Patient, Nurse, and Organizational Factors That Influence Evidence-Based Fall Prevention for Hospitalized Oncology Patients: An Exploratory Study.

BACKGROUND: Hospital falls remain common despite decades of studies and guidelines to reduce their rate. Research evidence alone is insufficient, and integration of patient values and preferences, clinician expertise and experiences, and organizational culture is needed to ensure sustainable practice changes. Little is known about the best strategies for integrating these constructs to sustain effective fall prevention programs. AIMS: Guided by the Comprehensive Framework for Implementation Research (CFIR), this study aimed to identify patient, nursing staff, and organizational-level factors that influence effective and sustainable fall prevention strategies with the goal of identifying variables amenable to targeted interventions. METHODS: A descriptive research design engaged four oncology units in a Midwestern academic medical center and included patients (N = 39) and nursing staff (N = 70). Questionnaire data were collected from patients with interview assistance, and nursing staff completed a demographic form and two standardized instruments adapted for the study. Data were analyzed using descriptive statistics and narrative summaries. RESULTS: Findings indicated two-thirds of patients did not see themselves at risk for falling, despite nearly half having a fall history. Nursing staff indicated knowledge gaps related to specific known risks and interventions, and confidence in fall prevention management was lowest for team communication about patient risks and engaging patients and families in preventing falls. LINKING EVIDENCE TO ACTION: Engagement of patients in fall risk assessment and management, clear and routine communication among team members, and creating a culture of true engagement with appropriate leadership and resources can potentially improve the sustainability of successful fall prevention programs. The CFIR can guide the planning of fall prevention and other evidence-based practice changes to become hardwired and sustainable over time even with the ongoing introduction of new initiatives.

Comparing the ratio of mean red blood cell transfusion episode rate of 1 unit versus 2 units in hematopoietic stem cell transplant patients.

BACKGROUND: Two units of red blood cells (RBCs) were typically transfused with each transfusion among hematopoietic stem cell transplant (HSCT) patients. Concerns regarding this practice are increased morbidity, mortality, hospital-acquired infections, length of stay (LOS), and transfusion-related complications. This study compared outcomes of transfusing 1 unit of RBCs per transfusion episode to 2 units of RBCs per episode among HSCT patients. STUDY DESIGN AND METHODS: A retrospective record review was used to evaluate a practice change of transfusing 1 RBC unit per episode among autologous and allogeneic HSCT patients. Primary endpoints included: 1) mean number of RBC transfusion episodes during the hospital stay, 2) mean number of RBC units transfused adjusted by LOS, and 3) mean LOS. RESULTS: Among autologous patients, the ratio of mean rate of transfusion episodes for transfusing 1 unit versus 2 units per transfusion was 1.24, with a one-tailed 95% upper limit of 1.42. With a noninferiority upper bound of 1.50, using 1 unit per transfusion episode was noninferior to 2 units per transfusion episode (p = 0.011). Among allogeneic HSCT patients, the ratio of mean transfusion episode rate was 1.26 with a one-tailed 95% upper limit of 1.52, which was slightly above the 1.50 noninferiority bound (p = 0.061). CONCLUSION: A single-unit transfusion policy was not inferior to the 2-unit policy for autologous HSCT patients and trended toward noninferiority for allogeneic transplant patients. The mean volume of blood per LOS was lower for the 1-unit practice for both groups. The gains from the practice change may outweigh the risks of not changing.

Broadening cultural sensitivity at the end of life: an interprofessional education program incorporating critical reflection.

UNLABELLED: BACKGROUND/PROBLEM: End-of-life beliefs and practices are as varied as one's culture. Little is known about what interventions are effective in developing clinician's skills to deliver culturally sensitive end-of-life care. PURPOSE: Using a pre-post design, this pilot study aimed to evaluate the impact of a 2-stage educational program on enhancing clinician's knowledge and comfort in addressing and honoring diverse end-of-life care beliefs, as well as developing higher levels of cultural competence. METHODS: Twenty-four interprofessional team members practicing on a combined medical-surgical oncology unit attended an in-service session on the end-of-life care beliefs, practices, and preferences of the Latino, Russian, and Micronesian cultures and then participated in critical reflection sessions where culturally specific end-of-life care cases were discussed using a structured dialogue guide. Outcomes measured were cultural competence using the Intercultural Development Inventory, Frommelt Attitudes Toward Caring of the Dying, knowledge of cultural beliefs/traditions, and self-perceived comfort in providing culturally sensitive end-of-life care. FINDINGS: Collectively, the Intercultural Development Inventory showed that the team's perceived cultural competence was at the level of "acceptance" whereas team's developmental orientation was "minimization," meaning that the team overestimated its cultural competence. The t tests showed no significant differences between pre-post attitude and knowledge scores (P > .05). Despite these findings, staffs' perceived level of understanding of end-of-life care beliefs, preferences, and practices of the Latino, Russian, and Micronesian cultures, as well as comfort and effectiveness in providing culturally sensitive end-of-life care, were higher after the in-service and critical reflection sessions (P < .05). CONCLUSION: This 2-stage educational program did not significantly advance the team along the intercultural development continuum, nor did it significantly change knowledge and attitudes, likely due to the small sample and that maturity in cultural competence, evolves over a longer period of time. Educational programs that incorporate critical reflection sessions that promote interprofessional dialogue and learning, however, are promising practices for advancing cultural competence that are worthy of more rigorous study.