Background: The importance of the clinical learning environment in nurse education has gained increasing attention over the last decades. However, there is a lack of research on the learning environment, its significance and meaning in specialist nurse education. Objective: The objectives of the study were to investigate specialised nursing students' experiences of supervision during clinical practice and to compare students who were satisfied with the supervision with those who were dissatisfied with respect to a)organisation of supervision and number of preceptors, as well as time allocated by preceptors for b)supervision, c)reflection, d)discussion of intended learning outcomes, and e)assessments of students' performance by preceptors. Design: This study used a cross-sectional design. Sample and settings: A convenience sample of specialised nursing students was derived from five Swedish universities in the years 2016 and 2017. Methods: Data were collected using a questionnaire. Statistical analyses and a qualitative conventional content analysis were performed. Results: While almost all specialised nursing students reported that there had been time for discussion on their performance assessment, almost half of the students reported not getting time for supervision, or time for reflections and discussions on intended learning outcomes with the preceptor. Students reporting having time allocated for supervision by preceptors were found to be more satisfied with supervision. It was described as important that the preceptor(s)acknowledged the students previous work experiences. Even though being a registered nurse, reflections and feedback were described as valuable for the students learning. Several preceptors were described as positive allowing a broader picture and different views regarding working as a specialist nurse. Conclusions: This study indicates that supervision, in terms of discussions and reflections, of specialised nursing students is significant for learning experiences and satisfaction during clinical placement.

BACKGROUND: Advances in research and technology coupled with an increased cancer incidence and prevalence have resulted in significant expansion of cancer nurse role, in order to meet the growing demands and expectations of people affected by cancer (PABC). Cancer nurses are also tasked with delivering an increasing number of complex interventions as a result of ongoing clinical trials in cancer research. However much of this innovation is undocumented, and we have little insight about the nature of novel interventions currently being designed or delivered by cancer nurses.

OBJECTIVES: To identify and synthesise the available evidence from clinical trials on interventions delivered or facilitated by cancer nurses.

DATA SOURCES AND REVIEW METHODS: A systematic review of randomised controlled trials (RCT), quasi-RCTs and controlled before and after studies (CBA) of cancer nursing interventions aimed at improving the experience and outcomes of PABC. Ten electronic databases (CENTRAL, MEDLINE, AMED, CINAHL, EMBASE, Epistemonikos, CDSR, DARE, HTA, WHO ICTRP) were searched between 01 January 2000 and 31 May 2016. No language restrictions were applied. Bibliographies of selected studies and relevant Cochrane reviews were also hand-searched. Interventions delivered by cancer nurses were classified according to the OMAHA System. Heat maps were used to highlight the volume of evidence available for different cancer groups, intervention types and stage of cancer care continuum.

RESULTS: The search identified 22,450 records; we screened 16,169 abstracts and considered 925 full papers, of which 214 studies (247,550 participants) were included in the evidence synthesis. The majority of studies were conducted in Europe (n = 79) and USA (n = 74). Interventions were delivered across the cancer continuum from prevention and risk reduction to survivorship, with the majority of interventions delivered during the treatment phase (n = 137). Most studies (131/214) had a teaching, guidance or counselling component. Cancer nurse interventions were targeted at primarily breast, prostate or multiple cancers. No studies were conducted in brain, sarcoma or other rare cancer types. The majority of the studies (n = 153) were nurse-led and delivered by specialist cancer nurses (n = 74) or advanced cancer nurses (n = 29), although the quality of reporting was poor.

CONCLUSIONS: To the best of our knowledge, this is the first review to synthesise evidence from intervention studies across the entire cancer spectrum. As such, this work provides new insights into the nature of the contribution that cancer nurses have made to evidence-based innovations, as well as highlighting areas in which cancer nursing trials can be developed in the future.

PROBLEM IDENTIFICATION: Symptom experience in patients with cancer consists of several dimensions, often measured descriptively within various populations but seldom used as intervention outcomes. This review aims at describing symptom dimensions as outcomes of interventions designed to alleviate symptoms in patients with cancer and to describe these interventions' effects on at least two symptom dimensions. LITERATURE SEARCH: The PRISMA statement for reporting systematic reviews was used. Searches were undertaken in various indexing sites. DATA EVALUATION: Extracted data included design, participants, intervention and control group treatment, targeted symptom dimension, and summary of results. SYNTHESIS: 2,041 articles were identified and 15 were included. The symptom dimensions were intensity, distress, prevalence, frequency, consequences, and quality. Eleven interventions had significant effect on symptom dimensions, mostly on intensity and distress. IMPLICATIONS FOR PRACTICE: Oncology nurses need clinical skills to be able to understand patients' experiences through their narratives. Various interventions are targeted at symptoms, and these need to be implemented to provide evidence-based symptom management.

Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of experti

Longitudinal studies exploring sexuality, body image and health-related quality of life (HRQoL) are lacking in patients treated with chemo- or chemoimmuno-therapy for hematologic malignancies. The aim was to describe and explore changes in sexuality, body image and HRQoL in patients treated for hematologic malignancies, from baseline until 6 months after treatment. Twenty patients above 45 years (median age 62) treated for DLBCL, CLL or AML participated. Data were collected at baseline, 1- and 6-months after treatment by means of three instruments: SAQ-S, BIS and EORTC QLQ-C30. The results showed that patients' sexuality was negatively affected 1 month after treatment, but after 6 months the patient reported scores had returned almost entirely to baseline scores. Body image was slight negatively affected after 1 month and after 6 months, 50 % reported that body image was not affected at all. Regarding HRQoL, patients reported gradually improved scores during the study period. Regression analysis showed that changes in sexuality and body image seemed to influence changes in HRQoL. This study has shown changes in sexuality, body image and HRQoL over time in patients above age 45 treated for hematologic malignancies. One month after treatment all three areas becomes negatively affected, and thereafter the patients' scores recovered to a great extent regarding these issues within 6 months. Sexuality and body image seem to be important aspects of HRQoL for these patients and need to be integrated in the cancer rehabilitation during and after treatment.

Säker och bättre vård vid livets slut – Erfarenheter av Liverpool Care Pathway i Arvika kommun

Bakgrund: Liverpool Care Pathway (LCP) är en standardvårdplan som syftar till att säkerställa en god vård vid livets slutskede oavsett vårdform. Genom bedömning av centrala behov och symtom, tydliga mål, samt utvärdering av given vård innebär LCP en struktur för att kvalitetssäkra vården. I en strävan efter en god vård i livets slut för alla har användningen av LCP blivit alltmer utbredd, men trots detta är den utvärderad i begränsad omfattning. Mot denna bakgrund, samt att LCP under de senaste åren ifrågasatts är det angeläget att studera effekter av LCP på kvaliteten av vården i livets slutskede.

Syfte: var att undersöka hur sjuksköterskor och omvårdnadspersonal i kommunal vård uppfattade att vården i livets slutskede påverkades efter införandet av LCP, samt vilken betydelse de anser att LCP fått för vården i livets slutskede.

Metod: Deskriptiv tvärsnittsstudie med kvantitativ ansats. Data samlades in mellan januari och juni 2014 med en studiespecifik enkät (50 frågor) med utgångspunkt i LCP. Tjugotvå sjuksköterskor och 120 omvårdnadspersonal (svarsfrekvens 63 %) verksamma på en korttidsavdelning, fem särskilda boende och inom fyra hemtjänstgrupper deltog. Icke parametrisk statistik användes för att testa skillnader inom- och mellan grupper.

Resultat: Både sjuksköterskor och omvårdnadspersonal ansåg att implementering av LCP inneburit att vårdens kvalitet i livet slut förbättrats. Omvårdnadspersonalen uppfattade att införandet av LCP innebar att patienterna erhöll bästa möjliga omvårdnad och medicinska vård i högre grad än sjuksköterskorna (p=.011). Att arbeta enligt LCP när patienten var döende innebar en vård som uppfattades både säker och av hög kvalitet av båda personalkategorierna. Vidare uppfattades LCP underlätta bedömning av patienternas symtom och behov, samt underlätta kommunikation och överföring av information mellan olika personalkategorier.

Slutsats: Att vårda patienter i livets slut i kommunal vård innebär en stor utmaning för både omvårdnadspersonal och sjuksköterskor. Genom att strukturera och systematisera vården vid livets slut med LCP säkerställs bedömning av patienters symtom och behov, bemötande av patienter och närstående samt kommunikation inom teamet. Parametrar som är betydelsefulla för en säker och god vård.

Background: Longitudinal studies examining sexuality, body image and health-related quality of life (HRQoL) in middle-aged and elderly patients treated with chemotherapy or chemoimmunotherapy for hematologic malignancies are lacking. The aim of this study was to describe and explore changes in sexuality, body image and HRQoL in patients treated

for hematologic malignancies, from baseline until twelve months after treatment.

Material and Methods: Patients above 45 years treated for Diffuse large B-cell Lymphoma (DLBCL), Chronic Lymphocytic Leukemia (CLL) or Acute Myeloid Leukemia (AML). Data were collected at baseline (n = 32), one (n = 25), six (n = 20) and 12 months (n = 19) after treatment by means of three instruments: The Sexual Adjustment Questionnaire (SAQ), The

Body Image Scale (BIS) and The European Organization for Research and Treatment of Cancer Quality of Life questionnaires (EORTC QLQ-C30, version 3). Descriptive- and non-parametric statistics were used.

Results: One month after treatment scores were lowered regarding sexual interest (P = 0.005), sexual function (P = 0.031), sexual satisfaction (P = 0.016, P = 0.004) and sexual relationship. After six months the patient reported scores had returned almost entirely to baseline scores, except for sexual relationship. At 12 months, sexual relationship was still negatively affected. Body image was reported to be affected in a low extent during

the study period. After six and 12 months, body image was reported to not be affected at all by 50% and 53%, respectively. However, women reported body-image to be more affected than men at one (P = 0.01) and 12 months (p = 0.021). Regarding HRQoL, patients reported gradually statistically significant improved scores during the study period.

Conclusion: In this study, sexuality, body image and HRQoL became negatively affected in patients with hematologic malignancies 45 years and older during treatment. Improvements were gradually seen after treatment, but the scores regarding sexual relationship were still affected after one year. Although sexual interest was reported to be low this finding highlights the need of support to these patients regarding sexuality during follow-up care. Furthermore, body image was more affected in women than in men indicating that interventions should be adjusted for sex. This was a small study and future studies with larger sample are needed.