Exploring health professionals' knowledge of cancer-related pain: a scoping review.

BACKGROUND: Cancer-related pain is a complex multidimensional experience that affects all aspects of life. To support those impacted by cancer-related pain it is essential that health professionals have adequate knowledge in its assessment and management. AIMS: To explore the knowledge of health professionals regarding cancer-related pain. METHODS: A scoping review methodology was used to systematically search the literature published between 2010 and 2020. Databases CINAHL, Medline and PsycINFO were searched using terms 'cancer pain', 'healthcare professional', 'knowledge', 'attitudes' and 'barriers'. FINDINGS: The search identified 38 articles. They focused on nursing knowledge with minimal involvement of allied health professionals. Knowledge levels were variable with the majority demonstrating poor knowledge. Common knowledge gaps included around fear of addiction, principles of cancer-related pain assessment and management, and interventional techniques. CONCLUSION: Knowledge of cancer-related pain is variable with several knowledge gaps. More work is needed to ensure health professionals have adequate knowledge regarding the complexity of cancer-related pain.

A feasibility study of dementia communication training based on the VERA framework for pre-registration nurses: Part II impact on student experience.

BACKGROUND: People living with dementia have complex communication needs, especially during acute hospital admissions. The VERA framework (validation, emotion, reassurance, activity) was designed to promote person centred communication between student nurses and people living with dementia, but there is limited evaluation of its impact. AIM: To measure the impact of dementia communication training (based on VERA) plus older adult unit (OAU) placement on students' ability to recognise opportunities for person centred (PC) communication compared to OAU placement alone. METHOD: A control pre-post-study design was used. Dementia communication training plus follow-up during OAU placement was delivered to 51 students (5 OAU, two hospitals) while 66 students (7 OAUs, five hospitals) acted as controls. The primary outcome was students' ability to recognise PC communication assessed using case vignettes. Data were collected using electronic survey and focus group interviews. Data analysis used independent non-parametric Mann-Whitney U test and thematic analysis. RESULTS: In total 52 students (response rate 40%) completed surveys at the end of placements (38 intervention, 14 control group students). In the intervention group, participants were significantly more likely to identify PC responses with a mean score of 10.5 (SD 3.0) compared with 7.5 (SD 3.0) in the control group (p = 0.006). In focus group interviews (n = 19 students), the main themes were connecting with patients, VERA in practice, communication challenges, and learning environment. VERA was described as a flexible approach that added to participants' communication toolkit. The learning environment, complexity of patients and organisational resources were important contextual factors. CONCLUSION: The VERA framework has potential as a foundation level dementia communication training intervention, but it requires more rigorous testing. Nursing can lead the way in developing and embedding evidence-based, interdisciplinary dementia communication training in preregistration curricula.

A dementia communication training intervention based on the VERA framework for pre-registration nurses: Part I developing and testing an implementation strategy.

BACKGROUND: People living with dementia experience progressive difficulty in expressing physical and emotional needs. Health care staff including student nurses require training to develop compensatory communication strategies. However, there is no standardised foundation level dementia communication training within pre-registration curricula. AIM: This article describes the theoretical underpinnings and development of a foundation level dementia communication skills training based on the VERA (Validation, Emotion, Reassurance, Activity) framework. METHOD: The training strategies drew on behavioural change theory using the COM-B model and Gagné's 9 Events of Instruction. The VERA framework was operationalised using a multicomponent teaching strategy. The intervention was refined based on quality improvement Plan-Do-Study-Act cycles with feedback from people living with dementia, facilitators and student nurses. Data collection used semi-structured questionnaires (n = 51) and four focus group (n = 19) interviews with students. Data analysis involved descriptive statistics and thematic analysis. RESULTS: The intervention was a 2.5-hour face-to-face training session delivered at the start of students' older adult unit placement with follow-up reflection sessions during placement. Training was delivered to 51 students, all students described the training as useful and would recommend it to their peers. Elements of the training that were highly valued were: opportunities to express concerns in caring for people with dementia, applying the VERA framework using role play and outlining realistic expectations of VERA. Students recognised the need for on-going training especially for more complex patients. CONCLUSION: Combining behaviour change and education theory with stakeholder feedback strengthened the development of VERA as a foundation level dementia communication training for pre-registration nurses.

Exploring the work of nurses who administer chemotherapy to children and young people.

PURPOSE OF THE RESEARCH: To explore the knowledge, attitudes and beliefs of nurses who administer chemotherapy to children and young people. METHODS AND SAMPLE: A national postal survey of nurses working within the 21 cancer centres in the United Kingdom and Ireland. The questionnaire included 25-items addressing the attitudes, beliefs and concerns regarding nurses' roles, support mechanisms and educational preparation related to administration of chemotherapy. RESULTS: In total 286/507 (56%) questionnaires were returned. The majority of nurses worked in inpatient +/-outpatient (78%) settings and most gave chemotherapy on a daily basis (61%). The median time working in oncology was 10 [range 0.5-32] years and time administering chemotherapy was 8 [0.1-32] years. Aspects of administration that caused the most worry included treatment side-effects, extravasation, dealing with allergic/anaphylactic reactions and knowledge deficits in colleagues. There was no significant difference in worry according to level of nurse education but those with an oncology qualification had less Knowledge-related worry (p = 0.05). There was no difference in attitude according to level of education or having an oncology qualification. There were significant correlations between time qualified, time working in oncology and the number of years administering chemotherapy and the worry domains (ranging from r = -0.14 to r = -0.24, p < 0.05); and attitude to chemotherapy (ranging from r = 0.12 to r = 0.26, p < 0.001). CONCLUSION: As anticipated nurses new to chemotherapy administration were initially anxious about the role and they worried about making a drug error. Education and support from colleagues appears to have a positive effect on reducing worry and increasing competence.

Exploring the work of nurses who administer chemotherapy.

There is little research exploring nurses' experiences of, and attitudes towards, the chemotherapy administration process. There is also limited work investigating practitioners' educational preparation for this aspect of cancer nursing. The aim of this study was to describe nurses' experiences, attitudes and educational preparation for the chemotherapy administration process. A postal survey was conducted across 26 London hospitals providing cancer services. A survey questionnaire was sent to all 526 nurses who administered chemotherapy in these hospitals, of whom 257 replied (response rate 49%). Nearly all nurses (n=244, 95%) reported being frightened, scared and anxious when initially working with chemotherapy. Of these 221(86%) stated they became more confident with experience, when supported by knowledgeable role models and following chemotherapy education. Over 80% (n=206) of the sample had received some form of education, whilst 241 nurses (94%) thought they could benefit from more. Nurses reported they were often or always worried about extravasation (n=113, 44%), anaphylactic reactions (n=95, 37%), and other nurses' education and knowledge deficits (n=118, 46%). Overall, nurses' attitudes towards chemotherapy were neither negative nor positive. Findings highlight the value of formal educational preparation in chemotherapy prior to undertaking this aspect of nursing. Positive role models for novice practitioners would appear important and role models themselves require continued professional development. Wide variations in educational preparation and practice exist and a co-ordinated education and training strategy for chemotherapy practice is warranted to underpin safe and effective practice in this area.