Nursing roles in cancer care are becoming increasingly autonomous and complex. In the Swedish setting, the role of contact nurses in cancer care (CNCC) exemplifies this movement and has been implemented and developed to enact person-centred care and improve quality. However, the scope and organisation of CNCC services vary across Sweden. The manner in which the implementation and development processes have unfolded within the governance and leadership structures of the cancer sphere is important to review in this regard, to effectively develop the role further. The aim of the study was to investigate stakeholders’ perceptions regarding what factors have impacted the implementation and development of the CNCC role in Swedish cancer care.A five-step concept mapping study was conducted, including preparation, generating ideas, structuring the ideas, concept mapping analysis and interpretation. Participants represented four stakeholder groups: local leadership and governance, regional and national leadership and governance, organised advocacy groups and academia. 83 persons completed the idea generation phase, 29 completed the sorting phase, and 25 persons participated in the interpretation phase.The concept map consists of 89 unique ideas in seven clusters labelled as follows: Understanding and delineation of the role, Variance in resource allocation and prioritisation, The importance of national governance, The importance of local governance, The legitimacy of nursing in the complex processes of cancer care, Motivation and support for competence development and Patients’ needs and position. Together, they depict how the negotiated nature of the implementation and development process on several structural levels has impacted the role. Role delineation difficulties emerged as a central topic. Leadership commitment and larger trends in nursing and healthcare also seem to have impacted the development and implementation of the CNCC role in Swedish cancer care. Insights from this study can inform the continued development of the role in Swedish settings and beyond.
Introduction Caregiver-led care of the indwelling pleural catheter (IPC) has been associated with higher rates of infection compared with nurse-led care, potentially due to breaches in aseptic technique while accessing the drain. Increased infection rates can lead to increased healthcare utilisation. In our centre, patients are reliant on caregivers to care for the IPC after discharge. We observed higher rates of IPC-related infection (22.7%) than reported in the literature despite strict adherence to surgical scrub and sterile protocol. We conducted a quality improvement (QI) project consisting of the introduction of standardised nurse-led IPC education, combined with community nursing support, with the aim of reducing both infection rates and healthcare utilisation.Methods A multidisciplinary team was convened to identify the driving factors for IPC-related complications. Following their recommendations, the QI approach comprised two sequential Plan-Do-Study-Act (PDSA) cycles. PDSA cycle 1 consisted of standardising the trainer performing the IPC training for caregivers. PDSA cycle 2 consisted of standardising the training of community nurses in IPC care for them to carry out both home visits and provide phone calls to patients. 50 patients with IPC were analysed, with 22 in the pre-intervention cohort and 28 in the post-intervention cohort. Outcomes were assessed using a pre/post-comparison, assessing IPC-related all-cause infection, empyema rates, healthcare utilisation and cost-effectiveness.Results The bundled intervention resulted in clinically important reductions in both all-cause infections (7.1% vs 22.7%) and empyema (3.6% vs 22.7%) and a statistically significant reduction in IPC-related readmission length of stay. Cost-effectiveness analysis revealed that the costs of the intervention were largely offset by the savings from reduced IPC-related empyema-related readmissions.Conclusion In cohorts with high IPC-related infection rates, standardised nurse-led IPC education combined with on-demand community nursing support was associated with lower rates of IPC-related empyema and shorter total readmission length of stay.
Background Systematic screening for bothersome urinary incontinence (UI) is underused in primary care settings, despite the high prevalence of UI and its negative impact on quality of life. Within one academic health system a quality improvement initiative was implemented within the electronic health record (EHR) to support screening for bothersome UI in adult women with a scheduled preventive visit. Understanding clinician perspectives around this workflow may lead to improvements in its acceptability to clinicians and use in routine care.Objective To summarise qualitative clinician feedback about this UI screening initiative.Methods We conducted interviews with participating primary care clinicians. Clinicians were eligible for participation if they spent the majority of their clinical time at a clinic that had adopted the UI screening interventions in the EHR for at least 3 months. The interview guide focused on the perceived impact, usability and challenges of the screening process and workflows. Interviews lasted approximately 30 min and were audio recorded and transcribed. Thematic analysis of transcripts was conducted.Results We interviewed 22 clinicians from 10 unique clinics. Qualitative feedback revealed that clinicians valued UI screening but experienced significant time pressure and competing priorities within a routine preventive patient encounter. Clinicians were comfortable discussing UI symptoms and diagnoses. In discussing UI treatment, clinicians expressed concerns about the side effects and costs of UI medications, highlighting a preference for referring patients to pelvic floor physical therapy and subspecialty care. Clinicians had neutral or positive attitudes towards the screening intervention and provided suggestions to improve the EHR alerts and order set.Conclusions Primary care clinicians we interviewed believe UI screening is important, and this screening intervention was acceptable and may improve patient care. Underlying structural constraints on primary care are barriers to this initiative and likely will be for other quality improvement initiatives.
Musculoskeletal (MSK) conditions are a leading cause of disability and work absence in the UK. Access to National Health Service (NHS) primary care remains a persistent challenge, driven by increasing patient demand, workforce constraints and inefficiencies embedded within traditional service pathways. In response, the growing need for timely and effective MSK management has accelerated the adoption of innovative digital solutions designed to transform service delivery, reduce waiting times and improve patient outcomes.The overall project aim was to enhance patient safety in a large Primary Care Network (PCN) by providing 24/7 access to digital triage alongside expanding patient choice by offering digital self-management at the point of access.During the 12-month evaluation, 822 patients completed digital triage, of whom 282 were offered, accepted and accessed digitally supported self-management using the app. Uptake was broadly representative of the wider PCN population and patient satisfaction was rated as good or very good using the Friends and Family Test. No safety concerns were identified in the available audit data.These findings suggest that digital triage and supported self-management were feasible and acceptable within a diverse and deprived primary care population, providing an additional option for accessing MSK care. Further research is required to establish the clinical and economic impact of these digital approaches.
