In a recent article for the International Journal of Nursing Studies in which, after long deliberations, my colleague Professor David Richards and I, made the decision to discuss our thoughts about nursing by addressing what we regarded as the ‘elephant in the room’. We also took the decision to ‘call a spade a spade’ as we bluntly named the paper ‘Shitty Nursing’ – The new normal? At the end of the paper we encouraged readers of IJNS to reflect on our opinions and to engage in the debate at a Twitter account created specifically for this topic. My lecture will address the core of our published paper, share some of the interesting responses we got on Twitter (some of which caused me to close down my account), as well as describe comments from Danish and Norwegian colleagues. I will also try to reflect on how as nurses we ended up at these cross roads and how this is now strongly related to the newest nursing conviction - ‘fundamentals of care’.
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This lecture will summarise the rationale for the hypothesis that anaesthetic technique during cancer surgery of curative intent might potentially influence risk of recurrence. It will trace the development of this research question from the first retrospective analysis, through experimental research to a decade-long prospective, randomised, controlled clinical trial which was published recently. It will outline future directions in this field, including the emergence of a new clinical subspecialty of Onco-Anaesthesiology. Read less

Since the early 1990s the nature of treatment in health care has evolved rapidly. New treatment possibilities have arisen and the traditional treatments have been re-named in the light of current developments and improvements in medicine and technology. Reality is marked by a reduced amount of in-patient treatment and a rapid growth in treatments in facilities for short-term stay such as ambulatories, day care centers and out-patient clinics.
The practice of nursing must be adapted to the clinical context, and in today's health care, this increasingly means that nursing takes place in time-limited encounters. Knowledge of how to provide nursing in time-limited encounters is necessary for all nurses, because even hospitalized patients pathways will consist of a series of time-limited encounters with different health professionals.  
The focal point of the presentation will be the acceleration of time and the opportunities and challenges this presents in a hospital context? The focus will be on how it is possible to practice good nursing in a very short time? What good nursing really is? What does the nurse needs to know about the patient to be able to help him or her well and safely through the patient pathway, and how does the nurse achieve this knowledge about the patient?
The presentation points to very essential aspects of nursing care. And the go home message is to understand that a basic condition for the existence of a highly specialized nursing care is that it is based on a foundation of very fundamental aspects of nursing care. Read less

Case presentations

Live Surgery

OR1: Right-sided colon cancer surgery (CME with Intracorporeal Anastomosis and perfusion assessment)

OR2: Left-sided colon cancer surgery (CME with left flexure takedown)

OR3: Combined endoscopic laparoscopic technique for colon cancer or advanced adenoma

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The bedside handover of bedside shift report is a method in which the clinical handover between nurses is performed at the patient’s bedside, with participation of the patient. Although the method is not new, the interest in bedside handovers has drastically increased during the last decade. It is believed to improve patient participation, patient safety and nurses’ efficiency. However, rigorous research to prove these statements was, until recently, missing.
In a recent, and still ongoing mixed method study, 14 nursing wards in Flanders implemented the bedside shift report in order to explore its feasibility, appropriateness, meaningfulness and effectiveness of bedside handovers) as a specific method to increase patient participation on nursing wards. By use of systematic reviews (n=3), observations (n=1661), qualitative interviews before and after implementation (n=195), and quantitative questionnaires (n=954). By doing, the study tries to determine the added value of the bedside handover.
The study provides useful insight for the future use and implementation of bedside handovers as the new standard in nursing. The insights are translated into five practical statements for nursing practitioners and nursing managers to assist them in future implementation processes of the bedside handover. So far, the study concludes by stating that the bedside handover profiles itself as a suitable intervention, superior to the currently used methods for handover without patient participation, for those deliberately choosing for more patient participation and for those willing to make the organizational transition to more patient-centeredness.
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Background
Knowledge about patients’ perspectives on prehabilitation is sparse. A better understanding could contribute to patient-centred prehabilitation programmes that enhance functional capacity and are considered relevant by patients – with a view to improving adherence.
 Aim
To investigate cancer patients’ perspectives on a predefined, home-based, multimodal prehabilitation programme with particular attention to feasibility and acceptability.
 Patients and Methods
Fifteen patients with peritoneal carcinomatosis of colorectal or ovarian origin undergoing cytoreductive surgery, with or without hyperthermic intraperitoneal chemotherapy, participated in semi-structured interviews. Malterud’s principles of systematic text condensation were used to analyse the data.
 Results
Patients had a positive attitude towards home-based prehabilitation. Yet, they would not follow the programme unconditionally, and several barriers to adherence were identified:
Everyday life: Patients focused on maintaining their everyday lives.
Preferences: Patients prioritised enjoyable activities especially in relation to exercise and nutrition.
Restrictions: Smoking and alcohol cessation led to concerns, as the preoperative period was perceived as stressful enough as it was.
Lack of belief: Some patients did not believe that they could influence recovery themselves.
 Conclusion
The findings underscore the complexity of developing a home-based programme that not only enhance functional capacity, but are also experienced relevant to the patients. Furthermore, it demonstrates how patient involvement in research has the potential to change preconceptions and change research plans. Read less

Are we done nursing when the patient has been discharged? Or could we do more to secure a successful self-rehabilitation? 

We might think that we have done the perfect job when discharging our patients after a successful abdominal surgery. But how does the patient experience the discharge and how empowered do we leave the patient to self-rehabilitation? 

Science indicate that there is an increased risk of postoperative complications and problems in maintaining the functional status of this patient group, if we fail to empower the patient properly.

But what concerns and challenges is actually faced by the patient? And how could we as professionals reduce the risk of complications and increase the patient’s ability to complete a successful self-rehabilitation?

This session will explore this topic and shed light on three key areas to focus on, when creating the optimal circumstances for successful self-rehabilitation.
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Enhanced recovery (ERAS) was introduced in the mid-90's and since then repeatedly documented to improve postoperative outcome regarding length of stay and medical complications without increasing readmissions. Due to the complexity of postoperative recovery, several challenges remain to be solved including the surgical stress responses (inflammatory) where further research is required to reduce the “high-inflammatory” responders. Also, more procedure-specific research is required in pain management and with a focus on high-pain responders (pain catastrophizers, opioid users, etc.). Although most focus has been laid on length of stay, the important future challenges are to find the right balance between major outpatient vs. inpatient surgery regarding safety. Furthermore, to objectively assess post-discharge functional outcomes where new technology is available. Finally, a challenge exists about how to make progress, where the two extremes being big pragmatic RCT’s vs. minor detailed hypothesis-generating cohort studies.
In summary, ERAS has come to stay, but need further improvement, implementation, better procedure-specific evidence of ERAS components and improved study design of ERAS, all based on the concept of “first better – then faster”.
 

References:
Joshi GP, Alexander JC, Kehlet H. Large pragmatic randomised controlled trials in peri-operative decision making: are they really the gold standard? Anaesthesia 2018;73(7):799-803. 
Memtsoudis SG, Poeran J, Kehlet H. Enhanced Recovery After Surgery in the United States: From Evidence-Based Practice to Uncertain Science? JAMA 2019;321(11):1049-1050. 
Kehlet H. Enhanced postoperative recovery: good from afar, but far from good? Anaesthesia 2020;75 Suppl 1:e54-e61.
 
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Complete mesocolic excision is now considered the gold standard of surgery for right-sided UICC stage I−III colon cancer, but the evidence for left-sided cancers is more contradictive. Some issues regarding CME are still debated. This presentation will discuss these issues from a Danish perspective with a focus on right-sided complete mesocolic excision. How do we select patients for right-sided complete mesocolic excision? Is the risk of perioperative complications acceptable? Which improvements in long-term outcomes as risk of recurrence and overall survival can we expect? Is the risk of bowel dysfunction increased after complete mesocolic excision?
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The process of handing over care is one with a high potential for error. Standardization of the handover process is deemed necessary to ensure continuity and safety of care. However, the handover process is also influenced by cultural and environmental issues that are not measurable and easy to standardize. This local context is of equal importance to improve the handover process. 
To capture the local context we used an iterative three round evidence based consensus approach with a group of nurses representing the clinical departments of our hospital to develop a blueprint for nursing handover. This process resulted in consensus on a set of 18 recommendations on how, what and where to handover as well as a bedside-safety check. In a pilot implementation of the blueprint we observed a continued trend of improvement in handover quality. The nurses perceived the use of the handover blueprint as an improvement and refinement of the existing handover process. Especially the introduction of the bedside-safety-check at shift handover was highly appreciated.  
For complex processes such as the handover process, a stepwise iterative approach and involvement of local users in the development, implementation and evaluation is essential to ensure a successful implementation. 
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This presentation concentrates on the question: What happens when certain moments in-between nurse and patient lights up and invite us into shared experiences of human end ethical meaningfulness?
With a theoretical departure in philosophical aesthetics put forth by Dorthe Jørgensen, the presentation points to such moments as moments of server beauty. This presentation inquiry into moments of beauty in nursing by questioning, how it is possible to describe the being of nurses in such moments, from a phenomenological and ontological approach.
The empirical departure is a phenomenological action research project named:  ‘Moments of beauty in Nursing – a source of innovation’. The research was anchored in 3 hospital wards in Denmark and 15 nurses participated as co-inquirers.
Through phenomenological descriptions and reflections a concept of ‘shared sensitive presence’ rise. ‘Shared sensitive presence’ refers to situations, where nurse and patient both are under the impression from communal life phenomena, while the phenomenon unfold. For example, nurse and patient in togetherness sense and share mortality as a communal human ground and existential reality.
In this presentation, Sine Maria Herholdt-Lomholdt will describe, explore and discuss ‘shared sensitive presence’ as a phenomenon that seems to exist in nurse’s practice. The phenomenon will be clarified using Baumgartens concept: ‘sensitive recognition’ and through the lenses of Heidegger. The phenomenon of ‘Shared sensitive presence’ will also be contrasted to other ways of describing similar situations, as eg. Carl Rogers concept of ‘empathy’ and Jungs archetype ‘The wounded healer’.
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Interesting fields for research in the treatment of colon cancer for the future are organ preserving treatment of early cancers, precision (neo)adjuvant treatment in combination with segmental resection, and multimodality treatment of locally advanced disease.
The RCT is probably not the appropriate study design to test technical innovations (i.e. Dutch LIMERIC II study) or active surveillance protocols that might safely replace segmental colectomy in early cancers. For the purpose of further reducing the indication and amount of (neo)adjuvant systemic therapy in stage II-III colon cancer, RCTs might be designed, but testing of (panels of) biomarkers can be more efficiently performed in large cohorts. Prevention, early detection and treatment of peritoneal metastases is subject of RCTs in the Netherlands (COLOPEC I and II, CAIRO 6), but new effective intraperitoneal treatment modalities should first be explored in organoid and animal models, before re-introducing this into clinical studies. Read less