Monica Bianchi

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.

Moral distress in undergraduate nursing students A systematic review

Background: Nurses and nursing students appear vulnerable to moral distress when faced with ethical dilemmas or decision-making in clinical practice. As a result, they may experience professional dissatisfaction and their relationships with patients, families, and colleagues may be compromised. The impact of moral distress may manifest as anger, feelings of guilt and frustration, a desire to give up the profession, loss of self-esteem, depression, and anxiety. Objectives: The purpose of this review was to describe how dilemmas and environmental, relational, and organizational factors contribute to moral distress in undergraduate student nurses during their clinical experience and professional education. Research design: The research design was a systematic literature review. Method: The search produced a total of 157 articles published between 2004 and 2014. These were screened with the assessment sheet designed by Hawker and colleagues. Four articles matched the search criteria (one quantitative study and three qualitative), and these were separately read and analyzed by the researchers. The process of review and analysis of the data was supervised by a colleague experienced in moral distress who provided an independent quality check. Ethical consideration: Since this was a systematic review, no ethical approval was required. Findings: From the analysis, it emerged that inequalities and healthcare disparities, the relationship with the mentor, and students’ individual characteristics can all impact negatively on the decisions taken and the nursing care provided, generating moral distress. All these factors condition both the clinical experience and learning process, in addition to the professional development and the possible care choices of future nurses. Conclusion: Few studies dealt with moral distress in the setting of nurse education, and there is a knowledge gap related to this phenomenon. The results of this review underline the need for further research regarding interventions that can minimize moral distress in undergraduate nursing students.

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.

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

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.

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.

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.