la présence de dispositifs médicaux. Objectifs: Réaliser une traduction en langue française (suisse francophone), un test de l'échelle Braden QD, évaluer sa cohérence interne, sa validité convergente, sa faisabilité et son utilité clinique. Méthode : lors de cinq enquêtes de prévalence, l'échelle Braden QD a été utilisée auprès de tous les enfants hospitalisés. Des tests psychométriques ont été mesurés. Un questionnaire de faisabilité et d'utilité clinique a été distribué aux enquêtrices. Résultats: L'échelle traduite a pu être testée auprès de 352 enfants. Les enquêtes ont montré que 5,1 % étaient à risques de développer une escarre et 85,8 % étaient porteurs de dispositifs médicaux. Un alpha de Cronbach à 0,710, avec une validité convergente élevée, de hauts scores de faisabilité et d'utilité clinique ont été retrouvés auprès des infirmières. Discussion et conclusion: Cette étude suggère que la version suisse francophone de la Braden QD est faisable, fiable et valide. Les infirmières ont estimé qu'elle était facile à utiliser et utile pour leur pratique.

Perceptions of inpatients and nurses towards the importance of nurses' caring behaviours in rehabilitation: A comparative study.

AIMS: This study was conducted to describe and compare nurses' and inpatients' perceptions of caring attitudes and behaviours in rehabilitation. METHODS: A comparative descriptive design was used. Perceptions of caring attitudes and behaviours were compared between 34 nurses working in rehabilitation and 64 elderly patients, using the Caring Nurse Patient Inventory-23, to explore Watson's carative factors through four dimensions. Patients' and nurses' ratings of importance for each dimension were compared. The study data were collected from 8 November 2017 to 5 May 2018. RESULTS: Patients' and nurses' responses showed high scores in terms of their perceptions of caring, with nurses having the higher scores, and significant differences were found between patients and nurses. Patients scored items linked to clinical aspects of caring as the most important, whereas nurses scored items linked to humanistic and clinical caring as equally important. Comfort care was considered important for nurses and patients. Both groups considered relational caring items as the least important. CONCLUSION: Results show that patients and nurses value clinical aspects of care, which is the visible aspect of care. The Caring Nurse Patient Inventory-23 is a reliable instrument to measure the nurses' and patients' perception of caring behaviours in rehabilitation.

Validation of the Critical Care Pain Observational Tool in Palliative Care.

PURPOSE: Pain assessment at the end of life remains a problem for patients who are unable to self-report their pain when transitioning across care settings. This study therefore tested the internal consistency and discriminant, concurrent, and convergent validity of the Critical-Care Pain Observational Tool (French version) when used with end-of-life patients in a palliative care setting. DESIGN: This was a descriptive correlational study that used a repeated-measures within-subjects prospective design. METHODS: The pain of 13 patients was assessed when at rest and during turning. RESULTS: The internal consistency reliability coefficient alphas were .64 at rest and .70 during turning. Discriminant validity was shown by a decrease in the total Critical-Care Pain Observation Tool score. Concurrent validity was demonstrated by the association between the patients' self-report of pain and the Critical-Care Pain Observation Tool score at rest (0.65, p < .016) and during turning (0.77, p = .002). Finally, the convergent validity between the Critical-Care Pain Observation Tool score and the Algoplus scale score was demonstrated with a Spearman's correlation coefficient of 0.76 at rest and 0.84 during turning. CONCLUSIONS: The results suggest that the Critical-Care Pain Observation Tool can be used with end-of-life patients in French-speaking countries.

[Emerging challenges linked to vascular access, the strategy to adopt faced with the changing profile of hospitalised patients]. / Enjeux émergents liés aux accès vasculaires, quelle stratégie face à l'évolution du profil des patients hospitalisés ?

Peripheral venous catheters are the most commonly used vascular devices in hospitals. The ageing population and the increase in comorbidities makes their insertion more complex. A survey carried out in surgical units describes the factors contributing to failures. It is important to improve the identification of patients with difficult venous access, to offer access to various techniques and devices, as well as to the expertise of a specialised team.

Le modèle de pratique des infirmières spécialistes cliniques aux Hôpitaux universitaires de Genève.

THE CLINICAL NURSE SPECIALIST PRACTICE MODEL AT GENEVA UNIVERSITY HOSPITALS.: A clinical nurse specialist practice model has been implemented at Geneva University Hospitals. It details the five dimensions of the function-clinical practice, coaching-consultation-guidance, research, leadership and collaboration, ethics-and its three spheres of influence-patients and their family, nursing teams, institutions. Arising from practice rather than the world of academia, it constitutes a tool to aid reflection among the nursing profession.

Role of advanced nurse practitioners in the care pathway for children diagnosed with leukemia.

PURPOSE: The development of advanced nursing practices (ANP) can meet challenges presented by evolving needs of health care. We aimed at describing the approach taken to implement ANP in a pediatric oncology-hematology unit. METHOD: The Participatory, Evidence-informed, Patient-centered Process for Advanced practice was considered as a conceptual framework for the development, implementation and evaluation of the nursing role. Successive steps were taken for identifying patients and family needs, defining the health care priorities, and establishing a new health care model. RESULTS: The seven steps of the PEPPA framework were carried out over a year and contributed to the identification of the tasks and the role of the advanced nurse practitioner in the patient care pathway. The implementation of ANP was gradually achieved with the development of new evidenced-based health care procedures. The subsequent approval of a contract specification for advanced nurse practitioners facilitated the onset of a specific consultation, which facilitated a holistic approach. CONCLUSION: The impact of the implementation can be appreciated at different levels: i) the patient and his or her family, with improvement of communication and continuity of care; ii) the interdisciplinary team, with development of a dynamic and greater motivation of the health care providers; and iii) the profession, with a greater recognition of the competencies and conceptualization of the new role. An assessment of the process, the structure and the results should be carried out to validate the role of the advanced nurse practitioner throughout the long journey of a child with leukemia.

Generating and selecting pain indicators for brain-injured critical care patients.

Current pain assessment tools for nonverbal critical care patients may not be appropriate for those with brain injury, as these patients demonstrate specific responses to pain. The aim of this study was to generate and select items that could be used to assess pain in brain-injured patients. A sequential mixed-method design was chosen with three consecutive steps: 1. Generate items with a literature review, the results of a pilot study, and interviews with 18 clinicians using the nominal group technique. 2. Evaluate content validity with 10 clinicians and four scientists, using a web-based questionnaire. 3. Describe and reduce items with the observation of 116 brain-injured patients in the intensive care unit during common painful procedures. This study took place between May 2010 and October 2011 in two tertiary hospitals in Western Switzerland. Forty-seven items were generated and reduced to 33 during the content validity process. The behaviors most frequently observed during turning were closing the eyes (58.6%), eye movements (57.8%), ventilator asynchrony (55.2%), and frowning/brow lowering (50%). Five items were observed in less than 5% of the patients during nociceptive procedure. Constant motor activity was observed more frequently at rest than during nociceptive stimulation. All physiologic items showed little variability and their reliability was low. Based on these results, the number of items was reduced to 23. This study identified items that could be specific to brain-injured patients and found that the variability of physiologic items was poorly assessed by clinicians.

Behavioral changes in brain-injured critical care adults with different levels of consciousness during nociceptive stimulation: an observational study.

PURPOSE: The primary objective of this study was to describe the frequency of behaviors observed during rest, a non-nociceptive procedure, and a nociceptive procedure in brain-injured intensive care unit (ICU) patients with different levels of consciousness (LOC). Second, it examined the inter-rater reliability and discriminant and concurrent validity of the behavioral checklist used. METHODS: The non-nociceptive procedure involved calling the patient and shaking his/her shoulder. The nociceptive procedure involved turning the patient. The frequency of behaviors was recorded using a behavioral checklist. RESULTS: Patients with absence of movement, or stereotyped flexion or extension responses to a nociceptive stimulus displayed more behaviors during turning (median 5.5, range 0-14) than patients with localized responses (median 4, range 0-10) or able to self-report their pain (median 4, range 0-10). Face flushing, clenched teeth, clenched fist, and tremor were more frequent in patients with absence of movement, or stereotyped responses to a nociceptive stimulus. The reliability of the checklist was supported by a high intra-class correlation coefficient (0.77-0.92), and the internal consistency was acceptable in all three groups (KR 20, 0.71-0.85). Discriminant validity was supported as significantly more behaviors were observed during nociceptive stimulation than at rest. Concurrent validity was confirmed as checklist scores were correlated to the patients' self-reports of pain (r s = 0.53; 95 % CI 0.21-0.75). CONCLUSION: Brain-injured patients reacted significantly more during a nociceptive stimulus and the number of observed behaviors was higher in patients with a stereotyped response.

[Contributions and difficulties of experienced nursing participating in a journal club: a qualitative research analysis]. / Apports et difficultés liés a la participation d'infirmières expérimentées a un journal club: une analyse de contenu qualitative.

INTRODUCTION: This article presents the impact of a journal club on expert nurses working in a hospital. AIM: This study describes the input of a journal club and the difficulties encountered by experienced nurses in pain management and palliative care. METHOD: Seven nurses participated in a written survey containing two questions about contributions and difficulties pertaining to their participation to a journal clubs. A qualitative inductive content analysis was used to organize and condense the collected data. FINDINGS: 127 meaning units were identified. The contributions were grouped in six categories: knowledge, discussion, professional assertiveness, reflection, theory-practice link and positive impulse. The difficulties were grouped in three categories: missing scientific knowledge, emotional impact and organization. Trusting and respectful interaction with peers promoted the integration of scientific knowledge. The results suggest that journal clubs' have an impact on nurses' professional assertiveness and are incentive to read scientific articles. CONCLUSION: Journal clubs are an interesting mean to initiate experienced nurses to read and critically appraise scientific articles.

Staff satisfaction between 2 models of care for the chronically critically ill.

INTRODUCTION: Chronically critically ill (CCI) patients are a growing population in intensive care units (ICUs), and evidence suggests that this patient group is perceived as demanding by healthcare professionals. However, information is scarce regarding organizational factors that affect staff satisfaction during the care of CCI patients. PURPOSE: The purpose of this study was to evaluate staff satisfaction between 2 models of care for the CCI. In the first model, a patient-centered program of care in a traditional ICU was evaluated. In the second model, care of patients hospitalized in a multidisciplinary ICU ward dedicated to the CCI was further evaluated. Indicators of staff satisfaction with respect to the care of the CCI were also identified. METHODS: A before and after study was used to evaluate the 2 models of care. After implementation of the first model in 2006, an initial evaluation was performed using a questionnaire given to ICU health-care personnel. In 2009, after implementing the second model (a separate ward for the CCI), a second evaluation took place. RESULTS: A total of 147 participants answered the questionnaire in both phases. Participants described CCI as a burden, and grouping these patients into 1 ward only increased this perception. Overall, the staff was more satisfied with the first model of care. In this model, the indicators of increased satisfaction were perceived access to professional development and the availability of information. CONCLUSIONS: Results from this study provide information about health-care professionals' perceived burden of care when treating CCI patients. Strategies promoting professional development have a potential to increase staff satisfaction when it comes to the care of this patient group.

Pain indicators in brain-injured critical care adults: an integrative review.

INTRODUCTION: Health professionals are confronted with the difficulty of adequately evaluating pain in critically ill, brain-injured patients, as these patients are often unable to self-report. In addition, their confused and stereotyped behaviours may change their responses to pain; the indicators and descriptors generally used to evaluate pain in the critically ill may therefore not be appropriate for brain-injured patients. AIM: The aim of this integrative review was to identify clinically measurable and observable pain indicators and descriptors for brain-injured, critically ill adults. METHOD: A search of electronic databases (Medline, CINAHL, Embase) combined with cross-referencing was performed. Articles were included if they described pain indicators in critically ill adults and included brain-injured patients in their population. RESULTS: Seven articles met the inclusion criteria. They were critically appraised for their quality and their relevance for the population of brain-injured patients. Behavioural pain indicators such as facial expressions, body movements and muscle tension were found in all of the articles. However, the descriptions of the indicators differ from one article to another. The intensity and nature of behavioural pain responses vary according to the level of consciousness. Changes in physiological parameters have also been reported, but these results are inconclusive. CONCLUSION: Additional research is needed to identify and better describe pain indicators that are specific to brain-injured patients in the ICU. Studies with large samples, different brain injury diagnoses and various levels of consciousness are warranted.

[Critical review of instruments to assess pain in the non communicative brain injured persons in intensive care]. / Revue critique d'instruments pour evaluer la douleur chez les personnes cérébrolésées non communicantes aux soins intensifs.

The purpose of this review is to critically appraise the pain assessment tools for non communicative persons in intensive care available in the literature and to determine their relevance for those with brain injury. Nursing and medical electronic databases were searched to identify pain tools, with a description of psychometric proprieties, in English and French. Seven of the ten tools were considered relevant and systematically evaluated according to the criteria and the indicators in the following five areas: conceptualisation, target population, feasibility and clinical utility, reliability and validity. Results indicate a number of well designed pain tools, but additional work is necessary to establish their accuracy and adequacy for the brain injured non communicative person in intensive care. Recommendations are made to choose the best tool for clinical practice and for research.

Diaries written for ICU patients.

Diaries are written for critically ill patients, to help them understand their intensive care stay and come to terms with their illness. The aim of this content analysis of eight such diaries is to understand the potential benefits for patients and families of this care intervention. A main category emerged: Sharing throughout the ICU time. Four themes were identified: (a) Sharing the story, (b) Sharing the presence, (c) Sharing feelings, and (d) Sharing through support. The first theme reflects the narration of daily events. The second is the perceived presence of health professionals and family at the patient's bedside and the presence of the patient as a person through the diary entries. The third theme describes the expression of feelings as written throughout the text. The last theme refers to the support offered to the patient. The diaries reflect the commitment and care of contributors to the patients' welfare.