EBP education and skills building for leaders: An RCT to promote EBP infrastructure, process and implementation in a comprehensive cancer center.

BACKGROUND: Implementation of evidence-based practice (EBP) in healthcare remains challenging. The influence of leadership has been recognized. However, few randomized trials have tested effects of an educational and skills building intervention for leaders in clinical settings. AIMS: Test effects of an EBP leadership immersion intervention on EBP attributes over time among two cohorts of leaders at a national comprehensive cancer center. METHODS: A stratified, randomized, wait-list group, controlled design was conducted. Participants received the evidence-based intervention one year apart (2020, n = 36; 2021, n = 30) with EBP knowledge, beliefs, competencies, implementation self-efficacy, implementation behaviors, and organizational readiness measured at pre- and post-intervention, and one- and two-year follow-ups. Participants applied learnings to a specific clinical or organization priority topic. RESULTS: Baseline outcomes variables and demographics did not differ between cohorts except for age and years of experience. Both cohorts demonstrated significant changes in EBP attributes (except organizational readiness) post-intervention. Mixed linear modeling revealed group by time effects at 3-months for all EBP attributes except implementation behaviors and organizational readiness after the first intervention, favoring cohort 2020, with retained effects for EBP beliefs and competencies at one year. Following Cohort 2021 intervention, at 12-weeks post-intervention, implementation behaviors were significantly higher for cohort 2021. LINKING EVIDENCE TO ACTION: An intensive EBP intervention can increase healthcare leaders' EBP knowledge and competencies. Aligning EBP projects with organizational priorities is strategic. Follow-up with participants to retain motivation, knowledge and competencies is essential. Future research must demonstrate effects on clinical outcomes.

Use of Exemplars: Identification of Best Practices in Cancer Prevention and Screening.

BACKGROUND: Prevention strategies help to teach what individuals can do to potentially offset cancer risks. Screenings can detect cancer at earlier stages, allowing for earlier treatments and better outcomes. OBJECTIVES: This article seeks to identify best practices in cancer prevention and screening. METHODS: This article presents exemplars in oncology nursing that illustrate implementation of best practices for cancer prevention and screening. FINDINGS: Oncology nurses are well situated to not only provide education about prevention activities, but also to encourage participation in recommended screenings. Implementation of evidence-based practice, along with the nurses' clinical knowledge and patient preferences, allows for the best outcomes for patients. The use of exemplars is an ideal way of telling nurses' stories to share their experiences and how they affected patient outcomes.

Pain Assessment: Use of the Defense and Veterans Pain Rating Scale in Patients With Cancer.

BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice. From postimplementation chart review and clinician satisfaction surveys, the DVPRS was evaluated for the following. FINDINGS: Seventy-eight percent of nurses surveyed (N = 64) preferred the DVPRS over any other pain assessment tool. Inpatient and ambulatory patients surveyed (N = 144) agreed that a Likert-type scale in the DVPRS was easier to understand, easier to use, and better in describing their pain than the numeric rating scale.

Global perspectives on cancer survivorship: From lost in transition to leading into the future.

In the decade since the Institute of Medicine's 2006 landmark report, entitled From cancer patient to cancer survivor: Lost in transition, cancer survivorship increasingly has become a distinct phase in the cancer journey. While much progress has been made toward creating a system of care that optimally addresses survivors' needs, significant gaps remain. An international symposium to discuss and explore global challenges in cancer survivorship care was held at the Canadian Association of Nurses in Oncology (CANO/ACIO) conference in Calgary, Alberta, in October 2016. In this paper, we summarize presentations from that symposium, exploring cancer survivorship care from Canadian, American, and International perspectives, and describing challenges, issues and gaps. Strategies are also discussed for oncology nurses, individually and collectively, to provide future leadership in shaping survivorship care to be more person centered and equity oriented.

Practice Innovations, Change Management, and Resilience in Oncology Care Settings.

Our commitment to advancing nursing practice and quality care for our patients must be at the forefront of our minds. Nursing's role in designing and implementing new innovations is integral to the advancement of healthcare delivery across the country.

Optic and otic side effects of molecular targeted therapies.

OBJECTIVES: To discuss the optic and otic toxicities associated with molecular targeted therapies including description, presentation, grading, and management of these toxicities. DATA SOURCES: PubMed, CINAHL, the Cochrane Library and nursing text books. CONCLUSION: Although targeted therapies often do not have the same systemic toxicities as chemotherapy, they have their own unique side effects. Optic and otic toxicities are seen with a variety of targeted therapies and, although these are not life-threatening toxicities, they do have the potential to severely impair a patient's quality of life. IMPLICATIONS FOR NURSING PRACTICE: Baseline optic and otic assessments along with periodic assessments throughout treatment can lead to early recognition of problems with the eyes or ears. Recognition and treatment of these problems will help maintain the patient's quality of life.

Evidence-based management of sepsis.

Sepsis is a potential life-threatening oncologic emergency. Early recognition and prompt intervention can decrease the morbidity and mortality associated with sepsis. The Surviving Sepsis Campaign Guidelines Committee updated its recommendations in 2012, outlining specific evidence-based interventions to manage sepsis.

Recommendations from a consensus development workshop on the diagnosis of fetal alcohol spectrum disorders in Australia.

BACKGROUND: Fetal alcohol spectrum disorders (FASD) are underdiagnosed in Australia, and health professionals have endorsed the need for national guidelines for diagnosis. The aim of this study was to develop consensus recommendations for the diagnosis of FASD in Australia. METHODS: A panel of 13 health professionals, researchers, and consumer and community representatives with relevant expertise attended a 2-day consensus development workshop to review evidence on the screening and diagnosis of FASD obtained from a systematic literature review, a national survey of health professionals and community group discussions. The nominal group technique and facilitated discussion were used to review the evidence on screening and diagnosis, and to develop consensus recommendations for the diagnosis of FASD in Australia. RESULTS: The use of population-based screening for FASD was not recommended. However, there was consensus support for the development of standard criteria for referral for specialist diagnostic assessment. Participants developed consensus recommendations for diagnostic categories, criteria and assessment methods, based on the adaption of elements from both the University of Washington 4-Digit Diagnostic Code and the Canadian guidelines for FASD diagnosis. Panel members also recommended the development of resources to: facilitate consistency in referral and diagnostic practices, including comprehensive clinical guidelines and assessment instruments; and to support individuals undergoing assessment and their parents or carers. CONCLUSIONS: These consensus recommendations provide a foundation for the development of guidelines and other resources to promote consistency in the diagnosis of FASD in Australia. Guidelines for diagnosis will require review and evaluation in the Australian context prior to national implementation as well as periodic review to incorporate new knowledge.

Discovering multiple myeloma early in ambulatory patients with chest pain.

Multiple myeloma (MM) is a systemic malignancy of plasma cells often characterized by sternal, rib, or back pain. This article describes how a patient who had chest pain for more than one month was mistakenly diagnosed with reflux esophagitis. Healthcare providers should be mindful of MM when determining the source of unidentified chest pain in patients.

A modified Delphi study of screening for fetal alcohol spectrum disorders in Australia.

BACKGROUND: There is little reliable information on the prevalence of fetal alcohol spectrum disorders (FASD) in Australia and no coordinated national approach to facilitate case detection. The aim of this study was to identify health professionals' perceptions about screening for FASD in Australia. METHOD: A modified Delphi process was used to assess perceptions of the need for, and the process of, screening for FASD in Australia. We recruited a panel of 130 Australian health professionals with experience or expertise in FASD screening or diagnosis. A systematic review of the literature was used to develop Likert statements on screening coverage, components and assessment methods which were administered using an online survey over two survey rounds. RESULTS: Of the panel members surveyed, 95 (73%) responded to the questions on screening in the first survey round and, of these, 81 (85%) responded to the second round. Following two rounds there was consensus agreement on the need for targeted screening at birth (76%) and in childhood (84%). Participants did not reach consensus agreement on the need for universal screening at birth (55%) or in childhood (40%). Support for targeted screening was linked to perceived constraints on service provision and the need to examine the performance, costs and benefits of screening.For targeted screening of high risk groups, we found highest agreement for siblings of known cases of FASD (96%) and children of mothers attending alcohol treatment services (93%). Participants agreed that screening for FASD primarily requires assessment of prenatal alcohol exposure at birth (86%) and in childhood (88%), and that a checklist is needed to identify the components of screening and criteria for referral at birth (84%) and in childhood (90%). CONCLUSIONS: There is an agreed need for targeted but not universal screening for FASD in Australia, and sufficient consensus among health professionals to warrant development and evaluation of standardised methods for targeted screening and referral in the Australian context. Participants emphasised the need for locally-appropriate, evidence-based approaches to facilitate case detection, and the importance of ensuring that screening and referral programs are supported by adequate diagnostic and management capacity.

Long-term forecasting of anesthesia workload in operating rooms from changes in a hospital's local population can be inaccurate.

BACKGROUND: Anesthesia department planning depends on forecasting future demand for perioperative services. Little is known about long-range forecasting of anesthesia workload. METHODS: We studied operating room (OR) times at Hospital A over 16 yr (1991-2006), anesthesia times at Hospital B over 26 yr (1981-2006), and cases at Hospital C over 13 yr (1994-2006). Each hospital is >100 yr old and is located in a US city with other hospitals that are >50 yr old. Hospitals A and B are the sole University hospitals in their metropolitan statistical areas (and many counties beyond). Hospital C is the sole tertiary hospital for >375 km. RESULTS: Each hospital's choice of a measure of anesthesia work to be analyzed was likely unimportant, as the annual hours of anesthesia correlated highly both with annual numbers of cases (r = 0.98) and with American Society of Anesthesiologist's Relative Value Guide units of work (r = 0.99). Despite a 2% decline in the local population, the hours of OR time at Hospital A increased overall (Pearson r = -0.87, P < 0.001) and for children (r = -0.84). At Hospital B, there was a strong positive correlation between population and hours of anesthesia (r = 0.97, P < 0.001), but not between annual increases in population and workload (r = -0.18). At Hospital C, despite a linear increase in population, the annual numbers of cases increased, declined with opening of two outpatient surgery facilities, and then stabilized. The predictive value of local personal income was low. In contrast, the annual increases in the hours of OR time and anesthesia could be modeled using simple time series methods. CONCLUSIONS: Although growth of the elderly population is a simple justification for building more ORs, managers should be cautious in arguing for strategic changes in capacity at individual hospitals based on future changes in the national age-adjusted population. Local population can provide little value in forecasting future anesthesia workloads at individual hospitals. In addition, anesthesia groups and hospital administrators should not focus on quarterly changes in workload, because workload can vary widely, despite consistent patterns over decades. To facilitate long-range planning, anesthesia groups and hospitals should save their billing and OR time data, display it graphically over years, and supplement with corresponding forecasting methods (e.g., staff an additional OR when an upper prediction bound of workload per OR exceeds a threshold).

Putting evidence into practice: prevention of infection.

The prevention of infection is an important outcome to measure in patients with cancer because infectious complications are a significant cause of morbidity and mortality. Nurses play a vital role in the prevention of infection in patients with cancer through nursing practice, research, and patient education. However, many common nursing interventions to prevent infection are based on tradition or expert opinion and have not been subjected to scientific examination. The 2005 Oncology Nursing Society Prevention of Infection Outcomes Intervention Project Team reviewed, critiqued, and summarized the research evidence for nursing interventions to prevent infections in patients with cancer. Pharmacologic and nonpharmacologic interventions were included because many advanced practice nurses prescribe medications. This article is an evidence-based review of nursing interventions to prevent infection in patients with cancer.

Nursing-sensitive patient outcomes: the development of the Putting Evidence into Practice resources for nursing practice.

The Oncology Nursing Society (ONS) has worked diligently to improve the care of patients with cancer and their families. A recent project that demonstrates this commitment toquality care is the development of nursing-sensitive patient outcomes resources. ONS has teamed researchers, advanced practice nurses, and staff nurses to develop Putting Evidence Into Practice resources that provide guidance for nursing interventions based on the evidence. The ability to provide evidence for nursing interventions is critical to all aspects of patient care, including patient teaching, development of patient care policies and procedures, and provision of direct patient care.