Integrative oncology for palliative care nurses: pre-post training evaluation.

OBJECTIVES: Integrative oncology (IO) is increasingly being incorporated in supportive and palliative cancer care. This study examined an IO-palliative care training programme for nurses from community and hospital settings. METHODS: A 120-hour course, attended by 24 palliative care nurses without IO training, included precourse/postcourse questionnaires examining knowledge, attitudes and level of IO-palliative care skills. Qualitative analysis examined precourse and postcourse narratives. RESULTS: Most (18; 75%) completed study questionnaires, with knowledge and attitudes towards IO changing only modestly and IO-related skills significantly for guidance on herbal medicine and lifestyle changes, manual-movement and mind-body modalities. Greater consultation skills were reported for fatigue, stomatitis, nausea, appetite, constipation/diarrhoea, insomnia, peripheral neuropathy and hot flashes. Trainees reported improved skills for pain (p=0.003), emotional (p<0.001) and informal caregiver-related concerns (p<0.001), with no change in palliative care-related skills. Qualitative analysis found both personal and professional attitude changes, with enhanced mindfulness and an expressed intent to implement the learnt skills in daily practice. CONCLUSIONS: The IO-palliative care nurse training programme increased IO-related and palliative care-related consultation skills for a wide range of quality of life-related concerns. Further research is needed to explore both short-term and long-term effects and the implementation of the learnt skills in clinical practice. TRIAL REGISTRATION NUMBER: NCT03676153.

Knowing 'something is not right' is beyond intuition: development of a clinical algorithm to enhance surveillance and assist nurses to organise and communicate clinical findings.

AIMS AND OBJECTIVES: To develop a clinical algorithm to guide nurses' critical thinking through systematic surveillance, assessment, actions required and communication strategies. To achieve this, an international, multiphase project was initiated. BACKGROUND: Patients receive hospital care postoperatively because they require the skilled surveillance of nurses. Effective assessment of postoperative patients is essential for early detection of clinical deterioration and optimal care management. Despite the significant amount of time devoted to surveillance activities, there is lack of evidence that nurses use a consistent, systematic approach in surveillance, management and communication, potentially leading to less optimal outcomes. Several explanations for the lack of consistency have been suggested in the literature. DESIGN: Mixed methods approach. METHODS: Retrospective chart review; semi-structured interviews conducted with expert nurses (n = 10); algorithm development. RESULTS: Themes developed from the semi-structured interviews, including (1) complete, systematic assessment, (2) something is not right (3) validating with others, (4) influencing factors and (5) frustration with lack of response when communicating findings were used as the basis for development of the Surveillance Algorithm for Post-Surgical Patients. CONCLUSION: The algorithm proved beneficial based on limited use in clinical settings. Further work is needed to fully test it in education and practice. RELEVANCE TO CLINICAL PRACTICE: The Surveillance Algorithm for Post-Surgical Patients represents the approach of expert nurses, and serves to guide less expert nurses' observations, critical thinking, actions and communication. Based on this approach, the algorithm assists nurses to develop skills promoting early detection, intervention and communication in cases of patient deterioration.