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- Yuliana Hanaratri (Indonesia)
- Yan Yin Lim (Singapore)
Introduction
- Yan Yin Lim (Singapore)
- Yuliana Hanaratri (Indonesia)
DEVELOPING A PRELIMINARY CORE SET OF NURSING-SENSITIVE INDICATORS FOR INTERNATIONAL PEDIATRIC ONCOLOGY NURSING PRACTICE: A MIXED METHODS DELPHI STUDY
- Courtney E. Sullivan (United States of America)
Abstract
Background and Aims
Nursing sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. The purpose of this research was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries.
Methods
A multiphase mixed methods research design intersected with a classical Delphi method was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified 5 potential NSIs/Constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into Round Two. Round Two: Panelists selected their top 10 NSIs/Constructs and ranked them by importance. Mean-importance scores were calculated through reverse-scoring; the top 10 NSIs/Constructs were integrated into Round Three. Round Three: Panelists ranked the top 10 NSIs/Constructs by order of importance, then rated each NSI/Construct for relevance and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics.
Results
Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs/Constructs identified by the expert panel, and ranked in order of importance, were: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs/Constructs were rated actionable; all but palliative/end of life care were rated as feasible to measure.
Conclusions
Findings provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement and benchmarking. These findings will inform future studies to finalize a core set of NSIs for pediatric oncology nursing internationally.
GLOBAL NATIONAL CANCER CONTROL PLANS: NURSE PARTICIPATION AND CHILD AND NURSING CONTENT
- Kathryn Burns (Hungary)
Abstract
Background and Aims
The 2020 WHO and International Council of Nursing Report called for increased nursing leadership in health policy development and decision-making to ultimately influence effective health systems and social care infrastructure. National Cancer Control Plans (NCCP) set a country’s course over an extended period. Nurse participation in NCCP development helps consider factors beyond general public health or biomedical treatment that may negatively affect cancer control. Aim: Locate NCCP across WHO regions to determine nurse participation, whether nursing was addressed, and/or whether childhood cancer action/outcomes were included.
Methods
A search was conducted on the International Cancer Control Partnership (ICCP) portal for NCCP. Internet searches revealed no additional NCCP.
Results
A total of 112 NCCP were located for 194 countries (57%). While 50% were expired, many other countries’ NCCP had no end date or only had NCD plans. The ratio of countries per region with NCCP ranged from 74% Europe to 36% Southeast Asia. Nurses were identified in NCCP development committees (or authors knew contributors as nurses) in 12% of NCCP. AFRO and European Regions each had 5 (24% and 13% respectively) and Americas had 4 (27%) plans with nurse contributors. Nursing was mentioned in 60% of plans and actions/outcomes for childhood cancer were included in 71%. Nursing was addressed in the domains of education/training and workforce/staffing while childhood cancer topics included prevention, awareness/detection, guidelines/protocols, and survivorship.
Conclusions
There is a paucity of nurses identified in NCCP development worldwide. This diminishes nurse leaders’ professional involvement at decision-making levels. The limited NCCP with nursing action/outcomes demonstrates insufficient recognition ofnursing's vital role in cancer control. There is a lack of prioritization of childhood cancers. Health authorities would be well advised to create/maintain free-standing NCCP, place on the ICCP portal for accessibility, and include nursing and childhood cancer action/outcomes to improve cancer control.
THE GHANAIAN PEDIATRIC ONCOLOGY NURSING PROGRAM PROMOTES NURSING CLINICAL EXPERTISE AND LEADERSHIP
- Kimberly A. Shepherd (United States of America)
Abstract
Background and Aims
Children with cancer in low- and middle-income countries are four times more likely to die of the disease than those in high income countries. Expert nurses are critical to a successful pediatric oncology program, yet few opportunities exist fornurses across Ghana to receive specialized nursing education. Aligned with priorities of the 2019 WHO Global Initiative for Childhood Cancer (GICC) workshop in Ghana, a collaborative was formed to build an accredited Pediatric Oncology Nursing Program. The COVID19 pandemic hit during planning, forcing a rapid transition to a blended curriculum of remote and in-person teaching.
Methods
The one-year program is a combination of didactic theory and clinical practicums, modeled on a curriculum previously created for the Ghana College of Nurses and Midwives by the Hospital for SickKids in Toronto. The program kicked off with a virtual three-day preceptor workshop, followed by theory blocks delivered by international faculty which incorporated breakout rooms, interactive lectures, and group work. On-site teaching and clinical practicums are delivered by local clinical experts. Learning is assessed through written assignments, presentations, examinations, and competence assessment.
Results
Of eighteen enrolled students, sixteen completed on-line evaluation forms, and reported satisfaction with content, delivery and assignments for Block One modules. Student ratings of each module ranged between an Overall Mean Score of 4.21 to 4.38 (of 5). All students scored competent or above for Competency Skills Assessment during the first clinical practicum. All enrolled students successfully passed the end of module examinations.
Conclusions
An accredited training program prepares students to lead nursing practice, education and training within their own institutions, and to serve as leaders for future cohorts of the program, aligning with the WHO GICC goal to expand capacity to deliver best practice in childhood cancer care.
BUILDING PEDIATRIC ONCOLOGY NURSING LEADERSHIP IN SUB-SAHARAN AFRICA
- Aisha Nedege (Uganda)
Abstract
Background and Aims
Pediatric oncology nursing training is a challenge to effective clinical oncology management in sub-Saharan Africa due to lack of expertise in the field. Global Hematology Oncology Pediatric Excellence (HOPE) set out to provide nurse leaders with training opportunities in leadership and management and to promote individual professional development by building and enhancing core competencies and strategic workplace management skills.
Methods
Global HOPE nurse leaders from Botswana, Malawi and Uganda participated in a year-long program focused on developing leadership skills. Participants completed five modules: essential nursing leadership skills, high-performance teams, diplomatic communication, strategic management and practice models, and nursing quality care. Each module consisted of lectures, discussion, readings, group activities conducted at their practice site, and forum presentations. Participants met monthly via ZOOM during the program.
Results
All nurse leaders completed the program requirements. Program results are presented by discussing completed activities designed to promote leadership skills. Learning activities included personal assessments of individual strengths and weaknesses, and interviews with nurse leaders at their institutions followed by oral presentations on key elements of leadership. Participants learned about high performance teams and interviewed their own site teams to explore barriers to team performance; recommendations for change to improve team performance were developed and shared with their teams. Effective communication strategies were explored using several change and practice management models to gain knowledge of strategic management. Participants chose a practice model and presented the framework during group discussion. Quality improvement processes were learned, and all nurse leaders completed the open course on Quality Improvement that is part of the Institute for Healthcare Improvement.
Conclusions
Global HOPE is making strides to enhance vital leadership skills among oncology nurse leaders. This translates to better patient care while shaping future approaches to oncology nursing in sub-Saharan Africa.
TUCK-IN ROUNDS: A STANDARDIZED EVENING ROUNDING PROCESS TO IMPROVE COMMUNICATION AND CARE COORDINATION
- Michael Terao (United States of America)
Abstract
Background and Aims
The goal for overnight patient care is different than during the day and involves timely recognition and interventions for patients with acute deterioration. To achieve these goals, clear communication between the medical team and nurses is crucial. At our institution, the cross covering medical teams and nurses routinely participate in night rounds. Prior to this effort, the content and structure of these rounds were not standardized and has led to lack of awareness of contingency plans, multiple follow-up conversations, and preventable errors. Our team sought to improve the quality of overnight patient care by targeting nurse to provider communication processes. The specific aim was to increase contingency plan discussion during night rounds from 20% to 80% in 1 year without increasing average time spent.
Methods
The multi-disciplinary quality improvement (QI) team used QI approaches per the Institute for Healthcare Model for Improvement. The team identified key-drivers necessary to increase contingency plan discussion. Interventions included implementing a rounding checklist in several phases and enforcing compliance through observation. Average frequency of contingency plan discussion and time spent per patient were plotted on control charts. Centerlines were shifted based on pre-established criteria for special cause detection in the context of interventions.
Results
From August 2019 to June 2020, average contingency plan discussion increased from 20% to 97%, without increasing time spent per patient. In addition, both nurses and providers reported increased perceptions in the quality of night shift care plan development.
Conclusions
Using QI methodologies, we successfully increased contingency plan discussion during night rounds without increasing time spent per patient. The revised process sets an expectation for the night shift: developing a clear plan for detecting and responding to patient deterioration. Further efforts are on-going to incorporate this standardized rounding process to new employee orientation.
WHAT MATTERS TO CHILDREN WITH CANCER A SYSTEMATIC REVIEW OF QUALITATIVE STUDIES AND PATIENT-REPORTED OUTCOME MEASURES (PROMS)
- Maria Rothmund (Austria)
Abstract
Background and Aims
Several patient-reported outcome measures (PROMs) for health-related quality of life (HRQOL) in children with cancer exist. However, these have been criticized for not accurately reflecting issues that matter to children and for seldom involving children in PROM development. We aimed to collect and compare the items assessed by existing PROMs and issues mentioned by children or parents in qualitative studies.
Methods
A systematic literature search on PubMed, PsycInfo, COSMIN, and Cochrane was conducted. Studies were included if (a) children (8-14 years) with cancer undergoing treatment completed PROMs or (b) children or their parents provided qualitative information on HRQOL issues of the child. Issues identified in qualitative studies and PROM items were mapped onto the conceptual framework of HRQOL in children with cancer proposed by Anthony et al. (2014).
Results
A total of 2551 records were identified of which 316 papers were included. Among the included studies, 78 collected qualitative data and 277 used PROMs (39 combined both methods). 142 different PROMs and more than 4000 individual items were identified. The major domains of physical, psychological, social, and general health proposed in the conceptual framework by Anthony et al. (2014) were confirmed and the majority of items mapped well onto the model. Most identified issues assessed physical function or symptoms while aspects of psychosocial functioning were often under-assessed in existing PROMs even though these emerged as key constructs in the qualitative studies.
Conclusions
This study offers a comprehensive overview of HRQOL issues for children with cancer. While physical aspects of the disease are covered, most PROMs lack a comprehensive assessment of key psychosocial issues and thus overlook fundamental features of the cancer experience of children. This calls for the development of a more comprehensive PROM for children with cancer including items which children themselves have identified as relevant and important to them.