Evidence-based practice for pain management for cancer patients in an acute care setting.

The purpose of this study is to implement an evidence utilization project using an audit and feedback approach to improve cancer pain management. A three-phased audit and feedback approach was used. A 46-bed oncology nursing unit in the university's cancer centre was selected as a research site. Nursing records extracted from 137 patients (65 for the baseline assessment and 72 for the follow-up audit) were used to examine nurse compliance with four audit criteria derived from best practice guidelines related to the assessment and management of pain. We observed a significant improvement in compliance from baseline to follow-up for the following criteria: documenting the side effects of opioids (2-83%), use of a formalized pain assessment tool (22-75%), and providing education for pain assessment and management to patients and caregivers (0-47%). The audit and feedback method was applicable to the implementation of clinical practice guidelines for cancer pain management. Leadership from both administrative personnel and staff nurses working together contributes to the spread of an evidence-based practice culture in clinical settings. As it was conducted in a single oncology nursing unit and was implemented over a short period of time, the results should be carefully interpreted.

Factors Related to Clinical Competence among Graduating Nursing Students during the COVID-19 Pandemic: A Cross-Sectional Study.

PURPOSE: This study investigated clinical competency, COVID-19-related anxiety, coping strategies, self-efficacy, and perceived stress among graduating nursing students during the COVID-19 pandemic. METHODS: We conducted a cross-sectional survey. Participants were recruited from universities located in four major cities in South Korea. General demographic information, clinical competency, self-efficacy, perceived stress, COVID-19-related anxiety, and coping strategies were assessed using reliable questionnaires. Descriptive statistics, correlations, and multiple regression tests were used to analyze the data. RESULTS: The mean clinical competency, self-efficacy, perceived stress, adaptive coping, and maladaptive coping were 138.16 ± 18.34, 83.85 ±14.02, 21.37 ± 5.79, 53.15 ± 4.64, and 30.98 ± 6.73, respectively. COVID-19-related anxiety was reported by 4.3% of participants. Clinical competency was significantly positively correlated with self-efficacy (r = .44, p < .001) and adaptive coping (r = .20, p = .035) and was significantly negatively correlated with maladaptive coping (r = .20, p = .035). The predictors of clinical competency were self-efficacy (ß = .434, p < .001) and adaptive coping (ß = .173, p < .039), which explained 23% of the variance in clinical competency. CONCLUSION: Self-efficacy and adaptive coping strategies are significant predictors of clinical competence during the pandemic. Planning and implementing various curricular and non-curricular activities to increase senior students' self-efficacy and adaptive coping strategies will help prepare competent nursing graduates for the pandemic when they enter the nursing workforce.

Surgery for posterior communicating artery aneurysms.

The most common site of internal carotid artery (ICA) aneurysms is at the posterior communicating artery (PComA) junction. Although ICA aneurysm surgery carries substantial risk, the ultimate outcome of patients with PComA aneurysms is better than those with aneurysms in other locations. The rate of successful surgical outcome increases when precise knowledge of the anatomy and understanding of the hazards associated with aneurysms in this region are combined with a well organized plan for the surgical approach. This article will describe details of the preoperative considerations, operative techniques, and surgical results for aneurysms arising at the ICA-PComA junction based on the 25-year personal experience of the senior author, comprising a total of 424 surgical cases.

Implementation of best practice for chemotherapy-induced nausea and vomiting in an acute care setting.

BACKGROUND: Chemotherapy-induced nausea and vomiting is the commonest side-effect for patients undergoing cancer treatment with chemotherapy. These symptoms can lead to nutritional deficiencies, dehydration and electrolyte imbalance, and negative impacts on quality of life. However, wide gaps exist between clinician and patient perceptions of nausea and vomiting. Effective communication about these symptoms is essential for proper treatment. We conducted a recent chart review to identify gaps in practice regarding chemotherapy-induced nausea and vomiting assessment and documentation. AIM: The goal of this project was to improve local practice in the management of chemotherapy-induced nausea and vomiting in patients with cancer. METHODS: This study used one pre- and two post-implementation audit strategies utilising the Joanna Briggs Institute Practical Application of Clinical Evidence System (JBI-PACES) and Getting Research into Practice (GRiP) module. The study was conducted in the 33-bed oncology ward of a large acute care hospital in Korea from February 2010 to June 2010. To facilitate evidence-based nursing practice, audit-feedback-re-audit cycles strategies were used. The audits included four criteria recommended by the Joanna Briggs Institute. RESULTS: There were statistically significant improvements in all four criteria. The first post-implementation audit showed that all four audit criteria rated >50% in compliance. At the second follow-up audit, all four audit criteria rated 100% compliance, indicating excellent compliance with best practice. The differences between the pre- and post-data were statistically significant (P < 0.001) for all four audit criteria. CONCLUSIONS: The results indicate that the pre- and post-implementation audits are an effective method in improvement of assessment, documentation and evidence-based nursing implementation for cancer symptom management.