An integrative review of adolescent trust in the healthcare provider relationship.

AIM: To conduct an integrative review of empirical studies examining factors affecting trust in the healthcare provider (HCP) relationship among adolescents. DESIGN: An integrative review was conducted. DATA SOURCES: The keywords adolescent, trust, healthcare provider and related words were searched in multiple online research databases. The results were limited to research published between 2004 and 2019. Seventeen primary sources were identified and synthesized in the final review. REVIEW METHOD: Guided by the Whittemore and Knafl integrative review method, a data-based convergent synthesis design was used to explore the key research question in both qualitative and quantitative research. RESULTS: This integrative review found that health care provider behaviours, such as confidentiality, honesty, respect, and empathy, promote adolescent's trust of the HCP. Notable gaps in the literature were also identified, including a lack of diversity among adolescent samples and HCP types and underdeveloped measures of adolescent trust of HCP. CONCLUSION: This integrative review informed the development of a new conceptual definition of adolescent trust of HCP, which embodies the key findings of the importance of HCP confidentiality, honesty, respect, and empathy. This definition can be used to develop instruments, interventions and policies that promote HCP trust among adolescents. Future research is needed to develop instruments to measure adolescents' trust of HCPs, evaluate trust of HCPs among diverse samples of adolescents and evaluate adolescent trust of HCPs with a variety of HCP types. IMPACT: The new conceptual definition of adolescent trust of HCP can be used to enhance nursing practice and design behavioural interventions to improve trust of HCP. To foster adolescent trust of HCP, policies should be enacted in healthcare institutions to explain confidentiality, provide notification of reporting mandates and formalize consent, assent and dissent for adolescents seeking health care.

Understanding Culture in Context: An Important Next Step for Patient Emotional Well-Being and Nursing.

The impact of culture on health has gained considerable importance in care delivery. This review discusses the complex interaction of culture and social determinants, and the combined impact of these on emotional well-being. Examples of this interaction are presented and recommendations for change within nursing to improve care are discussed.

Preparing Nursing Students for Interprofessional Practice: The Interdisciplinary Curriculum for Oncology Palliative Care Education.

Interprofessional educational experiences for baccalaureate nursing students are essential to prepare them for interprofessional communication, collaboration, and team work. Nurse educators are ideally positioned to develop and lead such initiatives. The purpose of this article is to describe the development and implementation of an interprofessional education (IPE) project involving students in nursing, medicine, social work, and chaplaincy. The Interdisciplinary Curriculum for Oncology Palliative Care Education project uses team-based palliative oncology education as the framework for teaching students interprofessional practice skills. The need for IPE is apparent, but there are very few comprehensive, successful projects for nurse educators to use as models. This article describes the development of the curriculum by the interprofessional faculty team. Issues encountered by nursing faculty members as they implemented the IPE experience are discussed. Solutions developed to address the issues and ongoing challenges are presented. This project can serve as a model of a successful IPE initiative involving nursing students.

Evaluation of an Interdisciplinary Curriculum Teaching Team-Based Palliative Care Integration in Oncology.

For students of the health care professions to succeed in today's health care environment, they must be prepared to collaborate with other professionals and practice on interdisciplinary teams. As most will care for patients with cancer, they must also understand the principles of palliative care and its integration into oncology. This article reports the success of one university's effort to design and implement an interdisciplinary curriculum teaching team-based palliative care in oncology which was mandatory for medical, nursing, social work, and chaplaincy students. Quantitative evaluation indicated that students made significant improvements related to palliative care knowledge and skills and readiness for interprofessional education. Qualitative feedback revealed that students appreciated the experiential aspects of the curriculum most, especially the opportunity to observe palliative teams at work and practice team-based skills with other learners. While there exist many obstacles to interprofessional education and hands-on learning, the value of such experiences to the learners justifies efforts to initiate and continue similar programs in the health sciences.

Pathways to a lung cancer diagnosis.

PURPOSE: The purpose of this qualitative descriptive study was to identify and describe pathways to a lung cancer diagnosis based on narratives of persons diagnosed with the disease. DATA SOURCES: Eleven adults with lung cancer were recruited from an academic thoracic oncology clinic in a large city in the southeastern United States. Moderately structured interviews were conducted by an experienced nurse practitioner (NP) to obtain information regarding the participants' experiences leading to their diagnosis. Qualitative content analysis was used to develop a typology of pathways. CONCLUSIONS: Findings revealed four distinct pathways: missing opportunities, waiting and seeing, being alarmed, and being blindsided. IMPLICATIONS FOR PRACTICE: The Pathways to a Lung Cancer Diagnosis Typology has important implications for clinical practice and can be used to inform NPs and other healthcare providers who provide care for patients at risk for or diagnosed with lung cancer.

The Interdisciplinary Curriculum for Oncology Palliative Care Education (iCOPE): meeting the challenge of interprofessional education.

UNLABELLED: Background: Interprofessional education is necessary to prepare students of the health professions for successful practice in today's health care environment. Because of its expertise in interdisciplinary practice and team-based care, palliative care should be leading the way in creating educational opportunities for students to learn the skills for team practice and provision of quality patient-centered care. Multiple barriers exist that can discourage those desiring to create and implement truly interdisciplinary curriculum. DESIGN: An interdisciplinary faculty team planned and piloted a mandatory interdisciplinary palliative oncology curriculum and responded to formative feedback. SETTING/SUBJECTS: The project took place at a large public metropolitan university. Medical, nursing, and social work students and chaplains completing a clinical pastoral education internship participated in the curriculum. MEASUREMENTS: Formative feedback was received via the consultation of an interdisciplinary group of palliative education experts, focus groups from students, and student evaluations of each learning modality. RESULTS: Multiple barriers were experienced and successfully addressed by the faculty team. Curricular components were redesigned based on formative feedback. Openness to this feedback coupled with flexibility and compromise enabled the faculty team to create an efficient, sustainable, and feasible interdisciplinary palliative oncology curriculum. CONCLUSION: Interdisciplinary palliative education can be successful if faculty teams are willing to confront challenges, accept feedback on multiple levels, and compromise while maintaining focus on desired learner outcomes.

Lung cancer stigma predicts timing of medical help-seeking behavior.

PURPOSE/OBJECTIVES: To examine relationships among demographic variables, healthcare system distrust, lung cancer stigma, smoking status, and timing of medical help-seeking behavior in individuals with symptoms suggestive of lung cancer after controlling for ethnicity, socioeconomic status, and social desirability. DESIGN: Descriptive, cross-sectional, correlational study. SETTING: Outpatient oncology clinics in Louisville, KY. SAMPLE: 94 patients diagnosed in the past three weeks to six years with all stages of lung cancer. METHODS: Self-report, written survey packets were administered in person followed by a semistructured interview to assess symptoms and timing characteristics of practice-identified patients with lung cancer. MAIN RESEARCH VARIABLES: Timing of medical help-seeking behavior, healthcare system distrust, lung cancer stigma, and smoking status. FINDINGS: Lung cancer stigma was independently associated with timing of medical help-seeking behavior in patients with lung cancer. Healthcare system distrust and smoking status were not independently associated with timing of medical help-seeking behavior. CONCLUSIONS: FINDINGS suggest that stigma influences medical help-seeking behavior for lung cancer symptoms, serving as a barrier to prompt medical help-seeking behavior. IMPLICATIONS FOR NURSING: When designing interventions to promote early medical help-seeking behavior in individuals with symptoms suggestive of lung cancer, methods that consider lung cancer stigma as a barrier that can be addressed through public awareness and patient-targeted interventions should be included.

Use of the Distress Thermometer to discern clinically relevant quality of life differences in women with breast cancer.

PURPOSE: The purpose of this study was to explore the ability of Distress Thermometer (DT) scores to discern important differences in quality of life scores among women with breast cancer. METHODS: The National Comprehensive Cancer Network's DT, the Functional Assessment of Cancer Therapy-Breast (FACT-B), and a demographic questionnaire were completed by 111 women recently diagnosed with breast cancer. RESULTS: Patients considered moderately to severely distressed (score ≥ 4 on DT) scored significantly lower on FACT-B QOL scales and subscales when compared to those in the group scoring 3 or below. For those scales for which minimally important differences (MIDs) have been established, differences between the two groups were 2-3 and a half times the established MID. CONCLUSIONS: Moderately to severely distressed patients have significantly lower QOL than those with expected or mild distress. The DT provides a quick and easy screening tool to alert the healthcare team to clinically relevant alterations in patients' QOL.

Determinants of quality of life in patients near the end of life: a longitudinal perspective.

PURPOSE/OBJECTIVES: to describe the quality of life (QOL) of patients near the end of life and to identify determinants of their QOL. DESIGN: descriptive, longitudinal. SETTING: university-affiliated cancer center, two private oncologists' offices, and patients' homes. SAMPLE: 80 patients with either stage IIIb or IV lung cancer newly diagnosed in the previous month or recurrent lung cancer with distant disease. METHODS: patients were interviewed for responses to instruments to assess demographic, physical, psychosocial, and spiritual characteristics. Baseline data were collected at the patients' places of oncology care. Home visits were made for the two-month and four-month data collection points. MAIN RESEARCH VARIABLES: QOL; symptom frequency, severity, and distress; functional status; anxiety; depression. FINDINGS: fifty percent of patients died within five months of their lung cancer diagnosis. Patients reported a relatively high QOL that did not change significantly as they approached the end of life. Symptom distress was the strongest determinant of QOL, followed by symptom severity, symptom frequency, and depression. CONCLUSIONS: QOL was most affected by symptoms experienced in patients with advanced lung cancer, particularly distress associated with symptoms. Interventions for symptom management must be implemented at diagnosis because patients in this population may approach the end of life quickly. IMPLICATIONS FOR NURSING: a routine and thorough symptom assessment is imperative for patients with advanced lung cancer. Attention to symptom distress is important because of its effect on QOL.

An evidence-based practice primer for infusion nurses.

Evidence-based practice (EBP) is the process of using current, best evidence to guide nursing care and improve patient outcomes. This article discusses the differences between research and EBP, reviews the process of EBP, and applies EBP guidelines to central catheter infections, a clinical problem relevant to infusion nursing.

Initiating and sustaining a standardized pain management program in long-term care facilities.

OBJECTIVES: To identify current pain management practices in the long-term care setting; and, implement and evaluate a comprehensive pain management program in the long-term care setting. DESIGN: An interventional pilot study. SETTING: Community-based long-term care facilities. METHODS: This study was conducted in two phases. Phase I consisted of interviewing long-term care facility administrators to ascertain current pain management policies and practices. This information was used to develop the Phase II intervention that involved collecting benchmark data, creating or modifying pain policies and procedures, implementing a pain management program and presenting educational programs. MEASUREMENTS: Interviews with long term care administrators; facility and resident demographic data; chart audits for pain assessment and management data; pharmacy audits; telephone surveys. RESULTS: Pain management policies and practices were inadequate prior to the study intervention. No facilities had policies or procedures that required ongoing (daily, weekly, etc.) pain assessment. Only one facility had mechanisms in place for measuring the presence or intensity of pain in their non-verbal, cognitively-impaired residents. Following the pain management program intervention, pain assessment significantly increased. and treatment for pain was provided for the vast majority of those indicating pain. All sites had a standardized pain assessment program in place one-year post-study completion. CONCLUSIONS: Standardized pain management programs are critical to improving pain management in long-term care settings. Improvement in long-term care pain management can be obtained through a comprehensive pain management program that involves staff education, changes in pain policies and procedures, and identifying pain management as a quality indicator.

Enhancing cancer nursing education through school of nursing partnerships: the Cancer Nursing Faculty Fellows Program.

This article describes the Cancer Nursing Faculty Fellows Program, an innovative program designed to provide nurse educators with state-of-the-art cancer knowledge to enhance their ability to teach cancer content. The Faculty Fellows Program was developed at the University of Louisville School of Nursing and was part of a multifaceted educational intervention to improve cancer nursing education. This intervention included comprehensive curriculum reviews, conferences with national consultants, cancer-specific faculty seminars, and funded instructional projects. The Faculty Fellows Program consisted of a mentored experience attending the Oncology Nursing Society Congress and a month-long intensive program to provide faculty with exposure to cancer experts, researchers, and clinical and community resources. By providing a forum for nurse educators to obtain this knowledge and provide the resources they need to change the way they educate nursing students, the program can significantly affect cancer-related nursing education and, ultimately, the care of patients with cancer and survivors.

The degree to which spiritual needs of patients near the end of life are met.

PURPOSE/OBJECTIVES: To determine to what degree the spiritual needs of patients near the end of life are met. DESIGN: Descriptive. SETTING: One inpatient and five outpatient hospices. SAMPLE: 62 female and 38 male hospice patients with a mean age of 67 years; 74% were dying from cancer. METHODS: Each subject completed the Spiritual Needs Inventory and rated life satisfaction via the Cantril ladder. MAIN RESEARCH VARIABLES: Spiritual needs and life satisfaction. FINDINGS: Women, patients residing in a nursing home or an inpatient hospice unit, and patients with lower levels of education reported a higher number of unmet spiritual needs. Needs that could be met independently by patients and were not related to functional status were met at a higher rate than those that were dependent on others and on functional status. CONCLUSIONS: Spiritual activities are important to patients who are near the end of life, but these patients may have a variety of unmet spiritual needs that depend on many factors, including the care setting. IMPLICATIONS FOR NURSING: Nurses must recognize the importance of spirituality to patients near the end of life. Assessment for specific spiritual needs can lead to the development of interventions to meet those needs. Meeting patients' spiritual needs can enhance their quality of life.

The Caring Connections Project: Providing palliative care to Medicaid patients with advanced cancer.

Palliative care, with its focus on symptom management, patient-centered goals, preparation for life's end, and preservation of quality of life in the face of advancing illness, is a rapidly advancing component of mainstream American medicine. Yet, access to palliative care is often lacking in the community setting and may be further hindered by the presence of healthcare disparities that impact the poor. This article presents a unique approach to assuring the availability of palliative care to Medicaid patients receiving case management services. This descriptive article describes the evolution of a palliative care management pilot program, the Caring Connections Program, beginning with the initial planning and progressing through implementation and provision of services to 56 persons. "Lessons learned" are shared to enable other providers to develop similar programs with success. Patient profiles and intervention strategies are offered to illustrate the work accomplished.

A community partnership model for developing a Center for Cancer Nursing Education and Research.

This article describes a partnership model used to establish the Center for Cancer Nursing Education and Research at the University of Louisville (U of L) School of Nursing. The model was used to bring together area nursing education programs, institutions providing cancer nursing care, and related community groups. The need for the project was directly related to the high cancer morbidity and mortality in the community. The U of L's strategic agenda and strong commitment to cancer prevention and care provided a growth opportunity for the recognition of nurses' role in cancer care. Nurses are positioned to influence cancer care across the continuum from prevention to end of life, and building the capacity for cancer nursing is essential to building a system of cancer care. This article describes an innovative partnership model used to stimulate a community-wide focus on cancer nursing. The organizational structure, development of partner relationships, description of project activities, and outcomes are presented along with a discussion of the said model's benefits and potential for replication.

Development and testing of the spiritual needs inventory for patients near the end of life.

PURPOSE/OBJECTIVES: To develop and test an instrument to measure the spiritual needs of patients near the end of life. DESIGN: Instrumentation methodology. SETTING: One inpatient and five outpatient hospices. SAMPLE: 62 female and 38 male hospice patients with a mean age of 67 years; most were Caucasian, Protestant, and dying of cancer. METHODS: Items for the Spiritual Needs Inventory (SNI) were developed from a qualitative study of spiritual needs of dying patients. Data were analyzed for internal consistency using Cronbach's alpha and item-to-total correlations and for content and construct validity using factor analysis. MAIN RESEARCH VARIABLES: Spiritual needs and life satisfaction. FINDINGS: The total scale alpha of the 27-item SNI was 0.81. Item-to-total correlations ranged from 0.07-0.65, resulting in seven items being eliminated. A principal component factor analysis with a promax oblique rotation was used to estimate content and construct validity. A total of 17 items comprised the five-factor solution. Cronbach's alpha for the revised SNI was 0.85. CONCLUSIONS: The SNI is a valid and reliable measurement of spiritual needs of patients near the end of life. Further psychometric testing of this newly developed instrument is warranted. IMPLICATIONS FOR NURSING: Nurses must recognize the spiritual needs of all patients, particularly those near the end of life. The SNI may be useful in the clinical setting as well as in future studies of spiritual needs of patients.

Kentucky's palliative care report card.

Last Acts released the first nationwide evaluation of palliative care services in November 2002. Each state was evaluated or "graded" on the following eight measures: advance care planning policies, location of death, hospice use, hospital end-of-life care services, care in ICUs at the end of life, pain among nursing home residents, state pain policies, and palliative care certified physicians and nurses. Kentucky scored well on state pain policies and number of nurses certified in palliative care but received low grades for hospital services and the number of patient deaths occurring in the home. This manuscript explores Kentucky's deficiencies and accomplishments related to the Last Acts evaluation and addresses opportunities for improving end-of-life care across the Commonwealth.