A nursing intervention aimed at reducing symptom burden during chemotherapy (CHEMO-SUPPORT): A mixed-methods study of the patient experience.

PURPOSE: CHEMO-SUPPORT is a nursing intervention that supports cancer patients in dealing with chemotherapy-related symptoms at home. The aims of the current study were (1) to determine how patients had experienced the intervention, and (2) to identify and better understand the mechanisms underlying CHEMO-SUPPORT's effects, its essential elements and possible pitfalls. METHODS: All 71 patients who had received the CHEMO-SUPPORT intervention completed a questionnaire, asking their opinion on the helpfulness, strengths, and weaknesses of the individual components of the intervention. Semi-structured interviews were also conducted with a purposeful selection of 9 of the 71 patients to get a deeper understanding of the patient experience. RESULTS: Nurses' caring support, combined with competent care, gave patients a sense of reassurance and made them feel (better) able to deal with their symptoms. The importance patients ascribed to the intervention varied according to the individual symptom experience and coping mechanisms of the patients, and by their experience with regular care. Patients rated the informational brochure component of the intervention most helpful. It served as their 'companion', offering support and expert advice at home. Patients felt that a strength of the brochure was the support they received from the quotes of fellow patients. CONCLUSIONS: The CHEMO-SUPPORT intervention made patients feel more reassured and empowered in dealing with symptoms at home. That the CHEMO-SUPPORT experience was influenced by personal and contextual factors highlights the importance of tailoring the intervention to each patient, as well as improving supportive and competent symptom-management support in daily oncology care.

Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.

OBJECTIVES: To identify the barriers and facilitators for fall prevention implementation in residential care facilities. DESIGN: Systematic review. Review registration number on PROSPERO: CRD42013004655. DATA SOURCES: Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles. REVIEW METHODS: This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified. RESULTS: We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers. CONCLUSION: Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills. Effective fall prevention must consist of multifactorial interventions that target each resident's fall risk profile, and should be tailored to overcome context-specific barriers and put into action the identified facilitators.

Characteristics and effectiveness of fall prevention programs in nursing homes: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVES: To determine characteristics and effectiveness of prevention programs on fall-related outcomes in a defined setting. DESIGN: Systematic review and meta-analysis. SETTING: A clearly described subgroup of nursing homes defined as residential facilities that provide 24-hour-a-day surveillance, personal care, and limited clinical care for persons who are typically elderly and infirm. PARTICIPANTS: Nursing home residents (N = 22,915). MEASUREMENTS: The primary outcomes were number of falls, fallers, and recurrent fallers. RESULTS: Thirteen studies met the inclusion criteria. Six fall prevention programs were single (one intervention component provided to the residents), one was multiple (two or more intervention components not customized to individual fall risk), and six were multifactorial (two or more intervention components customized to each resident's fall risk). Meta-analysis found significantly fewer recurrent fallers in the intervention groups (4 studies, relative risk (RR) = 0.79, 95% confidence interval (CI) = 0.65-0.97) but no significant effect of the intervention on fallers (6 studies, RR = 0.97, 95% CI = 0.84-1.11) or falls (10 studies, RR = 0.93, 95% CI = 0.76-1.13). Multifactorial interventions significantly reduced falls (4 studies, RR = 0.67, 95% CI = 0.55-0.82) and the number of recurrent fallers (4 studies, RR = 0.79, CI = 0.65-0.97), whereas single or multiple interventions did not. Training and education showed a significant harmful effect in the intervention groups on the number of falls (2 studies, RR = 1.29, 95% CI = 1.23-1.36). CONCLUSION: This meta-analysis failed to reveal a significant effect of fall prevention interventions on falls or fallers but, for the first time, showed that fall prevention interventions significantly reduced the number of recurrent fallers by 21%.

Internal consistency and construct validity assessment of a revised Facts on Aging Quiz for Flemish nursing students: an exploratory study.

BACKGROUND: Since more people are reaching older and older ages, healthcare systems are becoming in need of more and more knowledgeable nurses to meet the specific health care needs of older persons. Several instruments exist to measure and evaluate students' knowledge of older persons, ageing, and gerontological care; however, unequivocal evidence on their use and psychometric properties is scarce. The aim of the study was to validate a revised version of Palmore's Facts on Aging Quiz (FAQ). METHODS: A cross-sectional, exploratory study was conducted. Palmore's FAQ version 1 and Facts on Aging Mental Health Quiz were used as bases for the development of a revised FAQ instrument. Three researchers translated these instruments into Dutch. A panel of nine experts in geriatric research and gerontological care evaluated the translation and the face and content validity of the instrument. We used a cross-sectional, exploratory design to assess its internal consistency and construct validity. Cronbach's alpha coefficients, exploratory factor analysis, and the known-groups technique were used for these analyses. RESULTS: Based on the experts' consensus, a revised version of the FAQ, consisting of 36 items, was produced. Exploratory factor analysis did not reveal underlying constructs suggesting that the revised version encloses a more general concept of knowledge (e.g. about older persons, aging, gerontological care). Using the known-groups technique, we validated the instrument, showing that it discriminates between the knowledge of first- and third-year nursing students. The overall Cronbach's coefficient of 0.723 was acceptable and changed minimally (from 0.708 to 0.724) when items were removed. CONCLUSION: We conclude that the revised version of the FAQ can be used to properly evaluate nursing students' knowledge about older persons and gerontological care, as reasonable reliability and validity were established for this revised version of the FAQ.

Characteristics and effectiveness of complex nursing interventions aimed at reducing symptom burden in adult patients treated with chemotherapy: a systematic review of randomized controlled trials.

OBJECTIVES: The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy. DESIGN: We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way. RESULTS: We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in common. Although some interventions fail to show significant effects, others significantly reduce aspects of symptom burden by 10-88%. CONCLUSION: Although some complex nursing interventions in this systematic review produce clinically meaningful and statistically relevant reductions in symptom burden, based on the available data it is not possible to make definitive conclusions about the vital parts, circumstances or preferred target population of the interventions. Quality of the studies and modeling and piloting of the interventions are important challenges for future research.

Oncology patients' perceptions of "the good nurse": a descriptive study in Flanders, Belgium.

The image of "the good nurse" is mainly studied from the perspective of nurses, which often does not match the image held by patients. Therefore, a descriptive study was conducted to examine oncology patients' perceptions of "the good nurse" and the influence of patient- and context-related variables. A cross-sectional, comparative, descriptive design was used. The sample comprised 557 oncology patients at one of six Flemish hospitals, where they were treated in an oncology day-care unit, oncology hospital ward, or palliative care unit. Data were collected using the Flemish Care-Q instrument. Factor analysis summarised the most important characteristics of "the good nurse". We reassessed the reliability and construct validity of the Flemish Care-Q and examined the influence of patient- and context-related variables on patient perceptions. Using factor analysis, we grouped the different items of the Flemish Care-Q according to three characteristics: "the good nurse" (I) has a supportive and communicative attitude towards patient and family, (II) is competent and employs a professional attitude, and (III) demonstrates personal involvement towards patient and family. Median factor scores of Factors I, II, and III, respectively, were 8.00, 9.00, and 8.00 (varying from 1, not important, to 10, very important). In order of importance, Factors II, I, and III were identified as valuable characteristics of "the good nurse". Gender, care setting, and province were influential variables. As perceived by oncology patients, "the good nurse" has a broad range of qualities, of which competence and professionalism are the most valuable.

Elderly patients' and residents' perceptions of 'the good nurse': a literature review.

This article describes the findings of a mixed method literature review that examined the perceptions of elderly patients and residents of a good nurse in nursing homes, hospitals and home care. According to elderly patients and residents, good nurses are individuals who have the necessary technical and psychosocial skills to care for patients. They are at their disposal, promptly recognising the patients' needs. Good nurses like their job and are sincere and affectionate. They are understanding and caring. They do not hesitate to enter into a trust-based relationship with their patients. Knowing and understanding how elderly patients and nursing home residents perceive 'the good nurse' is crucial for providing quality care and for promoting better patient outcomes in geriatric care.