Giuseppe Aleo

The effects of swallowing disorders, dysgeusia, oral mucositis and xerostomia on nutritional status, oral intake and weight loss in head and neck cancer patients: A systematic review.

BACKGROUND Combined-modality treatment of head and neck cancer is becoming more common, driven by the idea that organ(s) preservation should maintain patient appearance and the function of organ(s) involved. Even if treatments have improved, they can still be associated with acute and late adverse effects. The aim of this systematic review was to retrieve current data on how swallowing disorders, dysgeusia, oral mucositis, and xerostomia affect nutritional status, oral intake and weight loss in head and neck cancer (HNC) patients. METHODS A systematic literature search covered four relevant electronic databases from January 2005 to May 2015. Retrieved papers were categorised and evaluated considering their methodological quality. Two independent reviewers reviewed manuscripts and abstracted data using a standardised form. Quality assessment of the included studies was performed using the Edwards Method Score. RESULTS Of the 1459 abstracts reviewed, a total of 25 studies were included. The most studied symptom was dysphagia, even if symptoms were interconnected and affected one other. In most of the selected studies the level of evidence was between 2 and 3, and their quality level was from medium to low. CONCLUSIONS There are limited data about dysgeusia, oral mucositis and xerostomia outcomes available for HNC patients. There is a lack of well-designed clinical trials and multicenter-prospective cohort studies, therefore further research is needed to ascertain which aspects of these symptoms should be measured.

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.

Perceived barriers to the professional development of modern nursing in Italy – A discussion paper

The aim of this paper is to discuss the development of modern nursing in Italy. Specifically, the paper aims to draw attention to the fact that while nursing in Italy has mirrored developments in Europe, in many respects the advancement of the profession is much less accelerated. The paper considers the reasons for this and the contributing factors and explores possible solutions.

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.

Barriers to research awareness among nurses in Italy

The achievement and spread of evidence-based practice, of which research use is a key factor, is challenging and requires more than desire and enthusiasm (Rickbeil & Simones 2012). Using research in nursing practice requires research awareness. Research awareness has been determined as having not only having a good understanding about the principles of research; but the confidence and authority to use research (McSherry et al. 2006). While little is known empirically about Italian nurses’ confidence and authority with regard to research, anecdotally both are low (Bressan et al. 2016). In keeping with international trends (Timmins et al. 2012, Gerrish and Clayton 2004) nurses’ research awareness in Italy is anecdotally affected by a lack of resources, confidence, knowledge, and the lack of a strategic leadership (Sasso et al. 2013). In some Italian health care settings, there are also reports of a culture that is not attuned to the use of research use, and in some cases there is limited managerial support. Additionally it has been acknowledged internationally that competing demands in an under-resourced health care environment place nurses in a position whereby they prioritise care and thus miss out some aspects that could be deemed of lesser priority (Kalisch et al. 2009). A recent Italian study found that up to 41% of care that nurses were expected to perform was missed (Sasso et al., 2016a,b).Within this context it has been found that nurses [understandably] prioritise the most urgent nursing tasks (usually tangible clinical tasks) at the expense of less tangible aspects of nursing (such as communication, developing relationships and patient education) (Sasso et al., 2016a,b, Aiken et al. 2012, Sermeus et al. 2011). However of greater concern is that the percentage of this ‘missed care’ is higher in Italy compared with other countries most likely due to a much lower staff/patient ratio than many European counterparts (Sasso et al., 2016a,b). While research awareness is not specifically measured within these studies it is very likely that is given a low priority due to the aforementioned constraints. There are also few national or local financial incentives for research and clear leadership within the discipline is lacking (Bagnasco et al. 2014). While there has been an impetus at national level towards setting up a national nursing research strategy this has never translated into a reality (Sansoni 2001). At the same time key nursing figures in Italian universities are actively working towards building research capacity (Bagnasco et al. 2014). As a result while published research in nursing was notably weak in the past, and mostly led by non-nurses, this situation is improving with an increasing number of robust nurse-led research and publications, with direct relevance to clinical nursing practice (Marucci et al. 2013). A further compounding factor in the use of research is limited access to libraries and Information Technology (IT) resources and the language barrier (Bressan et al. 2016, Sasso et al. 2013). As English is considered to the language of the health sciences this creates difficulty for Italian nurses who struggle with English comprehension (da Silva et al. 2009). At the same time publications in Italian do not always highlight the practical implications of the findings and/or the recommendations often have a limited evidence base (Fazzini 2012). Dissemination of Italian nursing research results in English peer reviewed is therefore essential to create a robust body of literature (Marucci et al., 2015, Sansoni et al. 2006). This would facilitate the exchange of knowledge and information with international colleagues, encourage debate and facilitate cultural exchange and dissemination (Marucci et al. 2013). One additional barrier to research in nursing is that some local regional research ethics committees are notoriously bureaucratic and frequently refuse or return applications made by nurse researchers on the grounds that they are not considered to be pertinent for the ethics committee. The need for qualitative research is not fully understood, for example, nor is it perceived as warranting ethical approval (Gallagher et al. 2014). While this does not necessarily hinder research on patients or nurses, Italian nurses as a result have difficulty getting their research published in prominent peer reviewed international journals without the necessary ethical approval. This issue affects not only professional confidence and international development but also the circulation and development of national research. For research-based practice to become a reality it needs to proceed through four distinct phases: research; communication of the research; reading and understanding the research; and research utilization (Jacobson 2000), and we have highlighted above that there are

Resilience as a concept for understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease (COPD): an integrative review

This paper was a report of the synthesis of evidence on examining the origins and definitions of the concept of resilience, investigating its application in chronic illness management and exploring its utility as a means of understanding family caregiving of adults with Chronic Obstructive Pulmonary Disease.

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

Professing nursing research The Italian experience

The need for, and value of, nursing should be obvious to all, both locally and globally, in extreme situations and in relation to the everyday. At the time of writing, the media is reporting on the catastrophic consequences of Ebola and on the positive contribution of nurses and doctors. The everyday care activities of local care-workers may receive less media attention but are no less important. The need for, and value of, nursing research should be as obvious too. In some countries, nursing research is well developed and acknowledged as a legitimate and necessary basis for nursing activities. In other places, positivist paradigms prevail and nurse researchers encounter resistance, scepticism and misunderstanding in relation to qualitative research and philosophical scholarship in particular. Italian nurse researchers seem a case in point. This collaborative editorial was inspired by conversations with Italian colleagues regarding the position of nurses and nursing research. Just this year, the first full professor of nursing in Italy was appointed in Rome. The first PhD programme for Italian nurses produced its first graduates only in 2010. Three lessons might be extracted from the Italian experience: nurse researchers require patience and tenacity to convey the meaning and value of qualitative research; research ethics committees as they are currently composed in most cases still do not appear to be ready to value the contribution of qualitative research; and engagement with researchers in the international research community is beneficial to all. One Italian experience we discussed was the ethical review process relating to a qualitative study on the theme of children’s experience of chronic disease. The research ethics committee members were sceptical of the scientific merit of the study. They questioned the relatively small number of research participants and the value of qualitative research. After four revisions in response to committee members’ comments, the study was eventually approved with one member declaring that this would ‘open up new horizons’. The tenacity and patience of the research team paid off, and, in the end, at least some resistance was overcome. Progress, it seems, was made in terms of an understanding of the value and potential of qualitative nursing research to explain parts of patients’ illness trajectory as well as of their family members that other research paradigms cannot reach. To overcome some of the challenges of negotiating the ethical review process, we agreed that research ethics committees require members with qualitative research expertise. A professor of nursing would be an ideal person for this role with the opportunity for mutual learning and cross-disciplinary dialogue. Regarding what a professor of nursing would profess in such a committee, we agreed that this would include the following: the value of research examining patient, family and practitioners’ experiences; the importance of research interventions that respect dignity and improve the quality of life of care-recipients and care-givers;

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.