Implementation of symptom protocols for nurses providing telephone-based cancer symptom management: a comparative case study

Background: The pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) team developed 13 evidence-informed protocols for symptom management. Aim: To build an effective and sustainable approach for implementing the COSTaRS protocols for nurses providing telephone-based symptom support to cancer patients. Methods: A comparative case study was guided by the Knowledge to Action Framework. Three cases were created for three Canadian oncology programs that have nurses providing telephone support. Teams of researchers and knowledge users: (a) assessed barriers and facilitators influencing protocol use, (b) adapted protocols for local use, (c) intervened to address barriers, (d) monitored use, and (e) assessed barriers and facilitators influencing sustained use. Analysis was within and across cases. Results: At baseline, >85% nurses rated protocols positively but barriers were identified (64-80% needed training). Patients and families identified similar barriers and thought protocols would enhance consistency among nurses teaching self-management. Twenty-two COSTaRS workshops reached 85% to 97% of targeted nurses (N = 119). Nurses felt more confident with symptom management and using the COSTaRS protocols (p < .01). Protocol adaptations addressed barriers (e.g., health records approval, creating pocket versions, distributing with telephone messages). Chart audits revealed that protocols used were documented for 11% to 47% of patient calls. Sustained use requires organizational alignment and ongoing leadership support. Linking Evidence to Action: Protocol uptake was similar to trials that have evaluated tailored interventions to improve professional practice by overcoming identified barriers. Collaborating with knowledge users facilitated interpretation of findings, aided protocol adaptation, and supported implementation. Protocol implementation in nursing requires a tailored approach. A multifaceted intervention approach increased nurses' use of evidence-informed protocols during telephone calls with patients about symptoms. Training and other interventions improved nurses' confidence with using COSTaRS protocols and their uptake was evident in some documented telephone calls. Protocols could be adapted for use by patients and nurses globally.Dawn Stacey, Esther Green, Barbara Ballantyne, Joy Tarasuk, Myriam Skrutkowski, Meg Carley, Kim Chapman, Craig Kuziemsky, Erin Kolari, Brenda Sabo, Andréanne Saucier, Tara Shaw, Lucie Tardif, Tracy Truant, Greta G. Cummings, Doris Howel

Uncertainty in cancer survivors : physical factors, beliefs about control, and psychological well-being

Cancer represents a threat to health which leads long-term cancer survivors to appraise uncertainty about the outcome regularly. This descriptive correlational study examined the level and stress of uncertainty and related variables in a sample of 72 adult cancer survivors of eight to twelve years. The conceptual framework was based on Hilton's uncertainty stress model (1988, 1994) and Lazarus and Folkman's conceptualization of coping (1984). The objectives were to determine if there was a relationship between person factors and uncertainty and between uncertainty and psychological responses. Data included demographic and physical status, locus of control, uncertainty and stress, depression, psychological distress, and perceived control. The overall level of uncertainty was low, but it was positively associated with recurrence, depression, and illness worry. Results support uncertainty as a mediator between person factors and psychological responses. Nursing implications include periodic assessment of uncertainty long after diagnosis

Disgraced : A study of narrative identity in organizations that suffer crises of confidence

This thesis investigates the interface between external impressions of an organization, often referred to as its brand and image, and internal expressions, its culture and the identity of its employees, in organizations that have suffered crises of confidence. More specifically, the thesis seeks to problematize the alignment ideal in the corporate branding perspective (de Chernatony, 2001; Harris and de Chernatony, 2001; Hatch and Schultz, 2001 and Balmer and Sonen, 1999), which suggests that organizations should actively seek to realign external and internal impressions, in cases where they have become misaligned. The feasibility of such an agenda is explored by empirically investigating two organizations where the brand-culture alignment has broken – whether and how easy it is to repair or realign. More specifically this is explored by analysing the narrative representations of managers and employees in disgraced organizations; how they articulate their identity in relation to the organization they work for, their own role in the events that caused allegations of misconduct in the press, as well assubsequent managerial efforts to realign internal and external impressions of the organization. Tentative findings suggest that managerial efforts to realign internal and external impressions are likely to meet considerable obstacles. A key proposition I advance is that the corporate branding perspective underestimates the cultural complexities involved in restoring the damage to a publicly disgraced organization's image. These complexities stem in large part from the pluralistic and fragmentary nature of contemporary Western discourses on morality and social legitimacy. It is increasingly difficult to arrive at a shared agreement on what moral standards should be employed when judging the probity of a specific organizational practice. Such discursive pluralism causes substantial difficulties in addressing allegations of misconduct and attempting to realign diverging impressions of the organization, without risking to offend the sensibilities of other stakeholders. It also implies a ready availability of alternative discursive resources for employee identification. Pluralism may be seen as a key feature of our time, whose implications for the notion of public disgrace has arguably been overlooked in the organizational doctrine related to the corporate branding perspective. Moreover, these findings suggest an understanding of identity as a more deeply felt human need to maintain a consistent and morally intelligible representation of self, as compared to the dramatist perspective of Goffman (1978), which underpins the corporate branding perspective and implies an understanding of selfhood as front stage selves, something that people ultimately don't take too seriousl

Collateral pledgeability and asset manager portfolio choices during redemption waves

This paper studies whether Eurosystem collateral eligibility played a role in the portfolio choices of euro area asset managers during the “dash-for-cash” episode of 2020. We find that asset managers reduced their allocation to ECB-eligible corporate bonds, selling them in order to finance redemptions, while simultaneously increasing their cash holdings. These findings add nuance to previous studies of liquidity strains and price dislocations in the corporate bond market during the onset of the Covid-19 pandemic, indicating a greater willingness of dealers to increase their inventories of corporate bonds pledgeable with the ECB. Analysing the price impact of these portfolio choices, we also find evidence pointing to price pressure for both ECB-eligible and ineligible corporate bonds. Bonds that were held to a larger extent by investment funds in our sample experienced higher price pressure, although the impact was lower for ECB-eligible bonds. We also discuss broader implications for the related policy debate about how central banks could mitigate similar types of liquidity shocks

Intervention patterns of pivot nurses in oncology

The Pivot Nurse in Oncology (PNO) is a health care professional dedicated to providing patients with cancer and their families with continuing and consistent supportive care throughout the care trajectory. The purpose of this paper is to describe the variation and frequency of nursing interventions delivered by 12 PNOs at our health centre. An administrative analysis over a three-year period revealed a total of 43,906 interventions that were grouped into 10 categories. This analysis provided a description of the intervention frequency and these interventions were further collapsed into the four role functions of the PNO. Coordination/continuity of care and the assessment of needs and symptoms were identified as the dominant practice domains of the PNO in the professional cancer navigator role

Caractéristiques des interventions des infirmières pivots en oncologie

L’infirmière pivot en oncologie (IPO) est une professionnelle de la santé dont la mission est d’offrir aux patients atteints du cancer et à leurs familles, des soins de soutien pour répondre à leurs besoins tout au long de la trajectoire des soins. Cet article a pour but de décrire les variations et la fréquence des interventions infirmières offertes par 12 IPO de notre centre de santé. Une analyse adminis- trative couvrant une période de trois ans a permis de dénombrer 43 906 interventions au total qui ont été reparties dans 10 catégories. Cette analyse a abouti à une description de la fréquence des inter- ventions, et celles-ci ont été regroupées selon les quatre fonctions clés du rôle de l’IPO. La coordination/continuité des soins et l’évaluation des besoins et des symptômes ont été dégagées comme les domaines de pratique prédominants de l’IPO à l’intérieur de son rôle de navi- gateur professionnel en oncologie