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BACKGROUND: Although existing trauma nurse courses provide basic education, advanced courses with simulation experiences that enhance team leadership, communication, and workflows are lacking. OBJECTIVE: To design and implement the Advanced Trauma Team Application Course (ATTAC) to promote advanced skills for nurses and respiratory therapists with varied experience and skill levels. METHODS: Trauma nurses and respiratory therapists were selected to participate based on years of experience and the novice to expert nurse model. Two nurses from each level (excluding novice) participated, ensuring a diverse cohort to promote development and mentorship. The 11-module course was presented over 12 months. A five-question survey was employed at the end of each module to self-evaluate assessment skills, communication skills, and comfort for trauma patient care. Participants rated skills and comfort on a "0-10" scale, with 0 being "not at all" to 10 being "extensively." RESULTS: The pilot course was conducted from May 2019 to May 2020 at a Level II trauma center in the Northwest United States. Nurses reported ATTAC improved assessment skills, team communication, and comfort in caring for trauma patients (mean = 9.4; 95% CI [9.0, 9.8]; scale of 0-10). Participants indicated scenarios closely mimicked real-world situations; concept application commenced directly following each session. CONCLUSION: This novel approach to advanced trauma education promotes development of advanced skills that enable nurses to anticipate needs rather than being reactive, engage in critical thinking, and adapt to rapidly changing patient conditions.
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Pessoal Técnico de Saúde , Comunicação , Humanos , Liderança , Centros de TraumatologiaRESUMO
OBJECTIVES: Remote patient monitoring became critical for patients receiving cancer treatment during the COVID-19 pandemic. We sought to test feasibility of an electronic patient symptom management program implemented during a pandemic. We collected and analyzed the real-world data to inform practice quality improvement and understand the patient experience. METHODS: Eligible patients had breast, lung, or ovarian cancers, multiple myeloma, or acute myeloid leukemia and 12 weeks of planned chemotherapy. Patients were notified that a symptom survey with common symptoms derived from the National Cancer Institute's Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events was available to complete using a smart phone, tablet, or computer. Patients recorded their symptoms and results were sent to the provider. Patients received care guidelines for mild/moderate severity symptoms and a phone call from the provider for severe reports. RESULTS: A total of 282 patients generated > 119 088 data points. Patients completed 2860 of 3248 assigned surveys (88%), and 152 of 282 patients (54%) had symptom reports that generated an immediate notification to the provider. Longitudinal data were analyzed to determine whether previous reports predicted a notification alert and whether symptoms resolved after the alert was addressed. CONCLUSIONS: An electronic patient symptom management program was implemented in the midst of the COVID-19 pandemic. Enrollment of 282 patients and a high survey completion (88%) demonstrated feasibility/acceptance. Patients reported symptoms at severe levels of 54% of the time and received self-management instructions and provider phone calls that resolved or decreased the severity of the symptom. A standard approach and validated instrument provide opportunities for improving and benchmarking outcomes.
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COVID-19 , Neoplasias , COVID-19/epidemiologia , Eletrônica , Humanos , Neoplasias/terapia , Cuidados Paliativos , Pandemias , Medidas de Resultados Relatados pelo PacienteRESUMO
PURPOSE OF THE REVIEW: The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. RECENT FINDINGS: The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
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Continuidade da Assistência ao Paciente/organização & administração , Países em Desenvolvimento , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Acessibilidade aos Serviços de Saúde , Humanos , Oncologia/organização & administração , Apoio Social , Fatores SocioeconômicosRESUMO
Nurses are on the frontline of palliative care, and in some countries, are the only contact for patients and families facing life-threatening illness. The Oman Cancer Association in the Sultanate of Oman, in collaboration with the Middle Eastern Cancer Consortium and the Oncology Nursing Society, led a palliative care initiative over the past decade to better integrate palliative care into the health care system. Components of this initiative include integrating palliative care into the health care curricula and providing palliative care education to over 400 nurses and other health care professionals within Oman. The four-part education series includes the following courses: (1) Foundations of Palliative Care, (2) Advanced Concepts in Palliative Care, (3) Palliative Care Leadership, and (4) Palliative Care Research. Additional participants from 17 different countries in the Middle East and northern Africa also attended the training. Twenty of the trainees who were considered palliative care leaders in their countries then participated in a Train the Trainer course. This group trained the last cohort of health care professionals in Oman and then took learned concepts and strategies back to their respective countries in order to provide country-wide education and build palliative care capacity in the region. Outcomes include the development of palliative care units, quality improvement projects that improved care, and advocacy projects to increase opioid availability within some countries. The collaborative continues its work and connections through social medial, email, and virtual collaboration. Other countries can use this model to permeate palliative care within their regions.
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Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Currículo , Humanos , Oriente Médio , Omã , Cuidados PaliativosRESUMO
BACKGROUND: A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. AIMS: The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. METHOD: A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale. Descriptive statistics, regression models, and trend analysis were employed to determine effectiveness. A subset of patients participated in telephone interviews; the obstetric team was surveyed regarding perceptions of the service. RESULTS: The sample included 192 women (195 pregnancies). Approximately 72% experienced less depression by the first follow-up visit. Patients taking three or more psychiatric medications attended more OBMHC visits. Trend analysis indicated that women with the highest levels of depression had the best response to the intervention. Three qualitative themes emerged: Safe Place, Mental/Emotional Stability, and Integrated Personalized Approach. Obstetric team members (n = 11) perceived the clinic to be helpful and noted improved access to mental health care. CONCLUSION: OBMHCs can be effective when psychiatric nurses are embedded within an outpatient obstetric service. Improved access, timely services, and patient reassurance can lead to an improved pregnancy experience and reduced depressive symptoms. The longevity of this clinic's experience serves as a role model for other centers to replicate this successful integrated model of care.
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Depressão Pós-Parto , Depressão , Depressão Pós-Parto/terapia , Feminino , Humanos , Saúde Mental , Gravidez , Escalas de Graduação Psiquiátrica , Estudos RetrospectivosRESUMO
BACKGROUND: Family health is an important issue which has attracted researchers from different fields. The present study aimed to validate the Persian version of the Family Health Climate Scale (FHC-Scale). METHODS: In this methodological research, a total of 620 individuals presenting to Comprehensive Healthcare centers affiliated with Mashhad University of Medical Sciences and Gonabad University of Medical Sciences were selected through random multistage sampling. Validation of the FHC-Scale was performed. First, the original scale was translated and back-translated. Then its content validity and construct validity were assessed using exploratory and confirmatory factor analysis. Reliability was assessed using internal consistency and stability. Data were analyzed using SPSS version 20 (IBM Corp., Armonk, NY, USA) and LISREL version 8.5 (SSI Inc., Skokie, IL, USA). RESULTS: Results of exploratory factor analysis showed that "physical activity" of family health climate scale (FHC-PA) has three dimensions: value, cohesion and information explaining 61.99% of the variance. "Nutrition" of family health climate scale (FHC-NU) had four dimensions of value, communication, cohesion and consensus explaining 66.19% of the variance. Internal consistency of the dimensions of (FHC-PA) ranged 0.82-0.85 and that for FHC-NU ranged 0.82-0.84. Confirmatory factor analysis revealed goodness of fit and confirmed family health climate scale (Nutrition and physical activity). CONCLUSION: Results of the study revealed that the FHC-Scale has appropriate reliability and validity for Iranian families. Therefore, the Persian version of the scale can be used for assessing health-related aspects of family.
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Saúde da Família , Análise Fatorial , Humanos , Irã (Geográfico) , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários , Tradução , TraduçõesRESUMO
BACKGROUND: America is amid an opioid epidemic, best characterized by liberal prescribing practices; widespread opioid misuse, abuse, and diversion; and rising rates of prescription-related opioid overdose. While many contributors to opioid overprescribing exist, orthopedic surgery is identified as a key driver. The purpose of this study is to determine predictors of ongoing opioid use >15 days post-total knee arthroplasty (TKA) and those patients prescribed >1350 morphine milligram equivalents (MMEs) in the 15 days following surgery. METHODS: A retrospective cohort study was conducted in patients undergoing TKA (January 2016-December 2017) in an integrated healthcare system. Outcomes of interest were patient and clinical characteristics. RESULTS: A total of 621 patients were included in the study. The majority were female (57.6%), were non-Hispanic/Latino white (92.3%), and from metropolitan areas (64.3%) with fewer than 110,000 population. Mean age was 66.3. Being female (odds ratio [OR] = 1.547, P = .092), having a higher body mass index (OR = 1.043, P = .036), and receipt of more postdischarge prescriptions in the 60-day follow-up period (OR = 8.815, P < .0001) were associated with a greater likelihood of receipt of opioid prescriptions for more than 15 days. Older patients (OR = 0.954, P = .01) and those discharged to home (OR = 0.478, P = .045) were less likely to receive >1350 MME; longer length of stay (OR = 1.447, P = .013) was more likely in those prescribed >1350 MMEs. CONCLUSION: Several predictors were associated with longer duration and higher doses of opioid prescriptions post-TKA. Further research is needed to ascertain the challenges of opioid prescribing from both the metropolitan surgical team and rural healthcare provider perspective.
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Analgésicos Opioides , Artroplastia do Joelho , Assistência ao Convalescente , Idoso , Artroplastia do Joelho/efeitos adversos , Feminino , Humanos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Alta do Paciente , Padrões de Prática Médica , Estudos RetrospectivosRESUMO
BACKGROUND: Lack of knowledge about pain is a common barrier to effective pain management. Educational pain management programs directed to health care professionals can improve knowledge and attitudes about pain. However, changing practice is more challenging, but can be achieved with more targeted educational interventions within the clinical setting. OBJECTIVES: The main objective of this study was to examine which of four separate pain management educational designs improved nurses' knowledge and attitudes toward pain over time. Secondary objectives were to compare and contrast nurse's knowledge and attitudes toward pain before and after the educational intervention. DESIGN: This randomized controlled trial using a four Solomon group design. SETTING: This study took place in Dubai Hospital, Dubai Health Authority, in United Arab Emirates between January 2019-April 2019. PARTICIPANTS: The sample consisted of 200 registered nurses who were randomly selected and assigned into four separate educational groups. Participants had at least one year of experience in Dubai hospital prior to data collection. RESULTS: paired t-test has shown the experimental group scored significantly higher than the control group (p < 0.01). One-way ANOVA revealed significant post-test score differences between groups p < 0.001. A repeated measures ANOVA with a Greenhouse-Geisser correction determined that mean scores over three months was not statistically significant. Indicating that the level of knowledge did not change over time within any of the groups. CONCLUSION AND RECOMMENDATIONS: The most important findings were the relatively low pre-test knowledge scores among staff nurses, and the significant improvement in knowledge for most test items following the educational intervention. Moreover, the level of knowledge and attitudes were maintained over three months. The pain management program proved to be effective in improving nurses' pain knowledge, attitudes, and assessment practices. Nurses in the experimental group increased their pain score significantly after the pain management program. Registration number: NETUBR.
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Atitude do Pessoal de Saúde , Competência Clínica , Enfermeiras e Enfermeiros , Manejo da Dor , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Dor , Emirados Árabes UnidosRESUMO
BACKGROUND: Previous approaches to measuring and improving nursing-sensitive, patient-centered metrics of pain quality and outcomes in hospitalized patients have been limited. METHODS: In this translational research study, we disseminated and implemented pain quality indicators in 1611 medical and/or surgical, step-down, rehabilitation, critical access, and obstetrical (postpartum) units from 326 US hospitals participating in the National Database of Nursing Quality Indicators. Eligible patients were English-speaking adults in pain. Trained nurses collected patients' perceptions via structured interview including 9 pain quality indicators, demographic, and clinical variables; these patient experience data were merged with unit and hospital level data. Analyses included geographic mapping; summary statistics and 3-level mixed effects modeling. RESULTS: Hospitals in 45 states and District of Columbia participated. Of 22,293 screened patients, 15,012 were eligible; 82% verbally consented and participated. Pain prevalence was 72%. Participants were 59.4% female; ages ranged from 19 to 90+ (median: 59 y); 27.3% were nonwhite and 6.5% were Hispanic. Pain intensity on average over the past 24 hours was 6.03 (SD=2.45) on a 0-10 scale. 28.5% of patients were in severe pain frequently or constantly. Race (nonwhite), younger age, being female and nonsurgical were associated (P<0.001) with greater pain. Care quality indicators ranking lowest related to discussion of analgesic side effects and use of nonpharmacologic approaches. CONCLUSIONS: Unrelieved pain remains a high-volume problem. Individual factors and unit type were significantly associated with pain outcomes. Hospitals can employ these quality indicators to direct continuous quality improvement targeting pain care quality.
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Recursos Humanos de Enfermagem Hospitalar , Manejo da Dor/métodos , Dor , Assistência Centrada no Paciente/métodos , Indicadores de Qualidade em Assistência à Saúde , Estudos Transversais , Feminino , Hospitais/normas , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Assistência Centrada no Paciente/organização & administração , Melhoria de Qualidade , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Effective cancer pain management mandates precise attitude, assessment, skills, and knowledge. Health professionals' knowledge and attitudes concerning cancer pain management have often been referred to as insufficient. AIMS: This study explored pain knowledge and attitudes of nurses working in oncology settings. SETTING AND PARTICIPANTS: Population 115 oncology nurses working at 2 hospitals in the United Arab Emirates. METHODS: A descriptive, correlational, cross-sectional design was used to examine nurse knowledge and attitudes about pain using the Nurses' Attitude and Knowledge Survey Regarding Pain (NKASRP) survey. NKASRP score differences were examined among nurses with varying demographics, levels of pain education and experience. RESULTS: The mean KASRP was 45%, significantly below the passing score of 80%. Pain management education was not found to have a significant impact on KASRP thus suggesting the need for more effective educational approaches to developing appropriate knowledge and attitudes towards pain among the nurses. No significant differences between sex, educational level, nursing and oncology experience, and nationality or religion were found. INTERPRETATION AND CONCLUSIONS: The study highlights the need for new initiatives targeting nurses working with cancer patients who are likely to experience significant pain. An ongoing need exists for more effective evidence-based educational programs in cancer pain management. Interactive teaching strategies such as on the job training, improvisational learning, and case studies should be tested for their influence on pain knowledge and attitudes and patient outcomes.
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Dor do Câncer/enfermagem , Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermagem Oncológica/métodos , Enfermagem Oncológica/normas , Enfermagem Oncológica/estatística & dados numéricos , Manejo da Dor/enfermagem , Inquéritos e Questionários , Emirados Árabes UnidosRESUMO
BACKGROUND: Pain continues to be a problem in hospitalized patients. Contextual factors contribute to the success of pain quality improvement efforts. AIMS: This paper describes nurse team leaders' perceptions of organizational context and factors perceived to help and hinder the process of leading a unit-based improvement effort focused on pain. DESIGN: Qualitative descriptive design. SETTING: Interviews took place over the telephone. PARTICIPANTS: Nurses from 106 hospitals across the United States. METHODS: Investigators interviewed 125 nurses leading a unit-based pain quality improvement project in partnership with the National Database of Nursing Quality Indicators. Lewin's Field Theory guided a thematic analysis. RESULTS: Key contextual factors related to the amount of change in the health care environment and characteristics of the organization and providers. Helping forces included characteristics of nurses, teamwork, a culture of quality, opportunities for learning, pain management resources, and accountability for pain management. Hindering forces included: barriers to involvement, attitudes and relationships, lack of knowledge, and types of patients. CONCLUSIONS: Overcoming the pervasive barriers of constant change and lack of staff involvement while also capitalizing on the culture of quality and characteristics of the health care team may further enhance and sustain improvement efforts related to pain management of hospitalized patients. New models for influencing quality improvement could be strengthened with involving frontline staff in both planning and implementation of improvement efforts. CLINICAL IMPLICATIONS: Because of the diverse responses, it is recommended that each unit conduct a force-field analysis to guide successful implementation of improvement efforts.
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Enfermeiras e Enfermeiros/psicologia , Manejo da Dor/normas , Melhoria de Qualidade , Adulto , Atenção à Saúde/métodos , Atenção à Saúde/normas , Feminino , Hospitalização/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Manejo da Dor/métodos , Pesquisa Qualitativa , Estados UnidosRESUMO
Pain is a nursing sensitive indicator and yet pain is often not well managed in both hospital and ambulatory settings. Improving nurse knowledge and attitudes about pain may translate to improved patient outcomes. The objective of this study was to investigate knowledge and attitudes about pain (KAP) in nurses who work in diverse settings, professional and personal characteristics that predict KAP, and whether KAP correlated with patient satisfaction according to Hospital Consumer Assessment of Healthcare Providers (HCAHPS). Descriptive, cross-sectional, correlational study. A large integrated health care facility in the northwest. A total of 217 registered nurses working in acute, ambulatory, and long-term care. A Pain Knowledge and Attitudes Survey was administered to registered nurses in diverse settings. Scores were examined for personal and professional predictors of KAP and correlated with HCAHPS patient satisfaction surveys. Nurses scored an average of 72%; nurses in long-term care scored the highest. Having more than 5 years of nursing experience, being a certified nurse, and receiving pain education in the last year were predictive of a higher score on the KAP survey, which explained only 9.8% of the variance. Unit mean KAP scores were highly correlated with unit-based HCAHPS scores (r = 0.917, p = .01). Certified nurses scored higher on the KAP survey, consistent with other studies. This study suggests that having more knowledge and better attitudes about pain may improve patient satisfaction of pain. Further studies are needed that link knowledge and attitudes about pain to patient outcomes.
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Conhecimentos, Atitudes e Prática em Saúde , Enfermeiras e Enfermeiros/normas , Dor/psicologia , Satisfação do Paciente , Adulto , Atitude do Pessoal de Saúde , Competência Clínica/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noroeste dos Estados Unidos , Enfermeiras e Enfermeiros/psicologia , Manejo da Dor/normas , Estudos Prospectivos , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: The aim of this study was to identify processes, outcomes, and lessons learned from designing a new evidence-based unit. A research study was conducted simultaneously to rigorously measure changes in patient and staff outcomes. BACKGROUND: Nursing leadership and frontline nursing engagement are critical in evidence-based design to promote positive outcomes and workflow. METHODS: Quality indicators were tracked premove and postmove. Nursing workflow was tracked, and teamwork was examined. RESULTS: The incidence of falls and methicillin-resistant Staphylococcus aureus decreased on the new unit. Patient satisfaction improved; the greatest improvement was noise reduction. Teamwork remained stable. Nurses spent significantly more time in the patient rooms on the new unit. CONCLUSIONS: This hospital found nursing engagement in the unit design process to be imperative to promote positive patient outcomes and stable or improved teamwork. Nursing leaders should be involved at the onset of the design process to facilitate optimal outcomes.
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Enfermagem Baseada em Evidências , Liderança , Papel do Profissional de Enfermagem , Recursos Humanos de Enfermagem Hospitalar/organização & administração , Fluxo de Trabalho , Humanos , Montana , Relações Enfermeiro-Paciente , Padrões de Prática em Enfermagem/organização & administração , Melhoria de Qualidade , Infecções Estafilocócicas/prevenção & controleRESUMO
OBJECTIVES: Provide an overview of navigation in three disparate populations: rural, Native American/Alaska Native, and low- to middle-income countries. Discuss gaps in care and opportunities to improve cancer care. METHODS: A literature search was conducted in PubMed and on Google Scholar using search terms, nurse navigation, cancer, disparit*, low- to middle-income countries, Native American, American Indian, and rural. Peer-reviewed research studies, review articles, databases and websites of professional organizations, and historical books were reviewed to provide an overview of oncology nurse navigation in underserved communities. Experiences in working with these populations over the past 30 years were also provided to support current literature. RESULTS: Forty references were included in this overview of nurse navigation in underserved communities. Nurse navigation in these disparate areas is in its infancy. While some programs exist and outcomes have been positive, their dissemination is sparse. A need exists to expand nurse navigation into these areas to provide care for these underserved communities. CONCLUSION: Oncology nursing navigation for each of these underserved communities requires a culturally sensitive approach. Many of these approaches are universal to cultural competency and can be applied to most disparate populations. IMPLICATIONS FOR NURSING PRACTICE: Nurses comprise the largest workforce around the globe and are well-equipped to develop navigation programs in some of the most disparate communities around the world. To do so, it is important to use a foundation of building trust, embracing individual differences, providing culturally sensitive education and resources for growth, and good communication.
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Área Carente de Assistência Médica , Enfermagem Oncológica , Navegação de Pacientes , Humanos , Enfermagem Oncológica/tendências , Enfermagem Oncológica/organização & administração , Navegação de Pacientes/organização & administração , Neoplasias/enfermagem , Acessibilidade aos Serviços de SaúdeRESUMO
OBJECTIVES: Provide an overview of how pain impacts mobility in patients with cancer. METHODS: A literature search was conducted in PubMed and on Google Scholar using search terms, cancer pain with mobility, acute and chronic pain syndromes, enhanced recovery after surgery, nursing care, and rehabilitation. Peer-reviewed research studies, review articles, and pain guidelines and position papers were reviewed to provide an overview on cancer pain, its impact on mobility, and the nurse's role in managing pain and optimizing mobility and functional outcomes. RESULTS: Firty-two references were included in this overview. This body of literature is replete with studies on the management of pain; however, the tie between pain and mobility has not been well described aside from the breakthrough pain literature. This manuscript weaves these two important concepts together to better inform nurses and other clinicians regarding the importance of managing pain to even begin mobilizing patients, especially following surgery and for other painful conditions. CONCLUSIONS: Oncology nurses play an integral role in assessing and managing cancer pain. It is important for nurses to recognize how their pain management interventions lead to improved mobility and functioning in patients with cancer. IMPLICATIONS FOR NURSING PRACTICE: Nurses comprise the largest workforce around the globe and are well-equipped to assess and manage cancer pain in all cancer care settings. As leaders within the healthcare team, making recommendations to better control pain and communicating with other team members regarding the pain plan is essential in improving mobility in patients with cancer.
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Dor do Câncer , Neoplasias , Manejo da Dor , Humanos , Dor do Câncer/enfermagem , Neoplasias/complicações , Neoplasias/enfermagem , Manejo da Dor/métodos , Manejo da Dor/enfermagem , Enfermagem Oncológica/métodos , Limitação da Mobilidade , Feminino , Masculino , Papel do Profissional de EnfermagemRESUMO
BACKGROUND: Perianal injuries in adults with hematologic malignancies can result in sepsis or death. Patients on a 36-bed acute care oncology unit experienced increased perianal injuries from 2018 to 2021 based on a chart review, which revealed that 24 patients with leukemia, all of whom had received cytarabine, developed perianal injuries. OBJECTIVES: This study examined whether a nurse-led educational intervention would decrease perianal injuries. METHODS: A survey examined baseline nurse knowledge on perianal injuries. Nurses received a 10-minute in-service education session about perianal injuries, their predisposing factors, and prevention strategies followed by a survey to test their knowledge. Twenty nurses completed the pre- and postintervention surveys. FINDINGS: After the intervention, staff knowledge increased by 33%. One year postintervention, perianal injuries had decreased by more than 50%. Nurse and patient education are vital to decrease perianal injuries in patients with leukemia.
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Neoplasias Hematológicas , Leucemia , Enfermeiras e Enfermeiros , Sepse , Adulto , Humanos , Competência ClínicaRESUMO
BACKGROUND: Transitioning into oncology practice can be challenging for new graduate RNs. High patient acuity, a steep learning curve, psychosocial challenges, and frequent patient deaths can be overwhelming. OBJECTIVES: The purpose of this program was to provide resilience training for new graduate oncology nurses as part of an existing nurse residency program. Building resilience among oncology nurses was a primary goal during the COVID-19 pandemic and continues to be an important goal. METHODS: Resilience training in this program consisted of didactic lectures, personalized goal setting, one-on-one mentoring, and a follow-up support group. Various measurement scales were used at baseline, 6 months, and 12 months to assess resilience, professional quality of life, and new graduate experience measures, including communication and organizational skills. FINDINGS: Resilience significantly declined from baseline to six months; professional quality of life and new graduate experience measures also worsened. Some improvements in organizational skills and communication emerged at 12 months. Results indicate an ongoing need to consider extending nurse residency programs, resilience training, and support beyond the traditional one-year period.
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COVID-19 , Enfermagem Oncológica , Qualidade de Vida , Resiliência Psicológica , Humanos , Enfermagem Oncológica/educação , Feminino , Adulto , Masculino , SARS-CoV-2 , Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/psicologia , Pandemias , Pessoa de Meia-IdadeRESUMO
Objective: Holographic Memory Resolution® (HMR®), a mind-based therapy, has been used for decades as a nonpharmacologic intervention for trauma imprinting to alleviate depression, anxiety, pain, and post-traumatic stress disorder (PTSD). No clinical studies were found examining the use of HMR®. This study examined the feasibility and preliminary efficacy of administering HMR® to individuals experiencing chronic pain and related biopsychosocial symptoms. Methods: A feasibility, mixed-methods study was conducted between October 2021 and July 2022 and included four HMR® sessions over 1-12 weeks. A convenience sample was comprised of 60 adults suffering from chronic physical or emotional pain of 4+ (0-10 scale) over 6+ months at two clinics in the U.S. Baseline and subsequent surveys after sessions 2, 3, and 4 assessed symptom response. Symptoms were longitudinally measured via self-report of depression, anxiety, somatic symptom burden, PTSD, and vitality. Results: 73% completed all four sessions, demonstrating feasibility. Ages ranged from 19 to 80 years, 85% were female, and 87% were Caucasian. 52% reported high risk for toxic stress. Four symptoms decreased significantly: depression (p = 0.05), anxiety (p = 0.03), symptom burden (p < 0.01) and PTSD symptoms (p = 0.01); vitality improved. Conclusions: HMR® may be a feasible intervention to address chronic pain and accompanying biopsychosocial symptoms; a randomized controlled trial is the next step to measure efficacy. Unlike other mind-based therapies, HMR® participants use their own internal language for identification and resolution of the pain. The trauma imprinting can then be gently addressed, and the memory-based components of pain resolved or reduced, which empowers participants to improve their well-being. Trial registration: ClinicalTrials.gov Identifier: NCT05001399.
RESUMO
Patients with cancer who are immunocompromised are at risk for catheter-associated urinary tract infections (CAUTIs). Many recommendations are available for healthcare organizations to use to reduce CAUTIs. Implementing vario.