Rural Cancer Survivors' Perceptions of a Nurse-Led Telehealth Intervention to Manage Cancer-Related Distress.

OBJECTIVES: To understand rural survivors' experiences of participating in a nurse-led telehealth visit designed to address cancer-related distress. SAMPLE & SETTING: 25 rural-dwelling, post-treatment adult survivors of head and neck cancer recruited from a cancer center clinic affiliated with an academic health system serving a rural catchment area in the southeastern United States. METHODS & VARIABLES: A descriptive multimethod approach using semistructured qualitative interviews and the Telemedicine Satisfaction and Usefulness Questionnaire. RESULTS: Three primary themes emerged from the qualitative interviews, related to trust, access to information, and technology barriers. Quantitative findings indicated high satisfaction with the nurse-patient relationship through telehealth and lower satisfaction with using telehealth equipment to connect to a visit. IMPLICATIONS FOR NURSING: Despite facing technology barriers, rural cancer survivors prioritize speaking with an oncology certified nurse through telehealth. Although they may be willing to be open and vulnerable with an oncology nurse about their distress, rural survivors are less likely to accept a referral to another provider of psychosocial care. Nurses can incorporate warm handoffs to increase psychosocial referral uptake for rural survivors.

Blood pressure reduction in difficult-to-control patients and the effect of a nurse-led program in Bulgaria.

Hypertension is a major contributor to cardiovascular morbidity and mortality. Although there has been significant improvement in blood pressure (BP) control during the last decades, it is still far from optimal. Several strategies for hypertension management have been proposed, and among all - nurse-led programs seem encouraging. AIM: To evaluate the effect of a complex nurse program aiming to reduce BP in patients with uncontrolled hypertension. PATIENTS AND METHODS: In a cardiologist's office, a trained nurse included patients with uncontrolled hypertension and newly referred patients with high BP in a program for hypertension management. It consisted of patient education, assessment of quality of life, lifestyle advice, medication improvement and adherence stimulation. All patients were followed for 6 months and their BP, lifestyle indicators, and quality of life measurements were recorded. Statistical analyses included two- and one sample t-tests, chi-square test, correlation and multivariate linear regression. RESULTS: Overall, 47 patients, presenting with uncontrolled hypertension and with BP>140/90 mm Hg were included in this research. Their BP was reduced within 6 months by mean 30 /11 mm Hg and after 6 months, from 162/88 to 133/77 mm Hg. The drop of BP values was present at the first month with mean BP 140/82 mm Hg. Control of hypertension improved from 2% to 55% at the 1st month mark and to 79% at the 6th month, p<0.0001. The decrease in SBP was positively correlated to decrease in waist circumference, p = 0.47, p = 0.009. In multivariate linear regression analysis, the difference in BP was significantly related to self-assessment health scoring and marginally significant with renal impairment. CONCLUSIONS: The development of a complex nurse-led program, tailored to patients with uncontrolled hypertension, leads to significant positive effect on BP decrease and improves hypertension control in primary care. This may be cost effective and improve BP control in low- to middle-income countries.

The nurse-led GILL eHealth intervention for improving physical health and lifestyle behaviours in clients with severe mental illness: design of a cluster-randomised controlled trial.

BACKGROUND: Clients with severe mental illness (SMI) have overall poor physical health. SMI reduces life expectancy by 5-17 years, primarily due to physical comorbidity linked to cardiometabolic risks that are mainly driven by unhealthy lifestyle behaviours. To improve physical health in clients with SMI, key elements are systematic somatic screening and lifestyle promotion. The nurse-led GILL eHealth was developed for somatic screening and the implementation of lifestyle activities in clients with SMI. Aims of this study are to evaluate the effectiveness of the GILL eHealth intervention in clients with SMI compared to usual care, and to evaluate the implementation process, and the experiences of clients and healthcare providers with GILL eHealth. METHODS: The GILL study encompasses a cluster-randomised controlled trial in approximately 20 mental health care facilities in the Netherlands. The randomisation takes place at the team level, assigning clients to the eHealth intervention or the usual care group. The GILL eHealth intervention consists of two complementary modules for somatic screening and lifestyle promotion, resulting in personalised somatic treatment and lifestyle plans. Trained mental health nurses and nurse practitioners will implement the intervention within the multidisciplinary treatment context, and will guide and support the participants in promoting their physical health, including cardiometabolic risk management. Usual care includes treatment as currently delivered, with national guidelines as frame of reference. We aim to include 258 clients with SMI and a BMI of 27 or higher. Primary outcome is the metabolic syndrome severity score. Secondary outcomes are physical health measurements and participants' reports on physical activity, perceived lifestyle behaviours, quality of life, recovery, psychosocial functioning, and health-related self-efficacy. Measurements will be completed at baseline and at 6 and 12 months. A qualitative process evaluation will be conducted alongside, to evaluate the process of implementation and the experiences of clients and healthcare professionals with GILL eHealth. DISCUSSION: The GILL eHealth intervention is expected to be more effective than usual care in improving physical health and lifestyle behaviours among clients with SMI. It will also provide important information on implementation of GILL eHealth in mental health care. If proven effective, GILL eHealth offers a clinically useful tool to improve physical health and lifestyle behaviours. TRIAL REGISTRATION: Clinical trial registration NCT05533749, registration date: 8 September 2022.

Palliative Communication in the Pediatric Intensive Care Unit.

Communication is a central aspect of nursing care and is especially important when pertaining to progressive illnesses and end of life. This article reviews basic palliative care terminology and outlines a variety of communication frameworks from the "dos" to the "don'ts." These communication strategies are meant to be added to the nurse's "toolbox" so that nurses may use them in various scenarios. These communication tools are meant to help mitigate the stress and discomfort nurses often feel when using palliative communication or delivering bad news.

Nurse-Led Rounds in the Pediatric Intensive Care Unit.

Pediatric intensive care units (PICUs) rely on interprofessional communication and collaboration to mitigate the risk for medical error. To operationalize these tenets, many PICUs use multidisciplinary bedside rounds as the foundation of their workflow. Bedside nurse participation in rounds is inconsistent, diminishing the return on team investment in patient safety. Given this dilemma, some institutions have shifted from provider-led to nurse-led rounds. Here, the authors explore the rationale, experiences, and outcomes of implementation of nurse-led rounds within 4 PICU service lines.

The efficacy of nurse-led hyperbaric oxygen therapy in improving the quality of life in patients with sudden hearing loss.

Background: The quality of life decreases in patients with sudden hearing loss due to hearing problems. In addition, complications due to hyperbaric oxygen therapy can reduce the quality of life. Aim: This study was conducted to examine the efficacy of nurse-led hyperbaric oxygen therapy in improving the quality of life in patients with sudden hearing loss. Subjects and Methods: This one-group pretest-posttest design study was conducted with 34 patients with Sudden Hearing Loss who applied to a university hospital for Hyperbaric Oxygen Therapy between November 2018 and February 2019. The data were collected using the Patient Information Form, World Health Organization Quality of Life Scale (WHOQOL-BREF), and Pure Tone Threshold Audiogram. Results: WHOQOL-BREF's quality of life rating (2.59 ± 0.86-3.68 ± 0.59), satisfaction with health status (2.65 ± 0.69-3.62 ± 0.60), physical domain (11.58 ± 2.08-14.84 ± 2.38), psychological domain (12.80 ± 2.21-15.82 ± 2.26), social domain (14.63 ± 3.09-16.78 ± 2.67) and environmental domain (14.25 ± 2.55-16.34 ± 2.60) mean scores significantly increased compared to the pre-treatment scores (p < 0.001). The presence of an acute illness in the last month, the persistence of sudden hearing loss symptoms, level of hearing loss, presence of chronic illness, and smoking were found to affect the quality of life. Conclusions: At the end of the nurse-led hyperbaric oxygen therapy in patients with sudden hearing loss, the quality of life increased and the hearing loss decreased. The most important factor affecting the quality of life was the persistence of symptoms of sudden hearing loss.

Differentiating Specialized and Advanced Nursing Roles: The Pathway to Role Optimization.

Aim: We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. Method: Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement. Results: Respondents (n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs (p < 0.001) and SNs (p < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership (p < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement. Conclusion: Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems.

[Cancer pain, a challenge for the nurse's own role]. / La douleur cancéreuse, un enjeu pour le rôle propre infirmier.

Because of its many specific features, cancer pain requires special management and a sound knowledge base. This article aims to take a fresh look at this type of pain, and share some of the elements that make it so specific. It also aims to provide a reminder of what cancer pain is, as well as clarifying the specific role of the state-registered nurse in its management.

'They're all individuals, none of them are on the same boat': barriers to weight management in general practice from the rural nurse perspective.

AIM: To explore nurses' experiences with, and barriers to, obesity healthcare in rural general practice. BACKGROUND: Obesity is a significant health risk worldwide, which can lead to many other physical and psychosocial health issues that contribute to a poor quality of life. Primary care is considered the most suitable context to deliver obesity management healthcare across the world, including New Zealand, which reportedly has 34% of all adults (and 51% Indigenous Maori) classed as obese. Nurses in primary care have a significant role in the multidisciplinary team and deliver obesity healthcare in general practice contexts. Yet, there is little focus on the nurse perspective of weight management, specifically in rural areas where medical staff and resources are limited, and obesity rates are high. METHODS: This was a qualitative research design. Semi-structured interviews with 10 rural nurses from indigenous and non-indigenous health providers were analyzed guided by Braun and Clarke () approach to thematic analysis. FINDINGS: Three themes were identified: limitations of a nurse role; patient-level barriers; and cultural barriers. Nurses reported experiencing significant barriers to delivering effective weight management in their practice due to factors outside the scope of their practice such as patient-level factors, social determinants of health, rural locality restrictions, and limitations to their role. While this study highlights that practice nurses are versatile with an invaluable skill repertoire, it also demonstrates the near impossibility for rural nurses to meet their rural patient's complex weight management needs, as there are many social determinants of health, sociocultural, and rural locality factors acting as barriers to effective weight management. Nurses experienced a lack of systemic support in the form of time, resources, funding, and effective weight management referral options. Future investigation should look to address the unique rural weight management healthcare needs that experience many barriers.

The effect of nurse-led empowering education on nutrition impact side effects in patients with colorectal cancer undergoing chemotherapy: A randomised trial.

OBJECTIVE: This study assessed the effect of empowering education on patient-reported outcomes and morbidity. METHODS: A randomised controlled trial was conducted on adults with colorectal cancer (43 + 40). The intervention consisted of one-hour empowering patient education on nutrition impact side effects. The effect was compared with standard care. The difference between the groups was analysed pre and post intervention. RESULTS: The change in malnutrition-related knowledge level was higher in the intervention group compared to control group (median 0.0, IQR 1.00 vs median 0.0, IQR 0.0, p = 0.028). Additional contacts with outpatient clinic were fewer in intervention group (median 0.00, IQR 0.00) compared to control group (median 1.00, IQR 2.00, p < 0.001). We did not find a statistically significant difference in the change in activation level, risk of malnutrition and quality of life between the groups. CONCLUSION: Empowering education may affect positively on patients' knowledge level related to malnutrition and reduce the number of additional contacts with health care thus reduce health care costs. PRACTICE IMPLICATIONS: Empowering education may be used in patients with colorectal cancer to improve knowledge and reduce additional contacts with health care. Further research is needed on the effect of empowering education in self-care.

The role of nurses in inpatient geriatric rehabilitation units: A scoping review.

AIMS: (1) To review and synthesize research on the contributions of nurses to rehabilitation in inpatient geriatric rehabilitation units (GRUs), and (2) to compare these reported contributions to the domains of international rehabilitation nursing competency models. The roles and contributions of nurses (e.g. Registered Practical Nurses, Registered Nurses and Licensed Practical Nurses) in GRUs are non-specific, undervalued, undocumented and unrecognized as part of the formal Canadian rehabilitation process. DESIGN: Arksey and O'Malley's methodological framework for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were used. METHODS: Six databases were searched for relevant literature: MEDLINE, PsychINFO, CINAHL, EMBASE, SCOPUS and Nursing and Allied Health. English articles were included if they examined nursing roles or contributions to inpatient geriatric rehabilitation. Integrated synthesis was used to combine the qualitative and quantitative data, and thematic analysis was used for coding. Three sets of international competency models were amalgamated to explore how different nurse roles in geriatric rehabilitation were portrayed in the included literature. RESULTS: Eight studies published between 1991 and 2020 were included in the review. Five main geriatric rehabilitation nursing roles were generated from synthesis of the domains of international rehabilitation nursing competency models: conserver, supporter, interpreter, coach and advocate. CONCLUSIONS: Nurses working in inpatient geriatric rehabilitation are recognized more for their role in conserving the body than their roles in supporting, interpreting, coaching and advocacy. Interprofessional team members appear to be less sure of the nurses' role in the rehabilitation unit. Nurses themselves do not acknowledge the unique rehabilitation aspects of care for older adults. Enhancing formal education, or adding continuing education courses, to facilitate role clarity for nurses in geriatric rehabilitation could improve nurses' and interprofessional healthcare team members' understandings of the possible contributions of nurses working in rehabilitation settings.

Acceptability, Appropriateness and Feasibility of a Nurse-Led Integrated Care Intervention for Patients with Severe Exacerbation of COPD from the Healthcare Professional's Perspective - A Mixed Method Study.

Purpose: To improve inpatient care and self-management in patients with severe acute exacerbations of COPD, we implemented a nurse-led behavioral intervention. This study aimed to assess implementation outcomes from the perspective of the healthcare professionals (HCP) who delivered it. Methods: Using an explanatory sequential mixed method approach, we conducted an online questionnaire and two small group interviews. We applied descriptive statistics for quantitative data, a framework analysis for qualitative data, and a mixed methods matrix to integrate the results. Results: A total of 19 of 27 invited participants answered the online questionnaire; 9 of 19 participated in the group interviews. The intervention's overall acceptability, appropriateness, and feasibility was rated high to very high (median 5/5; 4/5 and 4/5). Enablers to implementation included general recognition of the need for specialized care, sufficient knowledge of the intervention by HCP, and strong interprofessional collaboration. Main barriers included the lack of resident physician's resources and difficulties in adaptability. Conclusion: While the acceptance of the intervention was very high, the perceived appropriateness and feasibility were affected by its complexity. The availability of a knowledgeable interprofessional core team is a strategy that supports the implementation of complex interventions.

Community Collaboration: Clinical Experiences at a Pediatric Medical Day Care.

BACKGROUND: Faculty charged with ensuring appropriate clinical experiences for prelicensure students face numerous challenges, including limited access to specialty acute care sites, particularly maternal-child, ambulatory and community settings to prepare students to care for clients outside of the hospital. METHOD: An innovative collaboration with a pediatric medical day care provided prelicensure Bachelor of Science in Nursing students exposure to nursing roles in caring for medically fragile children outside of the acute care environment. RESULTS: Providing care for children with special needs allowed students to make connections between theory and practice, explore developmental concepts, and practice specific nursing skills. Student reflection logs and feedback from the facility staff were enthusiastic and positive about the collaboration. CONCLUSION: Clinical rotations in a pediatric medical day care provided opportunities for students to care for children with medical fragilities and gain new perspectives on nursing roles in the community. [J Nurs Educ. 2023;62(7):420-422.].

The role of critical care nurses in shared decision-making for patients with severe heart failure: A qualitative study.

AIM: Patients with severe heart failure undergo highly invasive and advanced therapies with uncertain treatment outcomes. For these patients, shared decision-making is necessary. To date, the nursing perspective of the decision-making process for patients facing difficulties and how nurses can support patients in this process have not been fully elucidated. This study aimed to clarify the perceptions of critical care nurses regarding situations with patients with severe heart failure that require difficult decision-making, and their role in supporting these patients. METHODS: Individual semi-structured interviews were conducted with 10 certified nurse specialists in critical care nursing at nine hospitals in Japan. A qualitative inductive method was used and the derived relationships among the themes were visually structured and represented. RESULTS: The nurses' perceptions on patients' difficult situations in decision-making were identified as follows: painful decisions under uncertainties; tense relationships; wavering emotions during decision-making; difficulties in coping with worsening medical conditions; patients' wishes that are difficult to realize or estimate; and difficulties in transitioning from advanced medical care. Critical care nurses' roles were summarized into six themes and performed collaboratively within the nursing team. Of these, the search for meaning and value was fundamental. Two positions underpin the role of critical care nurses. The first aims to provide direct support and includes partnerships and rights advocacy. The second aims to provide a holistic perspective to enable necessary adjustments, as indicated by situation assessments and mediation. By crossing various boundaries, co-creating, and forming a good circular relationship in the search for meaning and values, the possibility of expanding treatment and recuperation options may be considered. CONCLUSIONS: Patients with severe heart failure have difficulty participating in shared decision-making. Critical care nurses should collaborate within the nursing team to improve interprofessional shared decision-making by providing decisional support to patients that focuses on values and meaning.