Katrina Mary Recoche

Exploration of the role of specialist nurses in the care of women with gynaecological cancer: a systematic review.

AIM AND OBJECTIVE To evaluate the role and interventions used by specialist nurses in caring for women with gynaecological cancer. BACKGROUND Evidence evaluating the efficacy of specialist nurses in the gynaecological-oncology setting is limited and fragmented. DESIGN Systematic review including both randomised controlled trials and nonrandomised studies. METHODS Nine major databases were accessed from their date of inception to April 2013 with search results limited to publications from 1993-2013. Inclusion criteria were applied to select studies for review. Studies were critically appraised and assessment of the risk of bias performed. Data were extracted and compiled, with a narrative analysis undertaken. RESULTS Nine studies (six randomised controlled trials and three nonrandomised studies) testing interventions by specialist nurses in the gynaecological-oncology setting were included in the systematic review. Results for the randomised controlled trials and nonrandomised studies were reported separately to enable distinction between evidence levels. Risk of bias assessment revealed that the quality of the randomised controlled trials was mixed and highlighted the inherent flaws of nonrandomised study designs. Studies varied greatly in the type of intervention provided and the tools used to measure outcomes, contributing to mixed results. The review demonstrated some positive effects of interventions by specialist nurses for women with gynaecological cancer, although these must viewed in conjunction with the assessment of evidence quality. CONCLUSIONS This systematic review has contributed to our understanding of the patient-centred aspects of the specialist nurse role in the gynaecological-oncology setting and further research is required to evaluate the role overall. RELEVANCE TO CLINICAL PRACTICE The review indicates that interventions that either encompassed all domains of care, involved telephone contact or were executed between diagnosis and the completion of treatment were the most successful.

DVD-based stories of people with developmental disabilities as resources for inter-professional education.

Purpose. The use of DVD stories about people with developmental disabilities within inter-professional education (IPE) across healthcare disciplines was evaluated. Methods. First year healthcare students (n == 241) from an IPE unit responded to an attitude scale before and after viewing and discussing a DVD portraying the life and healthcare needs of an adult with cerebral palsy; a third round of data collection occurred later. Qualitative data were obtained from four first year and six second year tutors who discussed student reactions to the DVD. Six first year and four second year students participated in focus groups following viewing of a second DVD, about a young girl with developmental disabilities and complex health needs. Results. ANOVA of the attitude scores did not show significant differences from pre- to post-viewing and discussion of the DVD, nor at a third round of data collection. Qualitative analysis revealed that the DVDs did cause students to shift assumptions, perceptions and understanding of the disabilities depicted, and to learn about their own and other professions. Conclusions. DVD scenarios of real people with developmental disabilities in real settings offer a means of providing IPE opportunities. The data also point to the need and directions for the development of a new attitudinal measure.

The environment of inpatient healthcare delivery and its influence on the outcome of care

Aim: This paper addresses issues arising in the literature regarding the environmental design of inpatient healthcare settings and their impact on care. Background: Environmental design in healthcare settings is an important feature of the holistic delivery of healthcare. The environmental influence of the delivery of care is manifested by such things as lighting, proximity to bedside, technology, family involvement, and space. The need to respond rapidly in places such as emergency and intensive care can override space needs for family support. In some settings with aging buildings, the available space is no longer appropriate to the needs—for example, the need for privacy in emergency departments. Many aspects of care have changed over the last three decades and the environment of care appears not to have been adapted to contemporary healthcare requirements nor involved consumers in ascertaining environmental requirements. The issues found in the literature are addressed under five themes: the design of physical space, family needs, privacy considerations, the impact of technology, and patient safety. Conclusion: There is a need for greater input into the design of healthcare spaces from those who use them, to incorporate dignified and expedient care delivery in the care of the person and to meet the needs of family.

Getting the message across: does the use of drama aid education in palliative care?

Drama is a promising means of delivering educational messages in palliative care. Research studies have found drama to be an effective means of delivering educational messages in other domains of learning, such as teaching health education to children and adults and engaging the general public in health policy development. This paper discusses the potential of drama for palliative care education and provides an example of the use of a drama to deliver messages about death and dying at a conference on palliative care. The paper suggests a theoretical framework for how future drama productions could be developed to educate the community, health professionals and students about palliative care.

Experiences of gynecological cancer patients receiving care from specialist nurses: a qualitative systematic review

Background The care needs of women with gynecological cancer are complex and change over the course of their cancer journey. Specialist nurses are well positioned to play a role in meeting the needs of women with gynecological cancer although their role and scope of practice have not been well defined. As patients are a key stakeholder, understanding their experience of care is an important step in better defining the role and scope of practice of specialist nurses in gynecological oncology in Australia and New Zealand. Objectives This review sought to consider gynecological cancer patients’ experiences of specialist nursing care. Exploring the patients experience of care by a specialist nurse is one step in the process of better defining the role and scope of practice of specialist gynecological-oncology nurses in Australia and New Zealand. Inclusion criteria Types of participants This review included studies with a focus on women with gynecological cancer who had been cared for by a specialist nurse. Studies of women with gynecological cancer at any point on the continuum of care from pre-diagnosis to survivorship or end of life, including those with a recurrence of the disease, were included, with no limit to the duration of care received for inclusion in the review. Phenomena of interest Studies that explored how women with gynecological cancer experience the care and interventions of specialist nurses were included. Types of studies Qualitative studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for review. This review also considered the qualitative components of mixed method studies. Context Research conducted in any country was considered for inclusion in this review providing that the study was reported in English. Studies conducted in any setting including, but not limited to, acute hospitals, outpatient/ambulatory clinics, chemotherapy or radiotherapy units, support groups, palliative care units or the patients home were included. Search strategy A three-step search strategy was utilized in this review. An initial limited search of MEDLINE and CINAHL was undertaken followed by a comprehensive search using all identified keywords and index terms across all included databases. The reference lists of all identified reports and articles were hand searched for additional studies. Methodological quality Each paper was independently assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal instrument from the Joanna Briggs Institute the Qualitative Assessment and Review Instrument. When disagreement arose between the reviewers, the given paper was independently appraised by a third reviewer. Data extraction Data were extracted from papers included in the review using the standardized data extraction tool from Joanna Briggs Institute the Qualitative Assessment and Review Instrument. Data extraction was completed independently by two reviewers. Data synthesis Extracted findings from seven included papers were grouped according to similarity in meaning from which 11 categories were developed. These categories were then subjected to a meta-synthesis that produced a set of three synthesized findings. Results Key findings were extracted from six included papers and classified as unequivocal (U) or credible (C). A total of 30 findings were extracted and aggregated into 11 categories based on similarity in meaning. From the 11 categories, three synthesized findings were developed: i) Tailored care: specialist nurses play a role in understanding and meeting the individual needs of women with gynecological cancer; ii) Accessible care: specialist nurses guide women with gynecological cancer along the continuum of care and are an easily accessed source of knowledge and support; iii) Dependable expertise: women with gynecological cancer express trust and reassurance in the experience and expertise of the specialist nurse. Conclusions This systematic review synthesized the findings of seven studies that captured the experiences of women with gynecological cancer who received care from a specialist nurse. The specialist nurse offers tailored, accessible and expert care to women with gynecological cancer. From the synthesis it is recommended that women with gynecological cancer have access to the services of a specialist nurse at key points on the continuum of care, that specialist nurses provide information to patients on their disease and treatment in the form preferred by the patient and ensure that this information has been understood, and that specialist nurses are afforded time to spend with patients to enable greater exploration and identification of patient needs and the provision of personalized care. Further study that considers other key stakeholders in the specialist nurse role in gynecological oncology is recommended in order to gain a full understanding of specialist nurses’ contribution to the care of women with gynecological cancer. Additionally, it is recommended that further studies be conducted to seek the perspectives of women with gynecological cancer from culturally and linguistically diverse backgrounds and Indigenous populations on specialist nursing care as they appear to be under-represented in current research.

A Quantitative Systematic Review and Meta-Analysis of the Effectiveness of Oral Cholera Vaccine as a Reactive Measure in Cholera Outbreaks

Introduction The efficacy of oral cholera vaccines (OCVs) in laboratory conditions has been established, and the World Health Organization (WHO; Geneva, Switzerland) has recommended their preventative use in high-risk settings. The WHO recommendation has not been fully operationalized, nor has it been extended to apply to the reactive use of OCVs in real field epidemic conditions due to concerns about potential resource diversion, feasibility, cost, and acceptability. The purpose of this study is to assess and synthesize existing evidence of OCV effectiveness when used reactively in real field conditions. METHODS A systematic review and meta-analysis was conducted involving studies that investigated vaccine effectiveness when used as a reactive measure; that is, cases had reached epidemic threshold and a cholera epidemic was declared in real field epidemic conditions. OVID Medline (US National Library of Medicine, National Institutes of Health; Bethesda, Maryland USA), CINAHL (EBSCO Information Services; Ipswich, Massachusetts USA), and EMBASE (Elsevier; Amsterdam, Netherlands), along with grey literature, were systematically searched using pre-determined criteria. Two independent reviewers identified studies that met the selection criteria and data were extracted using validated tools. Pooled estimates were obtained using fixed effect models. RESULTS Of the 347 articles that met the inclusion criteria, four studies were retrieved for meta-analysis (three were case-control studies and one was a case-cohort study) involving a total of 1,509 participants and comprising 175 cases and 1,334 case controls. The effectiveness of one or two doses of either Shanchol (Shantha Biotechnics; India) or ORC-Vax (Vabiotech; Vietnam) OCVs showed a combined vaccine effectiveness of 75% (95% CI, 61-84). CONCLUSION A positive association was demonstrated between the reactive use of OCVs and protection against cholera. This supported the WHO recommendation to utilize OCVs reactively as an additional measure to the standard cholera epidemic response package. Schwerdtle P , Onekon CK , Recoche K . A quantitative systematic review and meta-analysis of the effectiveness of oral cholera vaccine as a reactive measure in cholera outbreaks. Prehosp Disaster Med. 2018;33(1):2-6.