Running head: CANCER CARE

How does Nurses Culture Impact on their Interaction with Patients in Cancer Care and

Recovery?

[Name of the Writer]

[Name of the Institution]

[Date]
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Table of Contents

Introduction......................................................................................................................................3

The Purpose, Aim, and Review Questions......................................................................................8

Methodology....................................................................................................................................9

Results............................................................................................................................................11

Critical Appraisal-Quality.............................................................................................................13

Conclusion.....................................................................................................................................15

References......................................................................................................................................17

Appendix 1.....................................................................................................................................20

Appendix 2.....................................................................................................................................24

Appendix 3.....................................................................................................................................26
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Introduction

The largest group of patients in palliative care consists of cancer patients. According to

forecasts, the number of cancer patients in the UK will increase and by 2020 the number of

cancer patients will be 37,000 annually, compared to 40,000 by 2025 (Gaudet, 2016). On the

other hand, cancer treatment outcomes have also improved in recent years and more and more

patients have after a year alive. The need for palliative care in Europe is estimated to increase by

20% over the next 10-15 years (including non-cancer patients). About two out of three cancer

patients need palliative care in the last months of their lives and one in three in the last weeks of

life need convalescent care. In the spring of 2010, the working group of the HUCH hospital area

investigated the path of hospice care in the Helsinki metropolitan area between primary health

care and special medical care. The working group's report found that the hospice path was

unstructured, that there was a great deal of variation in the level of expertise, and that there was a

lack of co-operation between the various units (Newell and Jordan, 2015). As the number of

cancer patients increases, the number of patients in need of palliative care will also increase and

the need for high-quality palliative care expertise will increase. A large proportion of patients in

need of palliative care are treated in primary health care, for example in health care wards, long-

term hospitals, nursing homes, and home care. Palliative care is also provided in specialist acute

care hospitals.

Therefore, there is a great need for expertise in palliative care in primary and specialist

care. As a nursing expert, a nurse is required to have ethical competence, health promotion

competence, clinical nursing competence, pharmacotherapy competence, decision-making

competence, teaching and supervision competence, co-operation competence, theoretical

competence, nursing research and development competence as well as management, social

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competence and multicultural nursing competence (Watts et al., 2018). In the future, the

implementation of good and effective palliative care requires uniform knowledge from nursing

staff about the care of a palliative patient and clear working methods for the development of

competence. To be able to assess and develop the palliative care competence of a cancer patient,

it is necessary to understand what is meant by the nurse's competence in the care of a palliative

cancer patient and what aspects belong to the care of a palliative cancer patient.

The quality of the relationship between the professional and the relative also has an

impact on the success of the treatment. With illness, the patient needs support to manage stress

and adapt. With relatives usually amid a crisis themselves, more distant relationships, such as

friends, acquaintances, or other patients, have been found to help the patient most effectively.

From the patient's point of view, involving relatives in nursing work is important, because the

support of relatives has been found to help the patient adapt to the situation and commit to

caring. Ownership support has also been found to have a positive effect on negative situations

and experiences (Granger et al., 2016). Other benefits studied include; the feeling of loneliness

decreases, self-esteem rises and the feeling of hope strengthens. It is important for patients that

relatives listen and talk to them, visit the hospital, and be present. Sharing information about a

patient's illness and treatment with relatives is also important for many patients. Sometimes,

however, patients want to keep their lives and daily lives as normal as possible, so that there is

no discussion about illness and the future. From the patient's point of view, concrete help may be

welcome. Concrete assistance may include, for example, feeding and watering the patient,

transporting to a hospital, assisting with washing and other medical procedures, bringing

food/drink/magazines, or assisting in financial matters, according to the patient's preferences and

wishes (Vinckx, Bossuyt, and Dierckx de Casterlé, 2018).

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When there is no treatment to cure or inhibit the progression of cancer, or it is otherwise

against the patient's interest to continue the treatment, it is decided to switch to palliative care.

Palliative care for cancer aims to relieve symptoms and improve the quality of life. A patient in

palliative care often suffers from fatigue, depression, anxiety, pain, dyspnea, nausea, anorexia,

and intestinal symptoms. In palliative care, the alleviation of mental symptoms is as essential as

the alleviation of physical symptoms. One in three cancer patients suffers from pain in the early

stages of the disease and as the disease progresses, up to two out of three patients suffer from

pain. There are many causes of pain, but in general, in cancer patients, the pain is due to either a

tumor or cancer treatments. The tumor can cause pain, for example, by pressing on a nerve or

pain-sensitive tissues around it, causing inflammation and swelling, or secreting chemical

substances that activate pain. Pain is treated using a WHO-defined staircase to choose treatment

(Groß et al., 2014). Paracetamol, an anti-inflammatory drug for tissue damage pain, is used for

mild pain. Opioids are used for severe as well as severe cancer pain, which has been estimated to

be effective for cancer pain. A combination of NSAIDs or paracetamol with opioids can help

relieve pain. Radiation therapy has been found to have a long-term (3-6 months) effect on

relieving pain. Radiation therapy can even take the cancer pains away completely and in some

cases even partially.

In palliative care, two-thirds of patients in late-life suffer from nausea and one-third from

vomiting. Nausea should be treated according to its cause and, also, the anti-nausea medication

should be used. Possible causes of nausea include gastric ulcer, infection, severe pain,

constipation, cough, chemotherapy and radiation therapy, medications, copious ascites, and

anxiety. Cancer patients most often suffer from nausea caused by cancer treatments and

medications. Meal-related nausea can be anticipated by taking an anti-nausea drug half an hour
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before a meal. Most cancer patients experience anorexia, which in turn impairs the patient's

nutritional status and thus impairs their quality of life at a stage when cancer has not yet

progressed to the convalescent stage. Cancer itself increases the need for energy, and combining

the patient's anorexia, nausea, or pain when eating it causes a nutritional deficit. In the late

stages, nutritional treatment of cancer is not seen to play a significant role in terms of quality of

life or life expectancy. Constipation is also a common symptom that occurs in about every other

patient in palliative care. Especially 80% of patients using opiates suffer from constipation (Udo,

Danielson, and Melin-Johansson, 2013). The purpose of laxatives is to prevent and treat the

problem. Diarrhea is a rare symptom in palliative care, but in cancer patients, it can be caused by

cancer treatments. In the final stages, nutritional cancer treatment is not seen to play a significant

role in terms of quality of life or life expectancy. Constipation is also a common symptom that

occurs in about every other patient in palliative care. Especially 80% of patients using opiates

suffer from constipation. The purpose of laxatives is to prevent and treat the problem. Diarrhea is

a rare symptom in palliative care, but in cancer patients, it can be caused by cancer treatments. In

the final stages, nutritional cancer treatment is not seen to play a significant role in terms of

quality of life or life expectancy. Constipation is also a common symptom that occurs in about

every other patient in palliative care. Especially 80% of patients using opiates suffer from

constipation. The purpose of laxatives is to prevent and treat the problem. Diarrhea is a rare

symptom in palliative care, but in cancer patients, it can be caused by cancer treatments.

Diarrhea is a rare symptom in palliative care, but in cancer patients, it can be caused by cancer

treatments. Diarrhea is a rare symptom in palliative care, but in cancer patients, it can be caused

by cancer treatments (Esplen et al., 2020).

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Treatment of mental symptoms is part of palliative care. The treatment of somatic and

mental symptoms go hand in hand and interact with the overall treatment. When somatic

symptoms are uncontrollable, functional capacity, and alertness decrease. This affects the quality

of life. Channeling energy and interest in positive things can then be almost impossible, as a

result of which it has an impact on mental well-being. The treatment of somatic symptoms plays

an important role in the mental well-being of palliative care in cancer patients. A serious illness

requires the ability to adapt to the situation and causes mental symptoms for about a third.

Mental symptoms most often manifest as depression, anxiety, and sleep disorders (Morgan et al.,

2018). In palliative care, professionals are required to have good interaction skills, patient

guidance, and listening skills to support the patient's mental balance in the best possible way and

to prevent mental illness. It is the responsibility of the caregiver to listen to the patient, support

them, and delve into the individual situation in the discussions. For some patients, it may be

necessary to start antidepressants.

The patients had not obtained information about cancer or its treatments on their initiative.

While in the hospital, they felt they had received enough information, but were unable to absorb

everything. Younger patients wanted more information than older ones. Postoperative

radiotherapy was known, but not the number of treatments. There was also some ambiguity

about the side effects caused by radiotherapy. The "cancer team" was also established, the

purpose of which was to develop cancer patient guidance across organizational boundaries (Yari

et al., 2019). Initially, the team looked at cancer patient guidance, problems, development needs,

and outlined the treatment path. Proper timing of guidance was perceived as problematic, as was

a lack of guidance material and caregivers 'limited knowledge of cancer treatments. The flow of

information between the various units also had its problem, which was to provide a concrete tool
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to improve the flow of information on guidance between primary health care and specialist care.

The teamwork resulted in a common cancer patient operating model for primary health care and

specialist care, and a patient guidance booklet to help with guidance, which has also been

implemented in electronic form (Flodgren et al., 2015).

The benefits of the project were that through guidance, the patient's readiness for self-

care develops and the patient is thus able to act as an expert in his or her illness. Uniform, well-

implemented patient guidance enhances the patient's right to self-determination and, when the

patient allows, also allows the relative to participate in his or her care. A common treatment

model on the side of primary health care and specialist care ensures the implementation of an

uninterrupted treatment process. Good, high-quality, and uniform patient guidance at different

stages of the care path saves caregivers time and eliminates unnecessary contact with patients.

The organization between primary and specialist care is facilitated. However, the individual

needs of patients require the nurse to develop interactional skills, a method of guidance, and

knowledge of cancer and its treatment. Through patient guidance, it is easier for the patient to

learn to take care of themselves and to act correctly when faced with problem situations, through

which the need for hospital care is reduced and thus also lowers the cost of cancer treatment

(Merchant, O'Connor, and Halkett, 2017).

The Purpose, Aim, and Review Questions

The purpose of the thesis is to describe, using a literature review, what current

international research data tells us about the kind of expertise required of a nurse in the palliative

care of a cancer patient and what kind of research has been done on the topic in the past. The aim

is to produce information that can be used to develop nurses 'skills in palliative care for cancer
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patients, for example by increasing nurses' knowledge of palliative care in cancer patients and to

develop basic and in-service training for nurses. The aim is also to demonstrate the need for

further research related to the topic.

1. What kind of research has been done on the palliative care expertise of a cancer

patient?

2. What does the nurse's competence in palliative care of a cancer patient include?

Methodology

Using the method of previous research data is compiled, structured, and described, in

which case the purpose is to describe the phenomenon under study and its key concepts. The aim

is to produce a qualitative description in response to a research question. Typical features of the

method are the lack of precise rules, looser research questions, and extensive research material.

The systematic method collects existing information from research on a selected topic, as well as

evaluates the quality of the information, and comprehensively combines the results. The progress

of the review is guided by precise pre-determined research steps. It is a method by which new

research needs may arise or it may prevent the initiation of unnecessary research (Riechelmann

and Girardi, 2016).

The studies of the literature review have been collected using a systematic information

retrieval method. The material has been collected from the electronic databases Cihnal, PubMed,

Medline, and Medic. A few of the studies in the material have been found in the source list of

research articles. Based on the research questions, the selection and exclusion criteria for the

collection of data were defined (Appendix 1, Figure 1), which guided the selection of research

articles. During the searches of the material, most of the potential results were obtained from
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Cihnal. No UK-language studies were found. In general, there is very little research information

on the topic of the thesis (NCT03273140, 2017).

Most studies were omitted from the full text because the subject had not been studied

from the perspective of the nurse's competence. Several studies were also omitted because they

dealt with convalescent care rather than palliative care and thus did not answer the research

questions in the thesis. A few studies were omitted because they dealt with palliative care in

pediatric patients. Three more studies were found in the study source lists and two studies were

found by manual search based on the study names. A total of 13 English-language studies were

selected as data. The studies are international studies from around the world. Because they dealt

with palliative care in pediatric patients. Three more studies were found in the study source lists

and two studies were found by manual search based on the study names (L. et al., 2014). A total

of 13 English-language studies were selected as data. The studies are international studies from

around the world. Because they dealt with palliative care in pediatric patients. Three more

studies were found in the study source lists and two studies were found by manual search based

on the study names. A total of 13 English-language studies were selected as data. The studies are

international studies from around the world.

Content analysis is a method of analysis that can be used to systematically organize,

analyze, and describe research data. In inductive or i.e. conventional content analysis, the

material is broken into pieces, after which similar pieces are collected together and the data can

be formed into a clear whole. In this way, answers are obtained to the purpose and goal of the

research, i.e. the results of the analysis. The data collected in inductive content analysis is thus

described in a compact, more concise form. The analysis obtained from the whole reveals the

research results on pre-set research questions (Arab et al., 2020). In this work, the material was
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analyzed by inductive content analysis, which included four steps: compilation and reduction of

original expressions, a grouping of reductions into subcategories, and division of subcategories

into upper categories (Appendix 1, Figure 2).

In the first stage of the analysis, we search the study for original expressions relevant to

our research questions. The unrelated text was excluded. Selected phrases, expressions, and

opinions were reduced or condensed so that the relevant information remained visible.

Theoretical concepts were created from reductions (Appendix 1, Figure 3). In the next step, the

concepts formed from the reduced expression were compared with each other and the similarities

were grouped. The goal of clustering was to collect similar reductions under the same subclass

(Appendix 1, Figure 4). The subcategories were named to best describe the content. The

subcategories belonging to the same topic were grouped into their groups, for which descriptive

titles, i.e. super categories, were developed. Subcategories and upper classes describe the results

for the research questions (Culligan et al., 2017). Even the most important main themes, i.e.

sections, were derived from the upper categories to facilitate the perception of the results

(Appendix1, Figure 5).

Results

The publication times of the analyzed studies (n = 13) varied between 2005 and 2014, of

which nine had been published between 2010 and 2015. The study group consisted of the largest

number of American studies (n = 7), of which four were American and three Canadian. The rest

were European (n = 3), Asian (n = 2) and Oceania (n = 1). Both quantitative and qualitative

research methods had been used in the studies. In the largest, some of the studies had examined

only the nurse's perspective (n = 12) and one study had examined both the nurse's and the
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patient's perspective (n = 1). The full analytical framework for the study results can be found in

Appendix 2. According to previous studies, the palliative care competence of a cancer patient

includes four main categories: competence in the treatment of physical symptoms (Figure 4),

support for mental well-being (Figure 5), patient-centered guidance competence (Figure 6) and

work community skills, and ethical competence (Figure 9). Competence in the treatment of

physical symptoms in the palliative care of a cancer patient includes two upper classes:

competence in the treatment of pain and competence in the treatment of other physical symptoms

(Figure 6).

Pain management expertise includes four subcategories (Figure 6). Pain relief was

mentioned as an important part of the nurse's competence in almost every study selected for the

review. Pain management was highlighted in the data as one of the most significant parts of the

nurse's palliative competence in a cancer patient. Comprehensive pain management primarily

involves the identification and assessment of pain (J. et al., 2015). Things to assess about pain

include the quality of the pain, the duration of the pain, the location of the pain, the intensity of

the pain, and the factors that increase or alleviate the pain. The nurse must also have the

sensitivity to assess pain from a patient who is unable to communicate. Speaking up and

discussing pain helps to understand the pain and is thus an important part of pain management

skills. Thus, the nurse must be able to assess the pain of nonverbal and verbal communication.

The nurse should be aware of the different pain management methods available, which include

both pharmacological and non-pharmacological pain management methods. Strong painkillers

are always associated with the risk of side effects, the identification, and knowledge of which is

part of the nurse's competence (Jackson et al., 2014).

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In summary of the research, it concludes that between the ages, independent information

retrieval has become easier since the Internet. Both studies revealed that the timing of guidance

is difficult, the patient does not absorb all the information at once, the younger and older people

have different needs for the amount of information, and the caregiver's inexperience or limited

knowledge of the issue affects the quality of guidance. The thing that still needs to be developed

is the flow of information between primary health care and specialist care about the instructions

given, and as a good example, we would recommend an electronic guidance booklet to see what

information the patient has received, what information he wanted and whether the given

guidance was sufficient.

Critical Appraisal-Quality

There are two upper classes of support for mental well-being: treatment of mental

symptoms and emotional support (Figure 7). Competence in the treatment of mental symptoms

consists of four subcategories (Figure 7). Imminent death and incurable disease increase the risk

of depression in the patient and his relatives. Unspecified stress is also common in palliative

patients and their relatives. Psychological care is part of palliative care. In a study published by

Little et al. In 2005, the main results were the nurse's ability to deal with a depressed person,

addressing depression, and discussing depression as part of palliative care skills. Assessing

depression, for example, using metrics developed to assess depression, was seen as important to

enable the nurse to assess whether a patient's condition requires consultation with a psychiatrist.

Other skills related to psychiatric care skills include relieving restlessness and anxiety, relieving

stress, and early detection of delirium. Emotional support falls into four subcategories (Figure 7).

Supporting the patient's mental well-being is built on a good care relationship (Wanchai, 2012).

A study published by Cameron and Watherworth in 2014 highlighted the importance of a good
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care relationship for a patient's mental well-being in palliative care from a patient perspective. A

good care relationship included e.g. a positive approach, creating a good atmosphere, responding

to the patient's needs, and calling the patient by their name.

In several studies, patient support was considered an important part of palliative patient

care and nurse expertise. In each study, mental support or mental care in one way or another as

part of palliative nursing. Supporting can be a consolation, listening, and the nurse making the

patient easily achievable. Spiritual support was also often highlighted alongside improving the

quality of life and alleviating (mental) suffering. As death approaches, it is natural for the patient

to seek to deal with the life he has lived and to understand his future death. Therefore, the

discussion of death and death is part of a nurse's palliative nursing skills. It is also the most

important means of alleviating a patient's fear of death. Discussing death may also be necessary

with the patient's relatives so that they can deal with impending death. It may also be necessary

to discuss the course of the disease, grief and loss, and the treatment of the rest of the life with

the patient and relatives (Deye, N., Vincent, F., Michel, P., Ehrmann, S., Da Silva, D. et al.,

2015).

There are three upper classes of patient-centered counseling expertise: patient-centered

action, support for relatives, and patient and family guidance (Figure 8). Patient-driven activities

fall into three subcategories (Figure 8). Patient orientation is an important value in all nursing

work, and its importance in palliative nursing work is even more emphasized. Many of the

studies selected for the data mentioned taking the patient’s individuality into account as part of

the nurse’s palliative care expertise. Consideration of individuality is the listening and

appreciative treatment of the patient’s wishes and feelings. Patient orientation is the focus on the

individual needs of the patient. Consideration of the patient's individual spiritual needs is also
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part of nursing work aimed at holistic care in palliative care. Palliative care should be culturally

sensitive, i.e. nursing is adapted to the patient's spiritual characteristics such as religion or

culture. The progression of illness and the approach to death individually affect the patient's

ability to function. The nurse's competence includes being able to assess the patient's functional

capacity and support the patient's independence for as long as possible. The upper class of

support for relatives consisted of four subclasses (Figure 8). In palliative care, the patient's

relatives are often closely present throughout the treatment process (Meyer, 2016). In a way,

relatives are part of the object of treatment, as they also have needs for emotional support and

adequate information. Palliative care is family-centered and values the perspectives of the patient

and their family. Supporting the patient's relatives is part of palliative care and through it part of

a nurse’s palliative nursing skills. In addition to caring for the patient, the nurse must be able to

provide relatives with the information and support they need. Sometimes there may be conflicts

between the patient and relatives in care-related decision-making, in which case the nurse must

be able to subtly act as the patient's lawyer, supporting will and at the same time helping to

maintain family dynamics between needs and family wishes (Maree and Fitch, 2019).

Conclusion

In recent years, the adequacy of patients' access to information has been studied in

nursing, and the lack of information is one of the most significant factors causing patient

dissatisfaction in nursing. The results of this study are consistent in that the nurse's competence

includes bringing his or her expertise to the use of both the patient and relatives. In the results,

the nurse's competence includes guidance, such as providing information on treatments, illness,

available services and medicines, and their side effects. The more the patient is aware of the
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opportunities available, the better he or she will be able to participate in their treatment.

Palliative care for a cancer patient brings together experts from different professions to work

together to provide the best possible palliative care for the patient. In many studies,

interprofessionalism was incorporated into the nurse's expertise. Multidisciplinary included not

only teamwork skills across professional boundaries, but also securing the flow of information

from one professional group to another and from one unit providing care to another, and

supporting the continuity of care, which is also related to a smooth flow of information.

The ethical treatment of expertise in studies of a nurse's cancer patient's palliative care

competence was considerably less than might have been expected based on the knowledge base.

Only a few studies of the material dealt with ethical competence, and even in them, the definition

of ethical competence was one-sided. However, ethical issues and ethical decision-making are

significantly present in palliative care, which is why it is unfortunate that the discussion of ethics

in this material was so limited. There is thus a need for research into the nurse's ethical

competence in the palliative care of cancer patients. Cancer itself causes physical symptoms,

such as tumor pain or nausea from cancer treatments and medications. However, certain key

features of palliative care are the same regardless of the disease, such as relief of physical

symptoms or mental support. Cancer patients need to consider the effects of cancer on the mind

and body, as well as the specifics of cancer treatment. Palliative care itself has been studied more

abroad, but palliative care for cancer patients, in particular, has not been studied

comprehensively enough. The nurse's holistic competence in the palliative care of a cancer

patient has also been little studied.

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Appendix 1

Selection Criteria Exclusion Criteria

 Scientific articles and publications  The study was published before 2000

 In English  Language other than English

 Published in 2000 or later  Full text not available

 The research answers the research  Studies that address the expertise of a

 questions health care professional other than a

nurse

 The study addresses palliative care in  The survey does not answer the

adult cancer patients research questions

 Full text available 

Figure 1. Selection and Exclusion Criteria

Original Reduction Lower class Upper class

4
1

expression The collected The similarities Similarities

original and repeated are sought in
Collect key expressions the lower
expressions reductions are
are reduced. classes, upper
related to Look for grouped into classes are
the topic, similarities in their own created for
tabulate reductions. entities, them.
them. subcategories are
created .

Figure 2. Progress of Inductive Content Analysis

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Provide
"Provide
effective
effective care Relieving Treating
treatment to
to alleviate shortness of shortness of
relieve
dyspnea in a breath breath
shortness of
PC patient"
breath

Figure 3. Example of Reduction and Conceptualization of the Original Expression

Pain-killers Evaluation of
orthodox the efficacy of
giving analgesics

knowledge of
Pain relief by
(medical) pain
medical
Medicinal management
methods mastery of methods
pain
management
methods

Figure 4. Example of Clustering

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Identifying the patient's physical needs

- Mastering pharmacological pain
Treatment of nausea
management methods
Treatment of constipation
- Drug-free
Treating fatigue
- mastery of pain management methods
Treatment of oral problems
- Pain assessment
Treating shortness of breath

Competence in the
Pain management
treatment of other physical
competence symptoms

Treatment of
physical symptoms

Figure 5. Example of the Division of Subcategories into Upper Classes and the Attachment of

Upper Classes to the Main Category

Mastery of pharmacological pain management

Pain methods
Identification of side effects of analgesics
management Mastering non-drug pain management
methods
skills Pain assessment

Competence in dentifying the patient's physical needs

Treatment of nausea
the treatment of Treatment of constipation
Treating fatigue
other physical Treatment of oral problems
symptoms Treating shortness of breath

Figure 6. Clinical Competence of Physical Symptoms in Palliative Care Of a Cancer Patient

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Identifying, evaluating, and understanding the

Treatment of psychological effects of illness
mental Identifying and assessing depression
symptoms Encountering a depressed patient
Helping patient and family stress management

Discussing death and the rest of life

Emotional Understanding and supporting spiritual needs
support Facilitating mental suffering
Building a good caring relationship

Figure 7. Supporting Mental Well-Being in Palliative Care Of a Cancer Patient

Patient- Considering the individuality of the patient

oriented
Coordinating the patient's culture and religion with nursing
Perception of the patient's spiritual needs
Supporting the patient's ability to function and act independent
activities

Supporting Enabling participation in family care

Taking care of and supporting the family
Supporting family dynamics
relatives Assistance in situations of conflict between the patient and the family

Answering patient and family questions

Patient and Providing expertise for the use of the patient and relatives
Assessing the need for information for the patient and relatives

family guidance Providing information and information on medicines, illness and treatment
Assisting the patient in decision making

Figure 8. Patient-Oriented Guidance in Palliative Care Of a Cancer Patient

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Wheter helping patients to consider

treatment options, responding to patients'
queries about Symptom management, or
offering information to allay anxiety, nurses
emphasize that being knowledgeable is an
important responsibility"
(Pavlish et al. 2009)
"Well if I liked to know anything I would ask the
girls in the Oncology and they were switched on,
they were excellent, and if they didn't know the
answer they would go and find it, no they were
brilliant."
- Patient (Cameron et al. 2014)

Figure 9. Direct Quotes from Studies on the Importance of Informing the Patient
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Appendix 2

Database and keywords All results Deleted Deleted Deleted all Accepted

on the road abstract text tin

on the road basic

on the road

CINAHL

palliative care (AND) onco- 219 196 10 11 Oncology nurses'

Logic Nursing Perceptions of nurs-

ing roles and profes-

sional attributes in

palliative care.

Oncology Nurses'

Personal Under-

standings About

Palliative Care.

palliativecare (AND) 23 13 5 5 0

knowledge (AND) Oncology

palliative care (AND) compe- 8 5 0 2 Palliative care

tence (AND) Oncology knowledge, attitudes

and perceived self-

competence of

nurses working in Vi-

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etnam.

knowledge (AND) palliative 11 5 2 3 Iranian nurses'

care (AND) Nursing cancer perceptions of

palliative care for

patients with

cancer pain.

cancer Nursing (AND) onco- 328 309 16 3 0

Logic Nursing
Appendix 3

Author (s), year, Research article Method Material Key results

country, name

where the study was

conducted

Cameron, Jenny - Patients' experi- ences Theme interview, The data included 10 Three main themes emerged from the results:

Waterworth, Susan. of ongoing palliative individual interview outpatients who had the importance of human relationships, a

chemother- apy for received positive attitude and enjoyment of life. The

2014, New Zealand metastatic colorectal chemotherapy as part importance of relationships with health

cancer: a qualitative of palliative care for professionals and a sense of companionship

study. more than 12 months. with other chemotherapy patients had a

positive effect on patients' experiences of

treatment. Positivity was a coping strategy

that also had negative effects, with patients

not being able to expose

their concerns and needs.

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Author (s), year, Research article Method Material Key results

country, name

where the study was

conducted

Nguyen, Ly Thuy - Palliative care Form interview, The sample of the The nurses' knowledge and perceived skills in

Yates, Patsy - Os- knowledge, attitudes cross-sectional study study was 251 nurses symptom management, as well as

Borne, Yvonne. and perceived self- who treated cancer psychological and mental aspects, were poor.

competence of nurses patients in three Talking about death and creating a

2014, Vietnam working in Vietnam. cancer hospitals in therapeutic relationship with the patient was

Vietnam. Nurses were felt uncomfortable.

interviewed

forms.
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Seyedfatemi, Naimeh Iranian nurses' Theme interview The sample of the The results revealed two main categories,

- Borimnejad, Leili - perceptions of study was 15 nurses which included both two subcategories.

Mardani Hamooleh, palliative care for working in three Coping with physical pain: the importance of

Marjan - Tahmasebi, patients with cancer Iranian teaching communication and medical pain relief.

Mamak. pain. hospitals. Psychological empowerment: supportive

behavior and stress reduction.

2014, Iran

Author (s), year, Research article Method Material Key results

country, name

where the study was

conducted

Daines, Patricia - Nurses' experiences Theme interview Fifty nurses The study highlighted eight general

Stilos, Kalli - Moura, caring for patients participated in the perspectives related to palliative care based

Shari - Fitch, Margaret and families dealing study, most of whom on caregivers' experiences. They included

- McAndrew, Alison - with malignant bowel had years of work perspectives on patient and family stress and
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Ashlinder, Gill - obstruction. experience in caring the caregiver-patient relationship in

Wright, Frances. for 11 or more cancer alleviating suffering.

patients.

2013, Canada

Soden, Katie - Ali, How do nurses in Interview and 104 nurses responded Most caregivers wanted more training in

Simone - Alloway, specialist palliative questionnaire to the survey. cancer pain assessment. Although there were

Lara - Barclay, David care assess and developed on the inconsistencies in the use of the terms, the

- Barker, Stephanie - manage break- basis of its results. results showed that pain management proved

Bird, Lydia - Hall, through cancer pain? to be good.

Lesley - Perkins, Paul. A multicenter study.

2013, England

Author (s), year, Research article Method Material Key results

country, name

where the study was

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conducted

Slåtten, Kari - Clinical competence Questionnaire The sample of the Good nursing routines correlate with

Fagerström, Lisbeth - in palliative Nursing study was 235 former strengths in pain management, treatment of

Hat- levik, Ove in Norway: the im- nursing students, of nausea, treatment of oral problems, relief of

Edvard. portance of good care whom 122 responded anxiety, and treatment of exhaustion.

routines. to the survey However, these five areas were rated very

2010, Norway (response rate high in the areas of competence. Another

50.6%). important area was the identification of the

%). Clinical nursing lack of care and the time available for nursing

experts who had work.

completed an

advanced course in

palliative nursing in

Bergen or Oslo were

selected for the

sample.
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in college.

Desbiens, Jean- Development of the Theme interview 17 nurses participated Important areas of the nurse's expertise in

François - Fillion, Lise. Palliative Care Nurs- in the study. All were palliative nursing emerged in total

ing Self-competence women, aged 24-62 50. There were 10 upper categories under

2011, Canada scale. aged and palliative which these 50 are classified. The upper

categories were

Physical needs; pain, physical needs; other

2-28 years of symptoms, psychological needs, social needs,

experience in medical spiritual needs, functional needs, ethical

treatment. needs, sectoral co-operation and

communication, personal and professional

matters related to care and convalescent care.

Results included pain assessment, nausea

alleviation, oral treatment, depression

assessment

and identification of own resources.

Brazil, Kevin - Brink, Knowledge and per- Form interview 69 nurses responded The average percentage of nurses answered
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Peter - Kaasalain - en, ceived competence to the study. The correctly was 52.5%

Sharon - Kelly, Mary among nurses car- ing questionnaire - 63.41%. The study showed nurses ’lack of

Lou - McAiney, Carrie. for the dying in long- interviews assessed knowledge about palliative care, particularly

term care homes. the nursing staff's the treatment and management of pain in a

2012, Canada knowledge of dying patient.

palliative care and

measured the nursing

staff's confidence in

their ability to

produce palliative

care.