Journal of Pediatric Hematology-Oncology Nursing最新文献

Background: Canada represents half of the Children's Oncology Group (COG) sites that have opted to customize content for families within the COG KidsCare app. It was unclear how many sites proceeded with developing and inputting customized content and how well the app and customized content were implemented into practice. This raised concerns that Canadian families were unaware of this new digital resource and did not have equitable access to customized content. This qualitative study aimed to understand nursing site leads' experiences including perspectives on facilitators and barriers to customization and implementation of the COG's KidsCare app. Method: Semi-structured interviews with clinicians who self-reported expertise in patient and family education local practices were conducted. Transcripts were independently coded by two team members using an iterative hybrid inductive/deductive approach, and analyzed using the Consolidated Framework for Implementation Research (CFIR), to summarize results. Results: The facilitators and barriers to implementing the COG KidsCare app with customization were categorized by five overarching CFIR-related themes: (a) features of the customized COG KidsCare app, (b) external environment, (c) institutional environment, (d) implementation team, and (e) the process of implementing and customizing the COG KidsCare app. Discussion: Nurses expressed feelings of tension between support and perceived value of the COG KidsCare app with customization, and their ability to successfully create, refine, implement content and disseminate to families. Using our RoadMap of recommended implementation strategies to integrate use of the app into practice may provide opportunity for successful implementation in a variety of contexts.

Sepsis is a leading cause of morbidity, mortality, and healthcare utilization for children worldwide. Forty-nine percent of pediatric sepsis patients have an underlying condition rendering them more susceptible to infection. One in six severe sepsis patients has an underlying neoplastic disease and has a 30% higher risk of death compared to other severe sepsis patients. Consequently, focus on pediatric sepsis management is paramount. In a 42-bed pediatric hematology-oncology unit, a Sepsis Algorithm was implemented aimed to improve nurses' ability to recognize, manage, and treat suspected and early sepsis and septic shock over a 4-year period. This algorithm consisted of various elements including ongoing educational offerings, quality improvement methodologies, and sepsis prevention interventions. The sepsis workflow provided targeted care guidelines and aligned interventions previously proven to improve patient outcomes. Pre- and posttests were administered with each educational offering to monitor effectiveness. Nurses demonstrated higher levels of understanding of sepsis recognition and prevention efforts following educational activities. Consequently, a 10.7% Sepsis Algorithm compliance and a 24.7% antibiotic administration within 1 hr compliance improvement was realized. Utilization of the Sepsis Algorithm contributed to maintaining a mortality rate of zero related to sepsis and/or septic shock while patients were in the hematology-oncology unit. Bedside nurses' sepsis management knowledge improved. The Sepsis Algorithm implementation was successful and improved patient outcomes.

Background: Safe medication delivery is an essential component of medical care in the overnight summer camp setting, especially for children with cancer and medical complexity. Blister packaging of medications is a method that may improve safety in this setting. Method: In this quality improvement project, we implemented and evaluated a system of on-site blister packaging of medications with the goal of optimizing the safety and efficiency of medication delivery at a large overnight summer camp for children with cancer. Data for the number and types of medications delivered and medication errors were described in the summer sessions prior to and post this implementation. Quantitative and qualitative clinician feedback was collected. Results: In the summer of 2023, there were 551 campers, 342 (62%) of whom received at least one medication and with the number of medications per child ranging from 0 to 18. There were 70/551 (20%) of campers who received high-risk medications defined as oral antineoplastic therapy and controlled substances. The frequency of medication errors was very low across all summer sessions. The mean number of errors in the preimplementation period was 1/1,000 errors per medication dispensed (0.1%), whereas in the postimplementation period, it was 0.4/1,000 (0.04%). In postcamp survey, qualitative responses from medical staff described that they perceived blister packaging of medications to improve safety and decrease workload. Discussion: The implementation of on-site blister packaging of medications is a feasible system for optimizing medication safety and delivery in an overnight camp for children with cancer.

Background: The objective of this systematic review was to identify the medication information needs and preferences of caregivers of children with cancer and explore the medication management challenges these caregivers experienced. Method: We conducted a systematic search of three databases (Cumulative Index to Nursing and Allied Health Literature, Embase, and Medline) for studies published from database inception to February 27, 2024, and assessed the medication information needs of caregivers of children with cancer. The methodological quality of qualitative studies was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. Quantitative and mixed-methods studies were appraised using the Mixed Methods Appraisal Tool. Results: A total of 813 articles were retrieved using our search criteria, of which 13 met the eligibility criteria. Three overarching categories were identified: caregiver medication information needs and preferences, medication management concerns and challenges, and medication management strategies. Most studies focused on the needs and concerns of mothers of children with acute lymphoblastic leukemia in high-income countries, leaving a knowledge gap in relation to the perspectives of other caregivers across a broader range of malignancies. Discussion: This systematic review underscores the critical medication information needs of caregivers managing chemotherapy for children with cancer. Caregivers require tailored, accessible information throughout the treatment trajectory to effectively manage medication regimens and mitigate potential errors. Addressing these needs through comprehensive education strategies is essential for enhancing caregiver self-efficacy and improving overall patient outcomes in pediatric oncology.

Background: Researchers and clinicians often use the six-item abbreviated Posttraumatic Stress Disorder Checklist-Civilian (PCL-6) for screening; however, the PCL-6 has not been validated for parents of children with cancer. A valid and reliable short screener like the PCL-6 would allow bedside and/or advanced practice nurses to quickly screen parents for traumatic stress and expedite referrals for support services. Method: This study used data collected during a multisite trial examining an intervention for children with cancer and their parents. This dataset included parental self-report measures of traumatic stress (PCL-6; Impact of Events Scale-Revised [IES-R]), mood disturbance (Profile of Mood States-Short Form [POMS-SF]), and wellbeing (Index of Wellbeing [IWB]). The sample included 136 parents of children (3-8 years old) undergoing cancer treatment at four hospitals. Analysis: For construct validity, we calculated Spearman's correlation coefficient using baseline scores of the PCL-6 with baseline scores for the IES-R, POMS-SF, and IWB. For internal consistency, we calculated Cronbach's alpha using the scores of each of the six items of the PCL-6 for all parent/caregiver participants at baseline. Results: Results indicate good convergent construct validity, reasonable divergent construct validity, and good internal consistency.

Background: As frontline healthcare workers, pediatric oncology nurses are at high risk for burnout, compassion fatigue, and decreased compassion satisfaction. Research indicates that up to 60% of oncology staff experience some form of burnout. This can lead to difficulties in personal and professional relationships, decreased staff retention, and negative effects on patient safety. This evidence-based practice project evaluated the impact of a staff well-being program on pediatric oncology nurses in a 28-bed hematology-oncology unit at a children's hospital. Method: After reviewing the literature related to compassion satisfaction, compassion fatigue, burnout, and well-being, an interdisciplinary team identified best practices for implementing a staff well-being program. This program integrated the components of Code Lavender, which is an alert designed to reduce stress and provide psychological first aid, including social support and a purposeful break from the unit, with staff debriefings, or dedicated time to reflect and focus on the team's emotional response and coping strategies. Results: Nurses reported that Code Lavender met their expectations; 69% agreed or strongly agreed that it had an immediate positive impact on their well-being. The team experienced challenges in coordinating debriefings with consistency, so the process was modified to develop a format that would address the needs of those who access the well-being program. There was a marginally significant improvement in compassion satisfaction from baseline to 12 months (p = .05). Discussion: Promoting healthcare worker well-being continues to be a priority to reduce burnout and to improve compassion satisfaction. Implementation of Code Lavender and debriefings is an important step toward improving the well-being of pediatric oncology nurses.

Background: Adolescents and young adults (AYAs) living with advanced cancer may experience a heightened risk for existential distress. Addressing AYAs' hopes can stimulate a dialogue about their concerns, values, and goals, provide a path to holistically support their existential needs, and potentially alleviate their distress. This study aimed to evaluate hope's role in a sample of AYAs living with advanced cancer. Method: This study used a Husserlian phenomenology-informed descriptive qualitative research design to elicit AYAs' experiences with hope while living with advanced cancer. Participants were virtually recruited from an academic medical center and an online non-profit organization. Thematic analyses were performed across the data set to identify final themes. Results: Fifteen AYAs aged 12-21 years diagnosed with advanced hematological (80%) or solid (20%) malignancies participated in this study. A main theme of Simple Supports of Hope with a subtheme of Diversion was identified. Participants described music as a form of diversion, which supported their hope. Participants found listening to music calming and comforting and helped them cope with their distress. Performing music provided a creative outlet for negative feelings associated with cancer treatment. Participants reported creating music transformed and deintensified the treatment environment and helped spread hope to healthcare staff. Discussion: AYAs may intentionally use music to improve emotional expression, empowerment, connection, and coping strategies throughout the treatment process for cancer. Additional research needs to be conducted exploring the use of music interventions such as therapeutic songwriting or compositional music therapy to assist AYAs with building coping strategies during treatment for cancer.

Background: Measles is reemerging as a public health threat, raising important questions about disease vulnerability among childhood cancer survivors. This secondary analysis assessed the seroprevalence of anti-measles immunoglobulin G (IgG) antibodies as a marker of immune status in survivors of childhood cancer and associated demographic/treatment variables. Method: Participants were childhood cancer survivors who were free of active disease, having routine blood studies drawn, and could provide documentation of having received two doses of measles, mumps, and rubella vaccine before their cancer diagnosis. Patient record review documented demographic and treatment variables. Antimeasles (rubeola) IgG antibody seroprevalence was assessed by enzyme immunoassay for vaccine-specific antibodies. Results: Of 270 survivors evaluated, 110 (42%) were female, 196 (75%) were White, and 159 (61%) were leukemia/lymphoma survivors. Of these 262, 110 (42%) had negative measles seroprevalence, suggesting loss of immunity. Conclusion: Measles antibody surveillance and the need for reimmunization for survivors of childhood cancer survivors outside the transplant setting remains controversial. Our analysis indicates that a substantial proportion of survivors lose vaccine-related immunity to measles. Pediatric oncology nurses play important roles in educating cancer survivors regarding their risk of measles infection, evaluating the need for reimmunization, correcting misinformation about vaccine safety and effectiveness, and working to optimize community herd-based immunity.