Dario Valcarenghi

Longitudinal qualitative exploration of cancer information-seeking experiences across the disease trajectory: the INFO-SEEK protocol

Introduction Α substantial corpus of literature has sought to describe the information-seeking behaviour of patients with cancer. Yet, available evidence comes mainly from cross-sectional studies, which provide ‘snapshots’ of patients’ information needs and information-seeking styles at a single time point. Only a few longitudinal studies currently exist; however, these are quantitative in nature and, despite successfully documenting changes in patients’ information needs throughout the clinical course of cancer, they have failed to provide an evidence-based interpretation of the causes and consequences of change. The goal of this study is threefold: First, we wish to provide a holistic understanding of how cancer information-seeking behaviour may evolve across different stages of the patient journey. Second, we will seek to elucidate the contextual and intervening conditions that may affect possible changes in information seeking. Third, we will attempt to identify what the consequences of these changes are, while heightening their implications for clinical practice and policy. Methods and analysis We will carry out a longitudinal qualitative study, based on face-to-face, in-depth interviews with approximately 25 individuals diagnosed with cancer. Patients will be recruited from 2 oncology hospitals located in Ticino, Switzerland, and will be interviewed at 3 different time points: (1) within 2 weeks after receiving the cancer diagnosis; (2) within 2 weeks after their initial treatment; and (3) 6 months after their initial treatment. All interviews will be recorded and transcribed verbatim. A grounded theory approach will be used for the analysis of the data. Ethics and dissemination The study protocol has been approved by the Ethics Committee of Canton Ticino (CE 2813). Participation in the study will be voluntary, and confidentiality and anonymity ensured. Prior to study participation, patients will be asked to provide signed informed consent. Findings will be disseminated in international peer-reviewed journals and presented in relevant conferences.

Student perspectives on: Does nursing have a future?

Our answer is ‘‘Yes, Nursing does have a future’’ . . . if our society perceives its usefulness, it will ask for its professional services, and if nurses will know how to value their own competences so that they may respond effectively to the new and changing needs of the population. The population’s future healthcare demand is increasing due to emerging global phenomena such as aging and chronic illnesses, causing serious issues of financial sustainability in many countries. In the future, along with the hospital services, there will be the need to have a well-structured network of community services to ensure healthcare continuum to all. In addition, there could be a change in the composition of the different professional profiles within the health workforce, with less physicians and the need to rethink the roles and the scopes of practice of other health professionals. Many studies have highlighted the important role nurses play, especially highly educated nurses, in improving patient outcomes. More nurse practitioners will have to provide besides care, taking directly care of patients (or better persons) and their informal carers/caregivers. There will be no future for nursing if its deep relationship is lost with the sick person (the ‘‘infirm,’’ which is the root of the Italian word for nurse ‘‘infermiere’’) and does not rediscover the great value of caring for the human body, according to the concept of ‘‘embodiment.’’ Nursing actions must continue to bear a high ethical value paying attention to the dignity and autonomy of the person, to the vision of the human being seen both individually and globally, and to the defense of human life in any circumstance and condition. Higher education needs to be reinforced, especially in the clinical field, so that it may stimulate innovation and research, as well as prepare professionals capable of providing high-quality care. It must be able to prove what is the added value and the real advantages of a nurse’s independent professional practice within the framework of healthcare systems that are radically changing. This scenario also offers new opportunities for the development of nursing, which would, however, need to be supported by its leadership to generate and value new competences. The latter would need to be addressed in order to respond effectively to the new and changing healthcare needs of the population and at the same time be pragmatic and flexible enough to adapt to new contexts and situations. The ethical conduct expected from nurses redeems them from the old role of mere executors of prescriptions made by others and encourages nurses to develop and assert their dignity as professionals, equipped with their own relational, educational, and technical competences.

Exploring the Interaction Between Nursing Decision Making and Patient Outcomes in 2 European Cancer Centers: A Qualitative Study

Background: In some clinical settings, nurses have difficulty describing the outcomes of their caring activities. Understanding the reasons for this could help nurse leaders to improve the effectiveness and visibility of nursing practice and safeguard nurses’ working conditions. Objective: The aims of this study were to understand how nurses working in 2 different adult cancer centers make healthcare decisions and assess the respective outcomes on their patients. Methods: Through a constructivist grounded theory approach, we involved 15 clinical cancer nurses with different experiences and educational backgrounds and 6 nurse managers, working in 2 comprehensive cancer centers, 1 in Italy and 1 in Switzerland. Data were collected in 2 phases using 20 semistructured interviews and 9 field observations. Results: Six macrocategories emerged: interacting with situational factors, deciding relevant interventions, using multiple decision-making approaches, evaluating interventions and reporting them, pursuing healthcare outcomes, and clarifying professional identity and roles. Nurses’ decision-making processes varied and were influenced by various factors, which mutually influenced one another. This process was interpreted using an explicative theory called “dynamic decision-making adaptation.” Conclusions: The present study showed how the aims, contents, and degree of autonomy in the nurses’ decision-making process are strongly influenced by the dialectic interaction between professional and contextual factors, such as competency and professional identity. Implications for Practice: Cancer nurses could influence their clinical practice by developing nursing competencies that effectively resolve patients’ problems. This is a key factor that nurses govern autonomously and therefore a responsibility that involves the entire nursing educational, organizational, and scientific leadership.

91 Comprehensive Geriatric Assessment (CGA) in the Elder Cancer Patient – Implications in Nursing Decision-making Process

Introduction: In the last decades there has been an important and progressive increase of elder cancer patients with consequent implications in oncology medical and nursing practice. As aging is a very diversified and individualized process, in the literature there is a general agreement about the importance and the essentiality of a comprehensive geriatric assessment (CGA) for the elder cancer patient in the oncology medical practice. Particularly CGA provides an evaluation of functional age and life expectancy,thus allowing tailoring of oncological treatments and preserving quality of life. The employment and utility of CGA for nursing practice in oncological settings is less explored in literature. For about two years, nurses of the Oncology Institute of Southern Switzerland outpatient department have applied an abbreviated comprehensive geriatric assessment (aCGA) for 140 elder cancer patients. No systematic data are available regarding how the use of this assessment modality has affected their care planning. Material and Method: The aim of this pilot qualitive study is to explore how nurses use the comprehensive geriatric assessment in their decision-making process for elder oncology patient care in an oncology outpatient department. In November–December 2011 two focus groups have been set up with twelve nurses who have utilized an abbreviated Comprehensive geriatric assessment (aCGA) for elder cancer patient in the last two years. The focus groups purpose is to explore whether and how the use of an aCGA has influenced nursing decision-making process and care planning in an oncology setting, by trying to identify which kind of decisions have been taken and interventions have been done in practice by using this method of multidimensional assessment. A framework analysis is being used for the data analysis. Result and Discussion: During the two years use of the aCGA, no systematic data were collected regarding the usefulness of such an assessment to improve nursing professional approach but the impression was that there is still a discrepancy between the data being collected by nurses and the actions which are implemented,as part of what can be managed by nursing staff independently. The study data, which will be available from February 2012, will be of help to verify this hypothesis. Conclusion: In order to improve nursing care quality, it is essential to understand the correlation between information which are collected and interventions which are realized in nursing practice. The data which are being collected in this study will help to clarify how this correlation is present particularly for the care of elder cancer patients in our oncology contest and the reasons for any difficulty.

4222 POSTER Activation of a Sharepoint of Nursing Research at the Oncology Institute of Southern Switzerland (IOSI)

Background: The nursing management of the Oncology Institute of Southern Switzerland (IOSI), which is a “Comprehensive Cancer Center” in the Tessin canton, in 2010 it has been activated a series of initiative for pushing the development of culture oriented research and to the “evidence based practice” through their operators. A office for the development and for nursing research has been created and has led an internal survey, an internal network has been created of referent person for the nursing research and has started multi periodical training initiative. However there was a lack of a continuous communication support, between various operators although belonging to the same Institute they are distributed in a large territory. Material and Methods: With the informatics department it has been decided to use the SharePoint, as it is a flexible tool, modular and interactive. Afterwards a mixed working group has been defined (nurse and head department) for developing the structure and the content. In more or less 2 months this sharepoint of the nursing research has been prepared,tested on a little group of colleague and therefore implemented. Results: From March 2011, all the Nurse staff is linked with the SharePoint in which they can follow 8 different paths to know what happen inside and outside the Institute (experiences, projects, useful link, oncology oriented publication and various initiative) and to have the opportunity to have a direct comparison with the colleagues. Only few persons have the possibility to modify the structure of the sharepoint, meanwhile for the others there is the possibility to see it and to interact expressing proposals or pointing out topics of discussion and/or deepen. For each new communication in two specific sectors (news or blogs) there is an alert sent out instantly via e-mail to all the on-line people. Conclusions: The sharepoint of the Nursing Research is an important tool of communication in the Institute to encourage the information sharing, the circulation of the best professional evidence and the sharing experience and proposals. However the tool alone isn’t enough, it become an important tool only if included in a integrated project of improvement of care quality and of development of professional culture oriented to the nurse research and of the using evidence in the own professional practice.