The relevance of the contribution of psychoneuroendocrinoimmunology and psychology of reasoning and decision making to nursing science: A discursive paper.

AIM: Patients' death or adverse events appear to be associated with poor healthcare decision-making. This might be due to an inability to have an adequate representation of the problem or of the connections among problem-related elements. Changing how a problem is formulated can reduce biases in clinical reasoning. The purpose of this article is to explore the possible contributions of psychoneuroendocrinoimmunology (PNEI) and psychology of reasoning and decision-making (PRDM) to support a new nursing theoretical frame. DESIGN: Discursive paper. METHOD: This article discusses the main assumptions about nursing and nurses' ability to face patient's problems, suggesting a new approach that integrates knowledge from PNEI and PRDM. While PNEI explains the complexity of systems, highlighting the importance of systems connections in affecting health, PRDM underlines the importance of the informative context in creating a mental representation of the problem. Furthermore, PRDM suggests the need to pay attention to information that is not immediately explicit and its connections. CONCLUSION: Nursing recognizes the patient-nurse relationship as the axiom that governs care. The integration of PNEI and PRDM in nursing theoretics allows the expansion of the axiom by providing essential elements to read a new type of relationship: the relationship among information. PNEI explains the relationships between biological systems and the psyche and between the whole individual and the environment; PRDM provides tools for the nurse's analytical thinking system to correctly process information and its connections. IMPACT ON NURSING PRACTICE: A theoretical renewal is mandatory to improve nursing reasoning and nursing priority identification. Integrating PNEI and PRDM into nursing theoretics will modify the way professionals approach patients, reducing cognitive biases and medical errors. NO PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public involvement in the design or writing of this discursive article.

The iceberg of genomics: New perspectives in the use of genomics and epigenetics in oncology nursing clinical reasoning. A discursive paper.

BACKGROUND: Although, there is a wealth of information in the medical literature on the usefulness of genomic testing in assessing risk and its application in medical oncology decision making, there are no theoretical reflections in the nursing field. AIM: To understand the implications of molecular biology in nursing practice and highlight the role of Nursing Theory in guiding nurses' reasoning. MATERIALS AND METHODS: Searching literature published between 2000 and 2022 in Medline and Google Scholar. Scientific evidence was analysed by the authors expert in different fields. RESULTS: Based on the findings of the literature, concerns have been raised about the proper care of cancer patients who have a genomic risk profile determination. In particular, the absence of theoretical thinking and conceptual models that consider developments in molecular biology and their impact on nursing, in addition to the prevalence of heuristic thinking and the application of clinical patterns in nursing practice, could induce patient misjudgement with inadequate planning of preventive, curative, rehabilitative and educational nursing interventions. Nurses working in the field of oncology should be aware that the risk profile determined by genomics tests is merely the visible and stated portion of the cancer patient: the tip of iceberg. DISCUSSION: This study demonstrates how genomic testing takes into account a fraction of genes discovered in tumour tissue to establish a risk profile. This subset differs, for example, from the social genome, which can determine the risk of dementia, cancer and cardiovascular disease, but in response to social adversity. Nursing theory, which views the environment as a metaparadigm, must consider a conceptual model that can integrate the findings of genomic testing with recommendations from studies on the social genome of humans to make it easier to build nursing treatments that can better reduce these risks. CONCLUSION: A nursing theoretical discourse on genomics is a paramount requirement for developing effective nursing care.

Exploring hospital compliance with the primary nursing care model: validating an inventory using the Delphi method.

BACKGROUND: The primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing. METHODS: The Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted "quite relevant" and "highly relevant". Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts. RESULTS: The first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3-4; mean I-CVI = 0.84; range: 0.83-1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83-4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93. CONCLUSION: Measuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others' research. Future research should be conducted to compare the results from the checklist with nursing outcomes.

Work with cancer or stop working after diagnosis? Variables affecting the decision.

BACKGROUND: Studies about work and cancer predominantly considered the return to work of cancer survivors. However, some studies highlighted that many patients work with cancer even immediately after the diagnosis. Little is known about the frequency, causes, and consequences of this behavior. OBJECTIVE: This study aimed to estimate how many cancer patients continue working in the month after the diagnosis in an Italian context and to determine which factors affect the decision to stop working in the same period. METHODS: One hundred seventy-six patients with breast, gastrointestinal, prostate, or female reproductive system cancer completed a survey with demographic, occupational, and psychosocial information. Clinical information was collected from medical records. We measured how many workers continued working in the month after cancer diagnosis without substantial interruptions and selected the best logistic regression model of this behavior's predictors. RESULTS: Sixty-eight percent of the patients continued working in the month after the diagnosis. Patients were more likely to stop working with a higher level of perceived work-health incompatibility (OR = 2.64; 95%CI: 1.48-4.69), an open-ended contract (OR = 3.20; CI: 1.13-9.09), and a complex treatment (surgery+chemo-/radio-therapy, OR = 4.25; CI: 1.55-11.65) and less likely with breast cancer (OR = 0.20; CI: 0.07-0.56), and more children (OR = 0.59; CI: 0.37-0.96). CONCLUSIONS: To continue working with cancer is a common practice among the newly diagnosed. The decision to suspend work activity relates to evaluating how much work activities hamper one's health care needs and the practical difficulties expected in handling cancer care and work.

Clinical pathways and patient-related outcomes in hospital-based settings: a systematic review and meta-analysis of randomized controlled trials.

Clinical pathways represent a multi-disciplinary approach to translate clinical practice guidelines into practical interventions. The literature from 2010 onward regarding the efficacy of adopting a clinical pathway on patient-related outcomes within the in-hospital setting has been not synthesized yet. For this reason, this systematic review and meta-analysis of randomized controlled trials aimed to critically synthesize the literature from 2010 onward about the efficacy of clinical pathways, compared with standard of care, on patient-related outcomes in different populations, and to determine the effects of clinical pathways on patient outcomes. We searched PubMed, Scopus, CINAHL, and reference lists of the included studies. Two independent reviewers screened the 360 identified articles and selected fifteen eligible articles, which were evaluated for content and risk of bias. Eleven studies were finally included. Given the commonalities of the measured outcomes, a meta-analysis including eight studies was performed to evaluate the effect size of the associations between clinical pathways and quality of life (OR=1.472 [0.483-4.486]; p=0.496), and two meta-analyses, including four studies, were performed to evaluate the effect sizes of the associations between clinical pathways with satisfaction (OR=2.226 [0.868-5.708]; p=0.096) and length of stay (OR=0,585 [0.349-0.982]; p=0.042). Reduced length of stay appeared to be associated with clinical pathways, while it remains unclear whether adopting clinical pathways could improve levels of quality of life and satisfaction. More primary research is required to determine in specific populations the efficacy of clinical pathways on patient-related outcomes.

Safe use of Peripherally Inserted Central Catheters for chemotherapy of solid malignancies in adult patients: A 1-year monocentric, prospectively-assessed, unselected cohort of 482 patients.

INTRODUCTION: Aim of this study was to analyze the overall complication and failure rates of Peripherally Inserted Central Catheters (PICCs), in a 1-year consecutive unselected cohort of 482 adult patients, affected by non-hematological malignancies undergoing chemotherapy. METHODS: Adult outpatients (aged 18-75 years), with an Eastern Cooperative Oncology Group (ECOG) performance status of 0-2, bearing solid tumors and candidates for intravenous chemotherapy were eligible for the study. Exclusion criteria were active infections, coagulopathy (defined as platelet count <50,000/µL and/or prothrombin time more than 18 s), life expectancy <6 months, or inability to give written informed consent. Devices were all implanted in an outpatients' hospital facility, following predefined evidence-based institutional guidelines and protocols by a PICC-dedicated team at the European Institute of Oncology in Milan, Italy, during the 12-month period from January 1 to December 31, 2019. RESULTS: Five-hundred PICCs were implanted in a cohort of 482 patients during the time interval of this study. Thirty devices were overall removed (6.2%), 23 as a consequence of a complication occurred, and seven inadvertently. The inserted PICCs accounted for a total of 49,718 catheter days in situ, median duration was 85.5 days [interquartile range (IQR): 56-146]. Overall there were 42 (8.7%) complications, corresponding to 0.84 catheter-adverse events (CAE)/1000 PICC-days (95% CI: 0.61-1.14). There were N = 13 (2.7%) thromboses, N = 11 (2.3%) irreversible occlusions, N = 7 (1.5%) accidental removals, N = 5 (1.0%) infections [two Catheter Related Blood Stream Infection (CRBSI) and three exit site/local infection], N = 3 (0.6%) ruptures and N = 3 (0.6%) primary or secondary malpositions. CONCLUSION: This large prospective study supports the increasing use of PICCs in adult oncology outpatients treated in specialized centers with chemotherapy for non-hematological malignancies. In this clinical setting, PICC failure occurred in 6% only of the inserted devices.

Incidence and Determinants of Port Occlusions in Cancer Outpatients: A Prospective Cohort Study.

BACKGROUND: Normal saline is considered a safe alternative for heparin as a locking solution in totally implantable venous access devices. The incidence rate of partial occlusion with the use of normal saline (easy injection, impossible aspiration) is estimated at 4%. OBJECTIVE: The aim of this study was to investigate determinants of partial occlusions with the use of normal saline solution and the maintenance of positive pressure in the catheter. METHODS: We enrolled 218 patients with different solid tumors who underwent pharmacologic treatment through the port with different frequencies: from once every week to at least once every month. The port was flushed with normal saline solution keeping a positive pressure in the catheter. RESULTS: We performed 4111 observations and documented normal port functioning in 99% of observations (n = 4057) and partial occlusions in 1% of observations (n = 54). Partial occlusions were significantly associated with frequency of port flushing (P < .05), chemotherapy (P < .001), and blood sample collection (P < .001). CONCLUSIONS: The use of positive pressure in addition to normal saline reduces the incidence rate of partial occlusions. The type of treatment, blood sample collection, and treatment schedule are important determinants of partial occlusions. IMPLICATIONS FOR PRACTICE: Nurses play a key role in maintaining a functioning port using positive pressure during the flushing techniques. Certain risk factors must be monitored to prevent partial occlusions, and certain patients are more likely to present with port-related problems.

How many research nurses for how many clinical trials in an oncology setting? Definition of the Nursing Time Required by Clinical Trial-Assessment Tool (NTRCT-AT).

Few resources are available to quantify clinical trial-associated workload, needed to guide staffing and budgetary planning. The aim of the study is to describe a tool to measure clinical trials nurses' workload expressed in time spent to complete core activities. Clinical trials nurses drew up a list of nursing core activities, integrating results from literature searches with personal experience. The final 30 core activities were timed for each research nurse by an outside observer during daily practice in May and June 2014. Average times spent by nurses for each activity were calculated. The "Nursing Time Required by Clinical Trial-Assessment Tool" was created as an electronic sheet that combines the average times per specified activities and mathematic functions to return the total estimated time required by a research nurse for each specific trial. The tool was tested retrospectively on 141 clinical trials. The increasing complexity of clinical research requires structured approaches to determine workforce requirements. This study provides a tool to describe the activities of a clinical trials nurse and to estimate the associated time required to deliver individual trials. The application of the proposed tool in clinical research practice could provide a consistent structure for clinical trials nursing workload estimation internationally.

Distress and Psychosocial Needs in Patients Accessing a Cancer Day Surgery Division: Implications for Clinical Decision Making.

Introduction: The Distress Thermometer (DT) was built and validated for screening cancer patients for distress, as suggested by the National Comprehensive Cancer Network. The current work was designed to measure the rates of distress in a sample of patients being hospitalized in a multidisciplinary outpatient surgery clinic. OBJECTIVE: To measure the rates of distress in a sample of patients referring to a multidisciplinary day surgery division in a comprehensive cancer center based in Northern Italy. Methods: A total of 177 patients were asked to fill in the (DT) before surgery. Results: Out of 177 patients, 154 (87%) patients completed the DT. While 13% of the patients indicated a total absence of distress, more than half of the sample declared a moderate or high distress. A total of 55% of patients presented at least three difficulties in the Problem List Checklist. Distress was not correlated with age or other medical and clinical variables. Number of emotional problems was the best predictor of distress at admission (ß = 0.655, p = 0.000). Conclusion: Screening for distress in a day surgery multidisciplinary oncology division is feasible and a relevant percentage of patients can be identified as clinically distressed. Outcomes also highlight the impact of age and precise physical and psycho-social signs as prognostic indicators of clinically significant distress. Measurement of distress and associated problems list represent the preliminary endpoint toward adequate recommendations that contribute to taking care of distress in cancer patients in cost-effective clinical setting.

[Recommendations and Italian standards for setting safe staff nursing levels in hospitals: results of a consensus conference]. / Raccomandazioni e standard italiani per dotazioni infermieristiche ospedaliere sicure: esiti di una consensus conference.

Nurse staffing levels have always been an issue and the optimal level and mix of nurses required to deliver quality care as cost-effectively as possible continues to be discussed at both national and international levels. In Italy, a network of experts rom ten local health and hospital authorities was set up in June 2010. The, main objectives of the network were to define, validate and approve a panel of relevant indicators, identify minimum standards of safety and develop recommendations to guide decision-making regarding hospital nurse staffing levels. The indicators and recommendations developed by the network are presented in this paper.