Journal of Pediatric Oncology Nursing最新文献

Background: Understanding parents' experiences is a prerequisite to developing interventions that are sensitive to needs of children and families. In China, little is known about parental experiences of having a young child with acute lymphoblastic leukemia (ALL). This phenomenological study aimed to describe parental experiences of having a young child with ALL in China.

Method: Ten parents, recruited in central China using purposive sampling, participated in face-to-face, in-depth interviews using Haase's adaptation of Colaizzi's phenomenological method.

Results: Five theme categories were identified: (a) The Cancer Diagnosis as a Terrible Disaster-The Sky is Falling, (b) Fighting the Beast, (c) Putting on a Happy Face and Other Coping Strategies, (d) Diagnosis Disclosure: If We Tell and How to Tell, and (e) Hope-Filled Expectations: Returning to Normal Life.

Conclusion: Parents put their child's health as their top priority. They strive to manage uncertainty about prognosis and cope with enormous pressures caused by children's suffering, financial burden, and stigma. Parents also express their resilience and hope throughout their child's cancer journey. Support services to strengthen specific families' protective factors (i.e., family/community support, hope, and positive coping) are needed to foster resilience and quality of life. Health care professionals should systematically assess parents' needs, provide validated education materials, and implement tailored interventions across the cancer continuum. Public education and advocacy about cancer is also necessary to decrease cancer-related stigma, and provide financial aid and health care resources in pediatric oncology.

Objective: The purpose of this study was to describe the caregiver's proxy-report of the quality of life (QoL) of children with cancer and the main family caregiver's competence, and to examine the role of said competence and other care-related variables in their proxy-reported QoL of children with cancer.

Method: This was a cross sectional, correlation design study conducted with 97 main family caregivers of children between the ages of 8 and 12 years with cancer residing in Colombia. The following variables were collected: main family caregiver and child sociodemographic characteristics (Survey for Dyad Care; GCPC-UN-D), The Pediatric Quality of Life Inventory 4.0 Cancer Module, and the Competence Instrument (caregiver version).

Results: The mean of the children's QoL was 102.0 points, and the caregivers' competence score was 211.24. Caregiver's competence (t = 5.814, p < .01), marital status (t = 1.925, p < .05), time as a caregiver (t = 2.087, p < .05), number of hours spent caring for the child (t = 2.621, p < .05), and caregiver's previous caring experiences (t = 2.068, p < .05) were found to influence caregiver's proxy-report of the QoL of children with cancer.

Conclusions: High competence in main family caregivers positively influence caregiver's proxy-report of the QoL of children with cancer. Study results also suggest that nurses should consider the caregivers' sociodemographic characteristics such as marital status, time as a caregiver, number of hours spent caring for the child, and caregiver's previous experiences because those aspects influence main family caregivers' proxy-report about their children's QoL.

Central line associated blood stream infections and complications in children require prevention strategies related to both traditional childhood activities as well as adverse events in the intensive care unit or bone marrow transplant unit. This study evaluated a nurse-invented product, the Line Snuggler, designed to protect intravenous tubing and central lines from contamination or entanglement. Patients (n = 30) were enrolled following the chemotherapy phase of transplant. Using a pre-post intervention design, each subject served as their own control for the control phase of the study (Days 1-3 without a Line Snuggler) and the intervention phase (Days 4-6 with a Line Snuggler), with bacterial levels of product and sheets tested on Days 1, 3, 4, and 6. At study conclusion, staff (n = 44) and parents/guardians (n = 25) completed an online survey assessing satisfaction with the product, and perceived utilization and safety. Using t tests, the Line Snuggler bacterial levels showed no difference in growth in adenosine triphosphate levels compared with the same patient's sheets, thereby supporting no increased risk of bacterial growth. Both staff and parents/guardians reported high satisfaction with their use of the Line Snuggler and noted the benefit of its protecting and bundling intravenous lines into a single organizer. This innovative product designed by nurses was evaluated as a means to provide exceptional, high-quality care to achieve the best outcomes while eliminating hospital-acquired complications (https://www.linesnugglers.com/).

Pill-swallowing training (PST) is a promising behavioral intervention. However, previous studies of PST have largely reported outcomes only in children aged 6 years and older. In the pediatric oncology setting, younger children may benefit from learning to swallow pills, with motivators such as avoiding bad-tasting liquid medications, simplifying oral medication routines, and accessing trials for patients with poor prognoses. Here, we briefly describe the standard PST intervention protocol and report success with very young patients experiencing a variety of medical, emotional, behavioral, and developmental complications. The current case series illustrates the utility of traditional behavioral PST interventions with novel supplements, such as intervention to increase general compliance or decrease anxiety, in four young children with cancer. These cases highlight the effectiveness of PST and describe the positive impact reported by each family. Developmental considerations for using PST with young children with cancer are offered.

Background: The experience of hematopoietic stem cell transplant (HSCT) on both the patients and their caregivers is complex and challenging during hospitalization and post discharge. Complex patient populations require heightened attention on discharge practices to ensure that they are prepared for home regimens. "Rooming in" is a standardized intervention implemented prior to discharge that allows patients and caregivers to assume post discharge care with the support of staff. Other complex patient populations have reported positive outcomes related to "rooming in." Aims: The purpose of this study was to assess the feasibility of a standardized "rooming in" intervention for discharge of pediatric HSCT patients. An additional aim was to describe the quality of discharge teaching, readiness for hospital discharge, and postdischarge coping difficulty in a cohort of HSCT patients using validated questionnaires. Method: Data were collected via medical chart review. A prospective cohort completed validated study questionnaires at discharge and 30 days postdischarge. Results: All caregivers of post-HSCT patients were able to complete the "rooming in" intervention. There was no statistically significant difference for length of stay between the retrospective and prospective cohorts. Caregivers enrolled on the study rated the Quality of Discharge Teaching Scale-Parent Form high (Mdn = 165). Conclusion: We conclude that "rooming in" is a feasible discharge intervention for caregivers of pediatric HSCT patients.

Background: Immunotherapy is a new and promising approach to treating pediatric cancers. These types of therapies have unique mechanisms of action for identifying and fighting cancer, as compared with traditional chemotherapy, and therefore are associated with different therapy-related adverse events (AEs). The purpose of this systematic review was to review available evidence to: (a) identify commonly reported AEs associated with immunotherapy agents frequently used in pediatric oncology and (b) generate recommendations for nursing practice.

Method: A clinical question was developed and used to guide the systematic literature review. Five immunotherapy agents (dinutuximab, blinatumomab, rituximab, inotuzumab ozogamicin, brentuximab vedotin) were selected for inclusion secondary to their high relevance to pediatric oncology. A literature search was conducted to locate articles published between January 1, 2003 and October 31, 2018.

Results: Seventeen articles met eligibility criteria for inclusion and were evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. The most commonly reported AEs for the selected immunotherapy agents were identified and summarized. Strong recommendations are made for nurses to become familiar with the unique AE profiles associated with individual immunotherapy agents. Agent-specific recommendations for nursing practice regarding AEs associated with dinutuximab and rituximab were generated.

Conclusions: Immunotherapy is rapidly emerging as an effective therapy for pediatric cancers. Nurses need to be aware of the breadth of agent-specific, immunotherapy-related AEs to appropriately monitor and manage patients receiving these therapies. Additional work is needed to confidently profile immunotherapy-related AEs in pediatric oncology and to develop agent-specific educational materials for patients/families.

Purpose: The purpose of this study is to identify controllable treatment-environment-related factors affecting the timing of a central line-associated bloodstream infection (CLABSI) onset in children with cancer with central venous catheters (CVC).

Design: This study is a secondary data analysis with the data extracted from electronic medical records in a tertiary hospital in South Korea. This study was conducted by reviewing electronic medical records of 470 pediatric cancer patients younger than the age of 18 years from 2010 to 2016.

Method: The timing of a CLABSI onset was identified through the onset of CLABSI and the duration of catheterization. Cox proportional hazards regression analysis was used to estimate the impact of variables on the timing of CLABSI onset. The duration of catheterization was estimated using the Kaplan-Meier method.

Finding: Multivariable analysis by Cox proportional model analysis showed that there are six independent variables affecting the timing of a CLABSI onset: length of stay in hospital, catheter insertion location, use of antibiotics on day of catheter insertion, catheter function, number of blood transfusions per 100 days, and number of blood tests per 100 days.

Conclusions: The findings of this study provide a foundation for the development of EBP-based CVC guidelines to effectively reduce CLABSIs and maintain a long-term CVC without a CLABSI.

Leukemias and lymphomas account for more than half of new cancer cases in children each year. As a result of advancements in clinical protocols, survival rates for hematological malignancies in children now approximately 80% to 90%. The short-term effects of chemotherapy are well documented; however, many late effects remain unclear, notably those on the humoral immune system. The recent resistance toward childhood vaccination in some communities in conjunction with a growing number of potentially underprotected survivors could place this population at increased risk for common communicable diseases. Additionally, survivors could serve as a significant reservoir for further spread of disease within the general population. The state of the scientific knowledge regarding humoral immunity in this population is insufficient for concrete conclusions. An intensive search of the literature on various platforms was performed to identify articles reporting on the rates of protection to common vaccine-preventable diseases in survivors of pediatric hematological malignancies. Articles were selected with respect to inclusion and exclusion criteria. Quality was evaluated against specific methodological standards. Each study shows evidence that participants were lacking immunity to at least one vaccination following treatment. A majority of participants recovered immunity after revaccination, with a small percentage remaining unprotected. There is no consistency between studies regarding the rates at which immunity is present; furthermore, there are no particulars on how long immunity persists following revaccination. Vaccination represents an instrumental public health initiative for reducing morbidity and mortality globally. The clinical ramifications of losing protection against vaccine preventable diseases are therefore serious.

Background: To reduce the risk of renal toxicity, urine specific gravity (SG) and pH (potential of hydrogen) parameters should be met before nephrotoxic chemotherapeutic agents are administered. The purpose of this study was to compare laboratory urine SG and pH values with those obtained with urine point-of-care (POC) testing methods commonly used when caring for children receiving nephrotoxic chemotherapeutic agents.

Method: A method-comparison design was used to compare the values of three POC methods for SG (dipstick, automated dipstick reader, refractometer) and three pH (dipstick, automated dipstick reader, litmus paper) methods with laboratory analysis of 86 urine samples from 43 children hospitalized on a pediatric hematology oncology unit in a large academic medical center. The Bland-Altman method was used to calculate bias and precision between POC and laboratory values.

Results: Except for the SG refractometer, bias values from Bland-Altman graphs demonstrated poor agreement between POC and laboratory urine SG and pH results. The precision values between these methods indicated overestimation or underestimation of hydration or urine pH status. Compared with laboratory methods, 31% of POC visual reading of dipstick SG values were falsely low-putting the patient at risk of not receiving necessary hydration and subsequent nephrotoxicity.

Discussion: In conclusion, most POC urine testing methods for SG and pH are not accurate compared with laboratory analysis. Because laboratory analyses can take longer than POC methods to obtain results, clinicians need to collaborate with laboratory medicine to ensure that an expedited process is in place in order to prevent chemotherapy administration delays.

More than one fourth of primary caregivers report clinically significant distress during the hematopoietic stem cell transplantation (HSCT) process. Providing early support to primary caregivers could reduce caregiver distress and improve the quality of life. This study examined the effects of a three-stage caregiver support intervention designed to reduce caregiver distress and improve quality of life during pediatric HSCT hospitalization. A two-group comparative study was conducted with repeated measures. Participants were randomly assigned to an intervention group or a control group. The intervention group received the support intervention 5 days before the transplant, 14 days after transplant, and 1 week before hospital discharge. The control group received standard support provided in the hospital ward. Measures were obtained at all three time points from self-report questionnaires, which were related to anxiety, depression, perceived stress, and quality of life. Findings indicated that primary caregivers in the intervention group (n = 22) reported significantly lower levels of perceived stress and higher levels of quality of life than the control group (n = 23) at 14 days after transplant. In the intervention group, caregiver distress significantly decreased from pretransplant through 14 days after transplant, while over the same period caregiver quality of life significantly increased. The intervention effectively changed the trend of distress and quality of life for caregivers of children during the process of HSCT and hospitalization. The findings of this study suggest that it is important to provide early targeted interventions at critical junctures for caregivers at risk of adverse outcomes.