Gianluca Catania

Effectiveness of complex interventions focused on quality-of-life assessment to improve palliative care patients’ outcomes: A systematic review

Background: One of the most crucial palliative care challenges is in determining how patient’ needs are defined and assessed. Assessing quality of life has been defined as a priority in palliative care, and it has become a central concept in palliative care practice. Aim: To determine to what extent interventions focused on measuring quality of life in palliative care practice are effective in improving outcomes in palliative care patients. Design: Systematic review according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and hand searches. Data sources: MEDLINE, CINAHL, EMBASE, PsycINFO, and the Cochrane Library were searched for articles published until June 2012, and through hand searching from references lists of included articles. Only studies that included adult palliative care patients, in any palliative care clinical practice setting of care, and with an experimental, quasi-experimental, or observational analytical study design were eligible for inclusion. All studies were independently reviewed by two investigators who scored them for methodological quality by using the Edwards Method Score. Results: In total, 11 articles (of 8579) incorporating information from 10 studies were included. Only three were randomized controlled trials. The quality of the evidence was found from moderate to low. Given a wide variability among patients’ outcomes, individual effect size (ES) was possible for 6 out of 10 studies, 3 of which found a moderate ES on symptoms (ES = 0.68) and psychological (ES = 0.60) and social (ES = 0.55) dimensions. Conclusion: Effectiveness of interventions focused on quality-of-life assessment is moderate. Additional studies should explore the complexity of the real palliative care world more accurately and understand the effects of independent variables included in complex palliative care interventions.

Factors influencing self‐management in patients with type 2 diabetes: a quantitative systematic review protocol

AIM To describe a protocol for a quantitative systematic review, to identify critique and summarize factors that influence self-management education. BACKGROUND Self-management education enables patients to manage their condition successfully and it is associated with better self-care, good control over lifestyle and leading the best possible quality of life, notwithstanding the presence of a chronic disease. Type II Diabetes is a chronic disease that requires lifestyle adjustments and disease management to keep glycaemia and long-term complications under control. Education has to be customized and based on an assessment that includes factors influencing self-management, such as personal characteristics that can optimize the educational intervention. DESIGN The protocol for the systematic review was conducted according to the guidelines of the Centre for Reviews and Dissemination, York (UK). METHOD The review question was defined in terms of population, interventions, comparators, outcomes and study designs. The protocol included decisions about the review question, inclusion criteria, search strategy, study selection, data extraction, quality assessment, data synthesis and plans for dissemination. Funding for the review was confirmed on January 2011 by the Centre of Excellence for Nursing Scholarship in Rome. DISCUSSION An initial summary will be made by tabulating the data; the review will be reported in a narrative style and be developed according to the PRISMA guidelines. The protocol for the systematic review will allow us to identify, among the factors influencing self-management in people with Type II diabetes, the personal characteristics most relevant to the factors of motivation and empowerment. In addition, the systematic review will also identify an appropriate self-management model.

The general results of the RN4CAST survey in Italy.

The issue of health workforce shortage and in particular of nurses, has been debated globally for almost three decades (Aiken & Mullinix 1987, Aiken et al. 1996, 2001, 2010), and has been exacerbated by the recent global financial crisis. The European RN4CAST project has shifted focus from considering only nursing workforce planning and workforce volumes to considering the impact of adequate nurse-patient ratios and work environment on patient safety and the quality of care (Sermeus et al. 2011).

The life experience of nutrition impact symptoms during treatment for head and neck cancer patients: a systematic review and meta-synthesis

PurposeIn the literature, there is limited research about the changed meaning of food, the eating and the eating experience during treatment in patients with head and neck cancer. This systematic review includes findings from a qualitative research synthesis to gain a deeper understanding of the influence and experiences of dysphagia, dysgeusia, oral mucositis and xerostomia in head and neck cancer patients (HNC) and suggests recommendations for care practice.MethodA systematic review and meta-synthesis techniques were adopted to identify, appraise and synthesize the relevant literature regarding the experience of nutritional symptoms of HNC patients conducted according to the PRISMA guidelines. Several electronic databases such as PubMed, CINAHL, Scopus, PsycINFO and the Cochrane Library databases were searched.ResultsA systematic search yielded 121 papers, of which 12 met the inclusion criteria. A thematic account of shared nutritional symptom experiences reported across studies is highlighted and presented. Eight major themes covering three key supportive care domains were identified: impact of symptoms (symptoms during treatment, symptoms working together, affecting daily living activities and physical changes, symptoms and food changes), changing social networks and support (social life restrictions, support of peers), nutritional concerns and strategies (coping strategies, professional support).ConclusionsDysphagia, dysgeusia, oral mucositis and xerostomia negatively affected the patients’ quality of life throughout the period of treatment. The patients’ nutritional symptom experiences do not occur in isolation. Therefore, acknowledging the patients’ eating difficulties and challenges can guarantee appropriate management and support to best manage symptoms in a timely manner.

Does quality of life assessment in palliative care look like a complex screening program

BackgroundPalliative Care (PC) is an approach that improves the Quality of Life (QoL). A number of QoL assessment tools have been developed and validated in PC. It is not clear how QoL should be measured in PC practice. A procedure of QoL assessment in clinical practice can be defined as a clinical intervention focused on QoL assessment. This is a typical complex intervention that should be appropriately developed and described in all its components and assessed for its effectiveness. The aim of this study is to define a framework to help researchers to develop and evaluate clinical interventions focused on QoL assessment in PC.MethodsA study group of experts in PC and in research methodology was set up to define a framework that would describe the principles of clinical interventions focused on QoL assessment in PC. The study group discussed the WHO Population Screening Principles as a possible useful framework. The new principles had to be developed taking into account the following criteria: 1) specific to PC practice; 2) address a single underlying characteristic; 3) anchored to relevant literature; 4) consistent with the WHO PC definition.With regard to contents and the format of the principles, discussions occurred among the study group members through a cognitive process.ResultsWe reviewed each of the WHO Population Screening Principles and adapted them to QoL assessment, taking into account the defined criteria. As a result, a new framework, the QoL Assessment Principles in Palliative Care was developed. It consisted of 4 sections, for a total of 11 principles.ConclusionsThe WHO Screening Principles framework was used to outline the eleven essential principles to be considered in developing and/or evaluating clinical interventions focused on QoL assessment in PC. The QoL Assessment Principles in Palliative Care identified could represent a methodological and ethical standard to be considered when developing and evaluating a clinical intervention focused on QoL assessment in PC.

What are the components of interventions focused on quality-of-life assessment in palliative care practice? A systematic review

Quality-of-life assessment is a central concept in palliative care. Clinical interventions focused on assessing quality of life are complex interventions. Current research is insufficient to determine how to implement interventions focused on quality-of-life assessment in palliative care. To explore the different components of interventions focused on quality-of-life assessment in palliative care, a systematic review and 5 databases were searched. Publications included were analyzed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Framework Programme 7 practical guidance on using patient-reported outcome measurements in palliative care and the Quality of Life Assessment Principles in Palliative Care. Interventions and their components were identified and discussed. Identifying problems and monitoring change or response to treatment, screening for hidden problems, and facilitating communication were the 3 different types of intervention identified. None of the interventions fulfilled all the 11 Quality of Life Assessment Principles in Palliative Care. Overall, 6 characteristics of the components were identified: the quality-of-life measure, educational training, completing the measure (patients or proxy), collecting quality-of-life data (baseline and further assessment), identifying a coordinator, and presenting quality-of-life data. Because of heterogeneity of interventions, it is not possible to recommend 1 preferred intervention.

Commentary on Nursing Ethics article Facilitating ethics education in nursing students

We found the article ‘Contribution of ethics education to the ethical competence of nursing students: Educators’ and students’ perceptions’ by Nancy Cannaerts et al. very interesting. We agree that nurses do not always have the competences to engage in ethical practice and that ethics education can increase ethical perception in nursing students and develop their reflective skills in a safe learning environment. In fact, we would suggest the simulation laboratory as a strategic safe learning environment for this purpose for various reasons. An ethical reflection on nursing actions implies the description of the ethical comportment on the basis of the models available in the healthcare and educational settings. Healthcare settings either have an organizational culture that can facilitate reflection in nursing students about ethical competence or are settings that do not support this type of reflection. Ethical education in nursing is facilitated through the identification of values, and organizational and personal models. For instance, an organizational model based on a list of tasks generates situations that are conditioned by a narrow vision focusing on the healthcare task, and not by a comprehensive view of the patient as a whole, by the rapidness of performing procedures and not by the humanization of care and viewing of patients as ‘persons’. Clinical training should offer students a learning opportunity that goes beyond the identification of the physiological needs, symptoms and the nursing interventions, and complete it with the identification of the values, choices and rights of the ‘persons’ they care for. Students often see ethics as a series of abstract principles and do not recognize the ‘ethical issues’ in nursing practice. Nursing curricula include contents regarding the ethical principles and the ethical nature of nursing behaviour. In order to interiorize ethical behaviour, this needs to be observed, practiced and experienced throughout the educational process. Such ethical competences can be built also by means of simulation labs and guided reflection and evaluated in appropriate settings that make ethical competence visible and measurable. During their education, students have difficulty recognizing the ethical implications of the actions linked to the care they provide to patients on a daily basis, in the relationships with their colleagues, and with the other healthcare team members. The exemplars that offer learning opportunities should be captured, discussed and shared by means of debriefing, starting from the clinical training experience. Clinical training is the context where all teachings, including ethics, are practically applied. Simulation centres can offer a protected and appropriate setting that facilitate this learning process and where students can integrate technical and relational behaviours with ethical decision-making through guided reflection exercises regarding the values at stake and the ethical implications embedded in the caring relationship. Realistic scenarios together with true life cases can facilitate reflection about daily practice and highlight the ethical complexity of the various scenarios. Therefore, also in the field of ethics education, teamwork between students and educators conducted in a simulated environment can be of great benefit in building the ethical competence of nursing students. Teamwork education conducted in a safe simulated environment also gives

Preparing healthcare students who participate in interprofessional education for interprofessional collaboration: A constructivist grounded theory study protocol

ABSTRACT This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE). Many studies have shown that IPE initiatives improve students’ understanding of the roles and responsibilities of other professionals. This improves students’ attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9–15 students and 6–9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes.

Including qualitative research in Randomized Controlled Trials (RCT): opportunities for nursing researchers

The Randomized Controlled Trial (RCT) has long been recognized as the gold standard approach to testing the efficacy of medicines. More recently the method is being used to test other health care interventions - such as surgical interventions, medical devices, wound management techniques and also nursing interventions. For many years the RCT has been seen as an exclusively quantitative approach - possibly as a result of its use predominantly by medical researchers and laboratory scientists - schooled in a particularly positivist research culture. This article is protected by copyright. All rights reserved.

RN4CAST@IT-Ped: nurse staffing and children's safety

Some authors argue that it is not longer ethically correct to expose hospitalized patients to death risks associated with understaffing (Nickitas, 2014). Also the Care Quality Commission (CQC, an independent regulator of all health and social care services in England) has included staffing levels as one of the auditing quality standards when inspecting hospitals and health centres. The Royal College of Nursing, in its document Mandatory Nurse Staffing Levels (RCN, 2012), clearly defined which nurse staffing levels should be adopted by policy makers to ensure the provision of safe care. However, even in the UK where such pressure exists there are no legally defined nurse staffing levels.