Nursing interventions for dyspnoea management among inpatients with cancer in palliative care.

BACKGROUND: Dyspnoea, a commonly reported symptom among patients with cancer, necessitates the need for appropriate non-pharmacological interventions for its management and suitable assessment scales. AIMS: To explore the nursing interventions and assessment scales for managing dyspnoea in patients with cancer receiving palliative care. METHODS: Systematic review. Five databases (CINAHL Complete, PubMed, Web of Science, Scopus and the Cochrane Central Register of Controlled Trials) were searched, and seven studies were identified. Only studies that comprised randomised controlled trials (RCTs), non-randomised controlled trials or quasi-experimental settings were included. FINDINGS: Nursing interventions, that support a patient's physical breathing and mental functioning, are effective in managing dyspnoea. It is crucial to use both subjective and physical assessment methods to accurately measure the outcomes of these interventions. CONCLUSION: These interventions have been proven to be effective, with outcomes centred on changes in physiological measurements and patients' subjective expressions.

Nurses' Informatics Competency Assessment of Health Information System Usage: A Cross-sectional Survey.

Nurses' informatics competencies are nurses' professional requirements to guarantee the quality of patient care and affect nurses' use of health information systems. The purpose of this survey was to describe nurses' perceptions of their informatics competencies regarding health information system usage. A previously tested web-based questionnaire with multiple-choice questions was sent to nurses whose e-mail address was available through three Finnish Nursing Associations (N = 58 276). A total of 3610 nurses working in Finland responded. Both descriptive and explanatory statistics were used to analyze the data. The three dependent variables "nursing documentation," "digital environment," and "ethics and data protection" were formulated from the data. Nurses' overall informatics competency was good. The "ethics and data protection" competency score was higher than that of "nursing documentation" or "digital environment." Recently graduated nurses and nurses working in outpatient care, virtual hospital, examination, or operation had highest "digital environment" competency score. Health information system experience was associated with "nursing documentation." Nurses are highly qualified health information systems users. However, the competency requirements generated by rapidly expanding digitalization have challenged nurses. It is important to increase educational programs for nurses of how to use digital devices, and how to support patients to use digital services.

Social and healthcare professionals' experiences of end-of-life care planning and documentation in palliative care.

AIM: To explore social and healthcare professionals' experiences of end-of-life (EOL) care planning and documentation in palliative care. DESIGN: A qualitative study with narrative methodology. METHODS: A narrative method with interviews was used. Data were collected from purposively selected registered nurses (n = 18), practical nurses (n = 5), social workers (n = 5) and physicians (n = 5) working in palliative care unit in five hospitals in three hospital districts. Content analysis within narrative methodologies was undertaken. RESULTS: Two main categories - patient-oriented EOL care planning and multi-professional EOL care planning documentation- were formed. Patient-oriented EOL care planning included treatment goals planning, disease treatment planning and EOL care setting planning. Multi-professional EOL care planning documentation included healthcare professionals' and social professionals' perspectives. Healthcare professionals' perspectives on EOL care planning documentation included benefits of structured documentation and poor support of electronic health record (EHR) for documentation. Social professionals' perspective on EOL care planning documentation included usefulness of multi-professional documentation and externality of social professionals in multi-professional documentation. CONCLUSION: The results of this interdisciplinary study demonstrated a gap between what healthcare professionals consider important in Advance Care Planning (ACP), that is, proactive, patient-oriented and multi-professional EOL care planning and the ability to access and document this in a useful and accessible way in the EHR. RELEVANCE TO CLINICAL PRACTICE: Knowledge of the patient-centered EOL care planning and multi-professional documentation processes and their challenges are prerequisites for documentation to be supported by technology. REPORTING METHOD: The Consolidated Criteria for Reporting Qualitative Research checklist was followed. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

End-of-Life Discussions From the Perspective of Social Care and Healthcare Professionals in Palliative Care.

This study describes the state of end-of-life discussions in Finland. A qualitative descriptive study with thematic interviews was conducted. Data were gathered from palliative care unit nurses, physicians and social workers. Inductive content analysis was used. According to interviewees (n = 33), the state of end-of-life discussion included three main categories. First, optimal end-of-life discussion time included early end-of-life discussion, end-of-life discussion at different phases of severe illness, and flexibility and challenges in scheduling end-of-life discussion. Second, end-of-life discussion initiators included both healthcare professionals and non-healthcare professionals. Third, social care and healthcare professionals' experiences of end-of-life discussion consisted of the importance and challenge of end-of-life discussion, end-of-life communication skills development in multiprofessional care context, and end-of-life communication in multi-cultural care context. The results can be used to justify the need of a national strategy and systematic implementation on Advance Care Planning (ACP), considering the multiprofessional, multicultural and internationalizing operating environment.

Continuity of Patient Information to Palliative Care.

The purpose of this study was to describe the sharing of knowledge and information to palliative care in terms of information content, information structure and information quality by means of Advance Care Planning (ACP). This study used a descriptive qualitative study design. Purposively selected nurses, physicians and social workers working in palliative care in Finland took part in thematic interviews in five hospitals in three hospital districts in 2019. The data (n = 33) were analyzed by means of content analysis. The results demonstrate the evidence-based practices of ACP in terms of information content, structure and quality. The results of this study can be utilized in the development of sharing knowledge and information and as the basis in the development of an ACP instrument.

Quality of information transferred to palliative care.

AIMS AND OBJECTIVES: To describe the quality of information coming from previous care units to palliative care. BACKGROUND: Information quality is an interconnected concept that includes different dimensions and can be viewed from different perspectives. More knowledge is needed from a multi-professional perspective on the information quality coming to palliative care. DESIGN: Descriptive qualitative study. METHODS: Altogether 33 registered nurses, practical nurses, social workers and physicians working in palliative care were purposively selected to participate in thematic interviews. The research was carried out in six palliative care units in three hospital districts. The data were analysed by using deductive and inductive content analysis. The COREQ checklist was used. RESULTS: Three main categories with thirteen categories were identified in connection with the deductive analysis based on the Clinical Information Quality framework: (1). Informativeness of information coming from previous care units to palliative care included accuracy, completeness, interpretability, plausibility, provenance and relevance. (2). Availability of information coming from previous care units to palliative care included accessibility, portability, security and timeliness. (3). Usability of information coming from previous care units to palliative care included conformance, consistency and maintainability. Each category is divided into sub-categories followed by narratives of their content. CONCLUSIONS: This study provides new knowledge on the quality of information coming to palliative care from a multi-professional perspective. Professionals working in palliative care units highlight issues describing good information quality, but also point out quality issues and areas for improvement. RELEVANCE TO CLINICAL PRACTICE: The results can guide the development of documentation practices and Health Information System development as well as be used in the generation of a new audit instrument of information quality.

Accessibility of care plan information from previous treatment setting in palliative care unit: A qualitative study.

AIM: To describe accessibility of care plan information from patients' previous treatment setting in palliative care. DESIGN: A qualitative descriptive study. METHODS: A total of 33 nurses, social workers and physicians were interviewed. Data were analysed by deductive and inductive content analysis. The Fit between Individuals, Task and Technology (FITT) framework was used as a deductive analysis framework. RESULTS: Individual-task Fit was described in relation to professional-specific care plan information in palliative care and use of time to obtain care plan information. Individual-technology Fit was described in relation to health informatics competencies and HIS usability. Task-technology Fit was described in relation to interoperability between care settings and healthcare providers and lack of interoperability between care settings and healthcare providers. RELEVANCE TO CLINICAL PRACTICE: The study confirms the need to review the HIS as a whole from a holistic and patient-oriented perspective to ensure the continuity of palliative care.

Using standardized nursing data for knowledge generation - Ward level analysis of point of care nursing documentation.

BACKGROUND: Standardized nursing terminology is a prerequisite for describing nursing care processes and generating knowledge for decision-making and management. The structure of the Finnish Care Classification (FinCC) facilitates documentation of nationally agreed core nursing data: nursing diagnoses, interventions, and outcomes. PURPOSE: To analyze the use of FinCC to assess patient care needs (nursing diagnoses), care implementations (interventions) and evaluation of the outcomes of nursing care in electronic health records. METHODS AND MATERIALS: The descriptive study applied purposeful sampling of nursing data from nursing data repositories in three surgical wards in tertiary and secondary care hospitals. The aggregated, anonymous ward level data from a six-month period was analyzed to show distributions within frequencies and means of component, main and subcategory level use of FinCC in the three hospitals. RESULTS: Each of the three levels of the FinCC (component, main and subcategory) were used for recording nursing care. In all hospitals, the three most used diagnosis components covered about one third of the use of all the 17 components. The five most used intervention components cover about one third of the components. The most often used components for diagnoses and interventions were Coordination of care and follow-up care, Pain Management, Activities of daily living and independence and Medication. The prevalence of different components and the main and subcategory level usage for both diagnoses and interventions varied between the hospitals. CONCLUSION: Standardized point-of-care nursing data makes patients' daily nursing care transparent. Structured, standardized, and point-of-care nursing data can be utilized to generate new knowledge of nursing care processes and nursing care practice at ward level.

Nursing staff's assessments of medication management process in the psychiatric and operative domains: A cross-sectional study after introduction of an electronic medication chart.

AIMS AND OBJECTIVES: To describe nursing staff's assessments of medication management process in the psychiatric and operative domains after introduction of an electronic medication chart. BACKGROUND: The medication management process includes all structures and practices within the organisation that guide and support medication administration and related procedures. DESIGN: A cross-sectional survey. METHODS: A Finnish version of the Medication Administration System - Nurses Assessment of Satisfaction (modified MAS-NAS) paper-based questionnaire was sent to all nursing staff (N = 855) working in operative (n = 498) and psychiatric (n = 357) domains in one central hospital. Data were analysed using statistical methods. RESULTS: In total, 324 nursing staff members participated. More than half agreed that medication management is efficient (64%), safe for patients (76%), and that the current medication administration system provides the necessary medical treatment information (e.g. prescriptions by physicians, medication data) (64%). Respondents' overall satisfaction with medication management process was slightly above average on a scale from 1 to 10 (mean = 6.2; SD = 1.8; median = 7, range 2-9). Respondents who used electronic medication chart reported higher overall satisfaction with medication management process (median = 7, mean = 6.1, SD = 1.8 and range 2-9) than those not using it (median = 6.5, mean = 6.3, SD = 1.6 and range 2-9). No statistically significant difference was found (U = 8552.000, p = 0.33). CONCLUSIONS: This study revealed several problems in the medication management process. The results can be used in developing the medication management process. RELEVANCE TO CLINICAL PRACTICE: Electronic medication chart should be used and developed further in terms of efficacy, safety and access. One year after the electronic medication chart was introduced, only half of the respondents had used it. That is why implementation of electronic systems or technological applications should be carefully considered as a whole.

Accessibility of information on patients' and family members' end-of-life wishes in advance care planning.

AIM: To describe healthcare professionals' accessibility and transfer of patients' and family members' end-of-life wishes in ACP to the palliative care unit. DESIGN: The study used a qualitative descriptive study design. METHODS: Purposive sampling was used. The data (N = 33) were collected through interviews with physicians, registered nurses, practical nurses and social workers. The data were analysed by inductive content analysis. RESULTS: Two main categories emerged. Patients' and family members' end-of-life wishes documentation in relation to changing information needs was described in relation to patients' condition and care context. Transfer of patients' and family members' end-of-life wishes to palliative care unit included written and verbal communication. Results showed lack of implementation of ACP early, lack of implementation about the holistic interpretation of ACP into medical notes and lack of transferability of ACP into documenting systems impacting on accessibility and realization for the patient and family members at the end-of-life.

Updating the Standardized Terminology for Nurses' Daily Documentation.

In Finland, the nationally unified and standardized nursing documentation model comprises the nursing process model and the Finnish Care Classification (FinCC). The aim of the study was to assess how well the further developed FinCC complies with actual nursing practices and how pragmatic and understandable it is. An e-questionnaire based on the revised version of the FinCC was sent to healthcare organizations (n=34) and Universities of Applied Sciences (n=14). Data was gathered and organized in Excel. Narrative comments were read and analyzed. The mean of questions of 17 components of both the FICND and the FICNI was over four (scale 1-5). The biggest revision of the FinCC is that different scales and evidence-based research have been utilized in the development of the terminology. Based on the findings, revisions have been made, and the new version, FinCC 4.0, will be published at the end of 2019.

Healthcare professionals' perceptions of advance care planning in palliative care unit: a qualitative descriptive study.

AIMS AND OBJECTIVES: To describe healthcare professionals' perceptions of advance care planning (ACP) in palliative care unit in hospital ward or outpatient clinic. BACKGROUND: Clinical guidelines recommend timely ACP as a central component of patient-centred palliative care. However, the ACP concept and terminology have been judged to be confusing, and practices are not established. Professionals' views are needed for ACP adoption and usage. DESIGN: Qualitative descriptive design. METHODS: The study used purposive sampling. The data were collected through focus group interviews with registered nurses and practical nurses and individual or couple interviews with physicians and social workers. The data (n = 33) were analysed by inductive content analysis. The study complied with the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. RESULTS: Three main categories emerged: Information content of ACP, coordination of care activities through ACP, and support for patients' and family members' coping. The information content of ACP included assessment of need for patient care, preparing for changes in patient's state of health and proactive medication. Coordination of care activities through ACP contained ACP care planning, cooperation and work practices between healthcare professionals. Support for patients' and family members' coping included communication between patient, family members and professionals and promoting patient self-care. CONCLUSIONS: ACP is a useful and proactive tool for integrating patient-centred information, care and services as well as support for patients' and family members' coping. Palliative care activities can be coordinated through ACP in a multidisciplinary manner. ACP is significant and relevant for both professionals' work and patient care throughout the service system. RELEVANCE TO CLINICAL PRACTICE: Results highlight the importance of proactive, concrete and holistic ACP. ACP should be up to date to reflect patient's current wishes. Raising professional awareness and implementing ACP into work processes are essential. Results can be utilised in planning and implementing interprofessional in-service training.

Electronic Medication Administration System Supports Safe Medication Administration.

The purpose of this study is to describe nurses' views of what supports safe medication administration in the current electronic medication administration system. Data was collected at the turn of 2014-2015 and open-ended answers were inductively analyzed using content analysis. The system's usefulness, good usability, and the feature that there is extra information available on medications and the patient-specific information needed in medication administration are elements that support safe medication administration. The study identifies wide support for the electronic medication administration system in safe medication administration.

Advance care planning for patients with cancer in palliative care: A scoping review from a professional perspective.

AIMS AND OBJECTIVES: To describe advance care planning (ACP) for patients with cancer in palliative care from professionals' perspective. BACKGROUND: The number of patients with cancer is increasing. Palliative care should be based on timely ACP so that patients receive the care they prefer. DESIGN: A scoping review. METHODS: A systematic literature search was conducted in January 2019. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist was used. The methodological quality of the studies was evaluated using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were analysed with content analysis. RESULTS: Of 739 studies identified, 12 were eligible for inclusion. The settings were inpatient and outpatient facilities in special and primary care including oncology, palliative and hospice care. ACP consisted of patient-oriented issues, current and future treatment, and end-of-life matters. The participants were nursing, medical or social professionals. ACP conversations rarely occurred; if they did, they took place at the onset, throughout and late in the cancer. CONCLUSIONS: Professionals could not separate day-to-day care planning and ACP. ACP documentation was scattered and difficult to find and use. Professionals were unfamiliar with ACP, and established practices were lacking. ACP conversations mostly occurred in late cancer. Further research clarifying concepts and exploring the significance of ACP for patients and relatives is recommended. RELEVANCE TO CLINICAL PRACTICE: Our results support the use of ACP by a multidisciplinary team from the early stages of cancer as a discussion forum around patients' wishes and choices. We showed the need to raise professionals' awareness of ACP. Education and appropriate data tools for ACP are important as they may reduce reluctance and promote ACP use. This paper contributes to the wider global clinical community by pointing out the importance of standardising ACP contents and practices.

Physicians' and nurses' experiences on EHR usability: Comparison between the professional groups by employment sector and system brand.

BACKGROUND: Usability associates with patient safety and quality of care. This article reports results from nation-wide usability-focused survey studies for physicians and nurses in Finland. Earlier research has shown dissatisfaction and serious deficiencies, which hamper the efficient use of health information systems (HIS); however, evaluation studies covering the viewpoints of both user groups are practically lacking. Our study aimed at comparing end-users' experiences on the usability of electronic health record (EHR) systems by employment sector and EHR brand. METHODS: To measure usability, we used the validated National Usability-focused HIS Scale (NuHISS). For this study, we selected 11 usability statements that relate to technical quality (n = 3), ease of use (n = 6), benefits (n = 1) and collaboration (n = 1), and were identical in both surveys. We report the responses from 3013 physicians and 2560 nurses working in public sector hospitals or primary care health centers in 2017. RESULTS: Results in total and by healthcare sector showed notable differences between nurses' and physicians' experiences on usability of their EHR systems. Physicians were more satisfied than nurses on technical quality and learnability of the EHR-systems, while nurses experienced the ease of use better and were more satisfied with collaboration aspects than physicians. Two EHR brands used in hospitals appeared to have succeeded in supporting physician workflows, while two others used in health centers were more suitable for nurses' needs. CONCLUSIONS: Nurses' and physicians' experiences on EHR usability appear to vary more by EHR brand and employment sector rather than either professional group being generally more satisfied. Development of EHR systems should consider the perspectives of these two main user groups and their working contexts.

Standardizing Key Issues from Hospital Through an Electronic Multi-Professional Discharge Checklist to Ensure Continuity of Care.

This article describes development of the multi-professional discharge checklist and its implementation into the nursing documentation system (NDS) as part of the patient's overall care plan. The aim was to harmonize patient's admission and care period documentation and to improve the quality of electronic nursing discharge summaries. The ultimate goal was to ensure continuity of care. The multidisciplinary discharge checklist was developed in two phases to support the discharge of elderly patients (over 65 years). First, the information content of the checklist was defined, and second, it was integrated into the NDS. Focus groups of social and healthcare professionals (n = 82) in specialist health care, primary health care and social services defined the information content and participated in the feedback and checking rounds. The development work should continue. Particular attention should be given to the technical performance of discharge checklists in the NDS.

Contents of Informational and Management Continuity of Care.

Continuity of patient care (COC) is considered an essential feature of good quality care, but the ambiguity of the concept has given rise to methodological challenges in scientific studies. This study has a strong link to the functional definitions of electronic health records (EHR). In order to evaluate how COC is achieved, through a discharge summary, for example, the contents of COC should be defined. Conceptual consensus on COC as a multidimensional concept has increased. This study was conducted to provide an overview of the dimensions and descriptions of informational and management continuity of care. A scoping review was conducted. We found that informational continuity of care refers to data tool, data content, data structures or information quality related processes. Management continuity of care refers to information flow, co-operation, co-ordination, multiprofessionality or management processes. We identified the need to define next the contents of relational and cross-border continuities.

Development of Elderly Service System on the Basis of Big Data.

This presentation includes action proposals with impact to growing older populations and shows how a plan for developing elderly service system was created as one part of a bigger welfare plan at one hospital district in Finland. The central part of preparing a plan was the public administration anonymous Big Data concerning ageing and functional capacity. The aim was to establish a customer-oriented plan based on the need for population service.

Development Needs of Electronic Nursing Discharge Summaries in Finland.

In this study the development needs of Electronic Nursing Discharge summaries (ENDS) mentioned by nursing professionals are classified and addressed using the FITT model ("Fit between Individuals, Task and Technology") framework.