Oncology nursing continues to evolve in response to advances in cancer treatment, information and biotechnology. As new scientific and technological discoveries are integrated into cancer care, oncology nurses need to play a key role in the management of this patient population. The role of the oncology nurse has expanded significantly and can differ greatly across cultures. Sophisticated treatments and the growth of targeted therapies will create the challenge of ensuring that all nurses working in this arena are well-educated, independent thinkers. Thus the future success of oncology nurses will focus on enhancement of nursing practice through advanced education. The increased globalisation of healthcare offers exciting opportunities to accomplish this goal by allowing for collaborative relationships among oncology nurses across the globe.
Nursing; cancer; oncology
The concept "intensified nursing" is mentioned in differentiation to concepts of "nursing care" or "nursing" which intensifies resources or patient contact. Especially psychic and social needs of patients are very appreciated in nursing. A similar type of nursing is known under the concept "advanced nursing practice" (ANP) which means, that a specialised, academically trained nurse offers an extended nursing care in which a focus on the published knowledge of evidence based research is made.
From the thin literature to this topic a selection of predetermined topics was analysed where at least two articles with a sufficient high methodical quality were available. The selected topic groups were: „Infant and paediatric nursing", "gerontology" and "oncology". Generally the five publications concerning infant and paediatric nursing could conclusive show a benefit of intensified nursing. Further research is still needed to prove intensified nursing care. Two publications could be found to the gerontological intensified nursing; both used an extended nursing model and an enlarged use of resources. Both studies demonstrated a measurable success in the applied parameters. Two studies also could be analysed in the oncological field in which successes were also provable by the applied parameters. The success was given especially in a higher patient satisfaction, one study showed an improved scheduling (time planning) of nurses.
There was not one article concerning economic questions of intensified nursing care. It has to be taken into account that the financial resources have to be used effectively also in nursing nowadays. It has to be assumed that the costs are driven by increased use of resources. Savings can be achieved, however, in the form of avoided therapies and days in hospital by intensified nursing. The intensified nursing can be considered as similar cost-effective as conventional models of nursing.
Ethically it is necessary to consider that the possibilities of the intensified nursing should be exhausted as much as possible for the patients. The daily work is limited, due to restrictions of resource. This means a conflict for nurses between knowledge and the predefined resource requirements which often leaded to overtaxing and dissatisfaction. It is desirable that decision makers of the health policy appreciate the evidence and promote intensified nursing care models.
Nursing science has to do special research to prove the meaning and effectiveness of intensified nursing and establish this in the health care delivery system.
This article describes successful institutionally-based programs for providing high quality palliative care to people with cancer and their family members. Challenges and opportunities for program development are also described.
Published literature from 2000 to present describing concurrent oncology palliative care clinical trials, standards and guidelines were reviewed.
Clinical trials have demonstrated feasibility and positive outcomes and formed the basis for consensus guidelines that support concurrent oncology palliative care models.
Implications for nursing practice
Oncology nurses should advocate for all patients with advanced cancer and their families to have access to concurrent oncology palliative oncology care from the time of diagnosis with a life-limiting cancer.
Cancer palliative care models; review; palliative care standards
Little is known regarding the feasibility and efficacy of an online continuing education program for oncology nurses. The Multiple Myeloma Mentorship Program, a quality improvement project for the Institute for Medical Education and Research, was designed to meet the educational needs of oncology nurses caring for patients with multiple myeloma. Twenty-five expert nurses with expertise in multiple myeloma from 23 cancer centers in the United States partnered with 50 oncology nurses in an electronic format from July 2009 to January 2010. The purpose of the program was to educate oncology nurses about the latest treatments and strategies for optimal side-effect management for patients with multiple myeloma. Nurse mentees selected their preferred form of learning—webcast, in-person speaker, or monograph. Two live webcasts allowed for didactic discussion between mentors and mentees. During and after the program, mentors conducted informal, unscripted interviews with nurse participants to determine preferred learning format, challenges, and implications for practice. Twelve nurses preferred Web-based learning to in-person presentations, citing flexibility and convenience as reasons for that choice. Time constraints with Web-based and in-person learning were a barrier to nurse mentees completing assigned modules. Several nurses implemented practice changes as a result of the program. Nurses who participated in the mentorship program were satisfied with the content. Learning styles and format should be considered in future mentorship programs.
Genetics and genomics are emerging as the central science for 21st century health care. Proficient nursing care incorporates this central science. Nursing genetic competency includes anticipating future demands spurred by knowledge advancement. Three emerging public health areas that call for future neonatal nursing genetic competency development will be discussed here: increasing emphasis on neonatal family health histories, population genetic biobanking, and family genetic advocacy. Neonatal nurses can develop genetic competency by targeting: 1) Collaborative efforts between nurse and family regarding neonatal family health history preparation and understanding its genetic implications; 2) Referrals to and partnerships with genetic advocacy groups in programs that empower neonate's families; 3) Familiarity with biobank practices that interface nursing care domains.
the EU Directive states the requirement of staff working in trials to be qualified by education, training and experience . This includes the research nurse; however, in the transition from ward nurse to research nurse, new and highly developed skills and knowledge are required in order to work effectively.
an educational programme was developed, which included a review of current knowledge and baseline practice, development of competencies related to the role of research nurse, haemato-oncology and clinical trial education to support this advanced practice for nurses in clinical trials.
overall, the feedback on the course by the nurses was very positive, and the nurses were able to undertake the role of research nurse within specified clinical trials.
The purpose of this literature review is to determine the current state of the science for the effectiveness of patient navigation on improving outcomes of cancer care across the continuum among Native Americans. The research will help healthcare professionals ascertain potential evidence-based practice guidelines and gaps in knowledge, which may provide direction for future research. Data synthesis included the use of Native navigation for cancer care, which has been demonstrated in limited, nonrandomized studies to improve cancer knowledge, access to care, and quality of life for Native Americans. Those studies had limitations, including small sample size, self-report of outcome measures, and lack of randomization. Evidence is insufficient to conclude that the use of Native navigation is superior to usual cancer care for Native American patients. Oncology nurses have a role in training personnel to serve as cancer navigators. Nurses need to be supportive of culturally appropriate navigation programs and know about services provided by navigators. In addition, nurse educators need to encourage Native Americans in their communities to consider choosing nursing as a profession. If an oncology nurse has an interest in research, opportunities exist to assist with or conduct research projects regarding Native cancer navigation. A particular need exists for addressing the gaps in research identified in this article.
Advance care planning (ACP) is a process of discussion about goals of care and a means of setting on record preferences for care of patients who may lose capacity or communication ability in the future. Implementation of ACP is widely promoted by policy makers. This study examined how community palliative care nurses in England understand ACP and their roles within ACP. It sought to identify factors surrounding community nurses' implementation of ACP and nurses' educational needs.
An action research strategy was employed. 23 community nurses from two cancer networks in England were recruited to 6 focus group discussions and three follow up workshops. Data were analysed using a constant comparison approach.
Nurses understood ACP to be an important part of practice and to have the potential to be a celebration of good nursing care. Nurses saw their roles in ACP as engaging with patients to elicit care preferences, facilitate family communication and enable a shift of care focus towards palliative care. They perceived challenges to ACP including: timing, how to effect team working in ACP, the policy focus on instructional directives which related poorly to patients' concerns; managing differences in patients' and families' views. Perceived barriers included: lack of resources; lack of public awareness about ACP; difficulties in talking about death. Nurses recommended the following to be included in education programmes: design of realistic scenarios; design of a flow chart; practical advice about communication and documentation; insights into the need for clinical supervision for ACP practice.
Nurses working in the community are centrally involved with patients with palliative care needs who may wish to set on record their views about future care and treatment. This study reveals some important areas for practice and educational development to enhance nurses' use and understanding of ACP.
The role of the genetic nurse has evolved historically with the emergence of clinical genetics in the field of health care. During 1994, a Practice Working Party was convened by the Genetic Nurses and Social Workers Association in response to discussion about the role of the nurse within and between regional genetics centres. The Working Party conducted a study of the current nursing practice and attitudes of nurses and clinicians to the nursing role, as a basis for future discussion and planning for educational needs. This paper describes the role of the genetic nurse within the United Kingdom and offers suggestions for assessment of competency. Strong themes emerging from respondents' comments include the need and desire for multi-professional team work, and it is apparent that most respondents felt the families' needs would best be served by a skilful combination of medical and nursing input, rather than adherence to traditional roles.
Rural nursing is recognized as a unique health care domain. Within that context, the preceptorship experience is purported to be an important approach to preparing safe and competent rural practitioners. Preceptorship is the one-to-one pairing of a nursing student with a professional nurse who assumes the mandate of teacher and role model in a designated clinical/contextual setting, in this case the rural setting. A research gap exists in the literature in which rural preceptorship is specifically explored. The purpose of this paper is to review preceptorship in relation to preparing nursing students specifically for the rural setting. Understanding how preceptorship as an educational model can prepare nursing students to transition to rural practice is an important endeavor. An authentic rural preceptorship may serve to influence the recruitment and retention needs for registered nurses in rural areas. A greater understanding of rural preceptorship serves to illustrate the appropriate support, socialization and contextual competence required to prepare nursing students for rural nursing practice. This paper's review may serve to highlight the research that currently exists related to rural preceptorship and where additional research can contribute to further understanding and development for authentic rural nursing preparation.
The purpose of this study was to explore nurses’ perceptions of nurse-physician relationships in ambulatory oncology settings, which are linked to patient safety.
This cross-sectional, descriptive study analyzed survey data collected in 2010 from oncology nurses employed in ambulatory settings. The sampling frame was the nurse licensure database in one state in the Southeastern United States. Nurses completed the Practice Environment Scale of the Nursing Work Index (PES-NWI), reported on the quality of care in their setting, and commented on factors that promoted or inhibited high-quality care delivery.
Data analysis used three study variables: empirically-derived values from the PES-NWI, a scale of nurse-reported quality of care in their setting, and open-text comments about features in their workplace that promoted or hindered high-quality care. After categorizing open-text comments, ANOVA was used to evaluate differences in PES-NWI subscales by comment category. Chi-square test statistics were calculated to examine differences in overall practice environment and quality of care by comment category.
Nurses reported their relationships with physicians as generally favorable. Qualitative findings suggest two themes that influence how nurses characterize their working relationships with physicians: 1) physician behaviors and 2) structural factors. Both PES-NWI scores and quality of care were rated significantly higher by nurses who wrote favorably about physicians.
Favorable nurse-physician relationships in ambulatory settings may reflect positive workplaces and promote high-quality care.
Consistent with findings from inpatient units, nurse-physician relationships are important to the quality of ambulatory oncology care. Systematic measurement and attention to reported deficits in these relationships may promote higher quality care.
The discipline of nursing continues to evolve in keeping with the dramatic expansion of scientific knowledge, technology, and a concomitant increase in complexity of patient care in all practice settings. Changing patient demographics require complex planning for co-morbidities associated with chronic diseases and life-saving advances that have altered mortality in ways never before imagined. These changes in practice, coupled with findings from sophisticated nursing research and the continuous development of new nursing knowledge, call for realignments of the relationships among academic faculty in schools of nursing, advanced practice nurse administrators, and staff nurses at the forefront of practice. This article offers a model designed to bridge the gaps among academic settings, administrative offices and the euphemistic “bedsides” where staff nurses practice. Here we describe the nurse attending model in place at the New York University Langone Medical Center (NYULMC) and provide qualitative data that support progress in our work.
Collaboration; attending nurse; practice support.
Although prayer potentially serves as an important practice in offering religious/spiritual support, its role in the clinical setting remains disputed. Few data exist to guide the role of patient-practitioner prayer in the setting of advanced illness.
To inform the role of prayer in the setting of life-threatening illness, this study used mixed quantitative-qualitative methods to describe the viewpoints expressed by patients with advanced cancer, oncology nurses, and oncology physicians concerning the appropriateness of clinician prayer.
This is a cross-sectional, multisite, mixed-methods study of advanced cancer patients (n = 70), oncology physicians (n = 206), and oncology nurses (n = 115). Semistructured interviews were used to assess respondents’ attitudes toward the appropriate role of prayer in the context of advanced cancer. Theme extraction was performed based on interdisciplinary input using grounded theory.
Most advanced cancer patients (71%), nurses (83%), and physicians (65%) reported that patient-initiated patient-practitioner prayer was at least occasionally appropriate. Furthermore, clinician prayer was viewed as at least occasionally appropriate by the majority of patients (64%), nurses (76%), and physicians (59%). Of those patients who could envision themselves asking their physician or nurse for prayer (61%), 86% would find this form of prayer spiritually supportive. Most patients (80%) viewed practitioner-initiated prayer as spiritually supportive. Open-ended responses regarding the appropriateness of patient-practitioner prayer in the advanced cancer setting revealed six themes shaping respondents’ viewpoints: necessary conditions for prayer, potential benefits of prayer, critical attitudes toward prayer, positive attitudes toward prayer, potential negative consequences of prayer, and prayer alternatives.
Most patients and practitioners view patient-practitioner prayer as at least occasionally appropriate in the advanced cancer setting, and most patients view prayer as spiritually supportive. However, the appropriateness of patient-practitioner prayer is case specific, requiring consideration of multiple factors.
Prayer; spirituality; religion; spiritual care; end-of-life care; palliative care
Nurses' practice takes place in a context of ongoing advances in research and technology. The dynamic and uncertain nature of health care environment requires nurses to be competent decision-makers in order to respond to clients' needs. Recently, the public and the government have criticized Iranian nurses because of poor quality of patient care. However nurses' views and experiences on factors that affect their clinical function and clinical decision-making have rarely been studied.
Grounded theory methodology was used to analyze the participants' lived experiences and their viewpoints regarding the factors affecting their clinical function and clinical decision-making. Semi-structured interviews and participant observation methods were used to gather the data. Thirty-eight participants were interviewed and twelve sessions of observation were carried out. Constant comparative analysis method was used to analyze the data.
Five main themes emerged from the data. From the participants' points of view, "feeling competent", "being self-confident", "organizational structure", "nursing education", and "being supported" were considered as important factors in effective clinical decision-making.
As participants in this research implied, being competent and self-confident are the most important personal factors influencing nurses clinical decision-making. Also external factors such as organizational structure, access to supportive resources and nursing education have strengthening or inhibiting effects on the nurses' decisions. Individual nurses, professional associations, schools of nursing, nurse educators, organizations that employ nurses and government all have responsibility for developing and finding strategies that facilitate nurses' effective clinical decision-making. They are responsible for identifying barriers and enhancing factors within the organizational structure that facilitate nurses' clinical decision-making.
The context for nursing informatics research has changed significantly since the National Institute of Nursing Research-funded Nursing Informatics Research Agenda was published in 1993 and the Delphi study of nursing informatics research priorities reported a decade ago. The authors focus on three specific aspects of context - genomic health care, shifting research paradigms, and social (Web 2.0) technologies - that must be considered in formulating a nursing informatics research agenda. These influences are illustrated using the significant issue of healthcare associated infections (HAI). A nursing informatics research agenda for 2008–18 must expand users of interest to include interdisciplinary researchers; build upon the knowledge gained in nursing concept representation to address genomic and environmental data; guide the reengineering of nursing practice; harness new technologies to empower patients and their caregivers for collaborative knowledge development; develop user-configurable software approaches that support complex data visualization, analysis, and predictive modeling; facilitate the development of middle-range nursing informatics theories; and encourage innovative evaluation methodologies that attend to human-computer interface factors and organizational context.
Cancer patients are increasingly known to use complementary medicine (cam) during conventional treatment, but data are limited on how Canadian oncology health professionals attempt to assist patients with their use of cam in the context of conventional cancer care. As part of a larger qualitative study assessing the perceptions of Canadian oncology health professionals regarding integrated breast cancer care, we undertook an exploration of current integrative practices of oncology health professionals.
Using an interpretive description research design and a purposive sampling, we conducted a series of in-depth qualitative interviews with various oncology health professionals recruited from provincial cancer agencies, hospitals, integrative clinics, and private practice settings in four Canadian cities: Vancouver, Winnipeg, Montreal, and Halifax. A total of 16 oncology health professionals participated, including medical and radiation oncologists, nurses, and pharmacists.
Findings highlighted two main strategies used by oncology health professionals to create a more integrative approach for cancer patients:
acting as an integrative care guide, and collaborating with other health professionals.
Although few clear standards of practice or guidance material were in place within their organizational settings, health professionals discussed some integrative roles that they had adopted, depending on interest, knowledge, and skills, in supporting patients with cam decisions. Given that cancer patients report that they want to be able to confer with their conventional health professionals, particularly their oncologists, about their cam use, health professionals who elect to adopt integrative practices are likely offering patients much-welcomed support.
Oncology health professionals; integrative cancer care; qualitative research; complementary therapies
Nurses’ research utilization (RU) as part of evidence-based practice is strongly emphasized in today’s nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses’ RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses’ RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation.
Data were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses’ instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied.
Of the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity.
A number of factors associated with nurses’ low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses’, specifically newly graduated nurses’, RU.
The objectives and goals of the Southern Swedish Malignant Melanoma (SSMM) are to develop, build and utilize cutting edge biobanks and OMICS platforms to better understand disease pathology and drug mechanisms. The SSMM research team is a truly cross-functional group with members from oncology, surgery, bioinformatics, proteomics, and genomics initiatives. Within the research team there are members who daily diagnose patients with suspect melanomas, do follow-ups on malignant melanoma patients and remove primary or metastatic lesions by surgery. This inter-disciplinary clinical patient care ensures a competence build as well as a best practice procedure where the patient benefits.
Clinical materials from patients before, during and after treatments with clinical end points are being collected. Tissue samples as well as bio-fluid samples such as blood fractions, plasma, serum and whole blood will be archived in 384-high density sample tube formats. Standardized approaches for patient selections, patient sampling, sample-processing and analysis platforms with dedicated protein assays and genomics platforms that will hold value for the research community are used. The patient biobank archives are fully automated with novel ultralow temperature biobank storage units and used as clinical resources.
An IT-infrastructure using a laboratory information management system (LIMS) has been established, that is the key interface for the research teams in order to share and explore data generated within the project. The cross-site data repository in Lund forms the basis for sample processing, together with biological samples in southern Sweden, including blood fractions and tumor tissues. Clinical registries are associated with the biobank materials, including pathology reports on disease diagnosis on the malignant melanoma (MM) patients.
We provide data on the developments of protein profiling and targeted protein assays on isolated melanoma tumors, as well as reference blood standards that is used by the team members in the respective laboratories. These pilot data show biobank access and feasibility of performing quantitative proteomics in MM biobank repositories collected in southern Sweden. The scientific outcomes further strengthen the build of healthcare benefit in the complex challenges of malignant melanoma pathophysiology that is addressed by the novel personalized medicines entering the market.
Malignant melanoma; Protein sequencing; Proteomics; Genes; Antibodies; mRNA; Mass spectrometry; Bioinformatics
To discuss recent technological advances in quality of life data collection and guidance for use in research and clinical practice. The use of telephone-, computer-, and web/Internet based technologies to collect quality of life data, reliability and validity issues, and cost will be discussed along with the potential pitfalls associated with these technologies.
Health care literature and web resources.
Technology has provided researchers and clinicians with an opportunity to collect QOL data from patients that were previously not accessible. Most technologies offer a variety of options, such as language choice, formatting options for the delivery of questions, and data management services. Choosing the appropriate technology for use in research and/or clinical practice primarily depends on the purpose for QOL data collection.
Implications for Nursing Practice
Technology is changing the way nurses assess quality of life in patients with cancer and provide care. As stakeholders in the health care delivery system and patient advocates, nurses must be intimately involved in the evaluation and use of new technologies that impact quality of life and/or the delivery of care.
Radiation, for either diagnosis or treatment, is used extensively in the field of oncology. An understanding of oncology radiation safety principles and how to apply them in practice is critical for nursing practice. Misconceptions about radiation are common, resulting in undue fears and concerns that may negatively impact patient care. Effectively educating nurses to help overcome these misconceptions is a challenge. Historically, radiation safety training programs for oncology nurses have been compliance-based and behavioral in philosophy.
A new radiation safety training initiative was developed for Memorial Sloan-Kettering Cancer Center (MSKCC) adapting elements of current adult education theories to address common misconceptions and to enhance knowledge. A research design for evaluating the revised training program was also developed to assess whether the revised training program resulted in a measurable and/or statistically significant change in the knowledge or attitudes of nurses toward working with radiation. An evaluation research design based on a conceptual framework for measuring knowledge and attitude was developed and implemented using a pretest-intervention-posttest approach for 15% of the study population of 750 inpatient registered oncology nurses.
As a result of the intervention program, there was a significant difference in nurse's cognitive knowledge as measured with the test instrument from pretest (58.9%) to posttest (71.6%). The evaluation also demonstrated that while positive nursing attitudes increased, the increase was significant for only 5 out of 9 of the areas evaluated.
The training intervention was effective for increasing cognitive knowledge, but was less effective at improving overall attitudes. This evaluation provided insights into the effectiveness of training interventions on the radiation safety knowledge and attitude of oncology nurses.
Nurses are an integral part of the spinal cord injury (SCI) rehabilitation team and provide significant education to the patient and family about the intricacies of living with SCI, as well as help manage the care process.
This is the second in a series of reports by clinical nursing leaders involved in the SCIRehab research project, a multi-center, 5-year study to record and analyze details of SCI inpatient rehabilitation, with focus on descriptions of time spent by nurses on bedside education and care management.
Six hundred patients with traumatic SCI were enrolled at six rehabilitation centers. Nurses providing usual care to patients with SCI documented the content and amount of time spent on each bedside interaction using portable electronic devices with customized software or a newly developed customized page in electronic documentation systems; this included details of education or care management. Patient and injury characteristics, including level and nature of injury, were taken from the medical record.
Nursing data for this report were derived from 42 048 shifts of nursing care. The mean total of nursing education and care management per patient was 30.6 hours (range 1.2–126.1, standard deviation (SD) 20.7, median 25.5). The mean number of minutes per week was 264.3 (range 33.2–1253, SD 140.9, median 241.9). The time that nurses spent on each activity was significantly different in each neurological injury group. Fifty percent of care management time was devoted to psychosocial support, while medication, skin care, bladder, bowel, and pain management were the main education topics.
Nurses in SCI rehabilitation spend a significant amount of time providing education and psychosocial support to patients and their families. Typically, this is not included in traditional documentation systems. Quantification of these interventions will allow researchers to discern whether there are pertinent associations between the time spent on bedside activities and patient outcomes. The data will also be relevant for patient care planning and acuity staffing.
Spinal cord injuries; Rehabilitation; Health services research; Nursing; Paraplegia; Tetraplegia
To provide an overview of research and practice related to patient-reported symptom and quality of life assessment integrated into clinical care.
Literature retrieved through the PUBMED and CINAHL databases.
Assessing and incorporating patient preferences, engaging the patient in self-report and extending the interaction to the place and time favored by the patient are necessary to bring meaning to the term, patient-centered. There is beginning evidence that these approaches can make a difference, improving care quality.
Implications for nursing practice
Oncology nurses no longer need to be constrained by paper symptom checklists. Patient-reported symptom and quality of life information can be electronically collected and simultaneously made available for home and clinical use through the utilization of Web-based programs.
cancer symptoms; quality of life; patient centered care; clinical informatics; patient reported outcomes
Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important.
This study is a comparative descriptive design that was conducted in an Iranian oncology centre. Convenience sampling was used to recruit 200 patients and 40 nurses to take part in the study. Data were collected over a period of 4 months in 2009 using the Caring Assessment Questionnaire, developed by Larson. Caring behaviors (n = 57) were ranked on a 5-point Likert-type scale and ordered in six subscales: "Being accessible", "Explains and facilitates", "Comforts", "Anticipates", "Trusting relationship", "Monitors and follows through". The data were analyzed using SPSS software version 13.0. The overall mean was calculated for each subscale to determine the rank distribution of the subscales. The nonparametric Mann-Whitney U test analysis of variables was used to compare patients' and nurses' scores on subscales.
The results demonstrate that both groups considered the same order of importance of caring, the high ranking of "Monitors and Follows through and "Being Accessible" and the low ranking of "Comforts" and "Trusting Relationships". Also, Patients only ranked "Being accessible" (p = 0.04) and "Explains and facilitates" (p = 0.03) higher than nurses.
The oncology patients and nurses perceived highly physical aspects of caring and the results provide for nurses to be aware of the need, during their interactions with patients, to validate the effect their intended caring has upon patients. By so doing and with further refinement of the concept of caring for nursing in studies such as this, the practical aim of making patients feel cared for can be achieved.
Nurses play a crucial role in patient-care. Therefore, assessing nurses’ clinical competence is essential to achieve qualified and safe care. The aim of this study was to determine and compare the competence assessments made by head nurses and practicing nurses in a university hospital in Iran in 2009.
A cross-sectional survey was conducted to make comparisons of both self-assessment of nurse competence as well as assessment made by their respective head nurses working in a university hospital setting in Iran. The instrument employed for data collection was Nurse Competence Scale (NCS), whose reliability and validity have been previously confirmed. The clinical competence of the nurses in 73 skills under 7 categories was determined based on a Visual Analogue Scale (VAS) (0 to 100). They were also asked to indicate the extent to which their competence was actually used in clinical practice on a four-point scale of Likert. The data was analyzed through descriptive and inferential statistics.
Comparison of self-assessment (87.03 ± 10.03) and the assessment done by head nurses (80.15 ± 15.54) showed a significant difference but no precise differences were found between the assessment methods for the frequency of using these competencies.
The results of this study indicated no consensus between the nurses owns assessment and their head nurse assessment. Therefore, it is necessary to use a combination of nurses’ competence assessment methods in order to reach a more valid and precise conclusion.
Clinical competence; competence assessment; head nurse; nurse; self-assessment
Purpose: To underscore the need for health system reform and emphasize nursing measures as a key component in our healthcare reimbursement system.
Design and Methods: Nursing-sensitive value-based purchasing (NSVBP) has been proposed as an initiative that would help to promote optimal staffing and practice environment through financial rewards and transparency of structure, process, and patient outcome measures. This article reviews the medical, governmental, institutional, and lay literature regarding the necessity for, method of implementation of, and potential impact of NSVBP.
Findings: Research has shown that adverse events and mortality are highly dependent on nurse staffing levels and skill mix. The National Database of Nursing Quality Indicators (NDNQI), along with other well-developed indicators, can be used as nursing-sensitive measurements for value-based purchasing initiatives. Nursing-sensitive measures are an important component of value-based purchasing.
Conclusions: Value-based purchasing is in its infancy. Devising an effective system that recognizes and incorporates nursing measures will facilitate the success of this initiative. NSVBP needs to be designed and incentivized to decrease adverse events, hospital stays, and readmission rates, thereby decreasing societal healthcare costs.
Clinical Relevance: NSVBP has the potential for improving the quality of nursing care by financially motivating hospitals to have an optimal nurse practice environment capable of producing optimal patient outcomes by aligning cost effectiveness for hospitals to that of the patient and society.
Adverse events; nursing-sensitive; quality measures; value-based purchasing