Examining the effect of an education intervention on nurses' medicines management knowledge.

BACKGROUND: Suboptimal medicines management due to inadequate knowledge can cause risks to patient safety and affect the quality of care and patient outcomes. AIM: To examine the effect of an educational programme on nurses' knowledge of medicines management. METHOD: A pre and post-design was used to evaluate the effectiveness of an educational medicines management programme. Data were collected from nurses before and after programme participation from September 2016 to June 2018. A total of 99 nurses received a multiple-choice questionnaire before and after the programme to assess for changes in their knowledge. Any changes in test performance following the medicines management programme were quantified and tested using McNemar's test and the generalised estimating equation for binary outcomes. The Chi-square test was used to analyse group differences. RESULTS: The nurses' scores were significantly improved after the medicines management programme on questions regarding documentation, observation, aseptic technique and pharmacology half-life. There was a significant improvement on one of the five questions relating to medicine calculation when converting doses from milligrams to grams. CONCLUSION: A mandatory hospital medicines management programme had some effect on increasing nurses' knowledge. However, it also was also found that the programme content could have been improved, particularly regarding nurses' responsibilities for medicines management at patient discharge and documentation when undertaking generic substitution.

Efficacy of Acupuncture/Acupressure in the Prevention and Treatment of Nausea and Vomiting Across Multiple Patient Populations: Implications for Practice.

Nausea and vomiting are complex symptoms related to many disease processes. With many pharmacologic interventions noted to have adverse effects, many patients are turning to alternative therapies, including acupuncture and acupressure. Their efficacy has been proven for nausea and vomiting related to pregnancy, in patients receiving chemotherapy, and in postoperative, pediatric, and female patients. There are minimal to no side effects with the use of acupuncture and acupressure for the treatment of nausea and vomiting. Providers should be encouraged to discuss the efficacy, benefits, and side-effect profile of acupuncture and acupressure with patients who suffer from nausea and vomiting.

Nursing students' perspectives on learning math for medication calculations in a Canadian nursing program in Qatar.

This study describes nursing students' perspectives on learning math for medication calculations in a Canadian baccalaureate nursing program in Qatar. There is a dearth of guidance within the nursing literature to support teachers to develop pedagogical methods to help improve students' math competence. Moreover, the challenge of teaching math skills to student nurses in Qatar is particularly difficult because there is little standardization of curricula in secondary education. Data collected from focus groups was analyzed using interpretive description. Focus groups included, Group 1 those students who were beginning to learn math for medication calculations and had not completed the required math module and Group 2, students who had not yet completed the math module. Themes emerging from the data included from first year students, 1. Fear of math resulting in resistance to learning math for medication administration. 2. Student success is dependent on good instructors. 3. Student resentment towards perceived 'complicated' math in the nursing program. Themes from second year students included 1. Lack of nursing student's confidence with medication calculation within the clinical settings 2. Lack of self-directedness to uptake math knowledge 3. Incongruence amongst clinical instructors with applied math practice whilst in the clinical setting.

Validation of the Arabic Version of the Chemotherapy-Induced Peripheral Neuropathy Assessment Tool.

BACKGROUND: Chemotherapy-induced peripheral neuropathy results in multidimensional neurological and muscular symptoms, which interfere with the patients' daily life. AIM: Examine the psychometric properties of the Arabic version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) among adult cancer patients. METHOD: A descriptive study design was used. A convenience sample of 210 patients was assigned to two groups: 135 who received chemotherapies of known neurotoxic potential and 75 who served as a comparison group. Translation and back-translation considering cross-cultural issues to produce the Arabic version of CIPNAT was used. Test-retest and internal consistency reliability were used to test the reliability of the tool, whereas for the validity, content and construct validity were assessed. RESULTS: Test-retest scores for the overall scale (r = 0.98, p = < .001), for the symptom experience subscale (r = 0.97, p = <.001), and for the interference subscale (r = 0.96, p = < .001) all showed evidence of reliability. Cronbach α coefficients were 0.97, 0.96, and 0.95 for the total scores, symptoms experience, and interference scales, respectively. Items to total correlation ranged from moderate to strong (0.55-0.81). The Content Validity Index was 0.83. The data support the evidence of discriminant validity, as significant differences were found between the groups with regard to symptom experience (t = 8.51, p = < .001), interference (t = 5.60, p = <.001), and total score (t = 7.88, p = < .001). CONCLUSIONS: The Arabic version of CIPNAT showed adequate reliability and validity to screen for chemotherapy-induced peripheral neuropathy symptoms and their interference in Arab countries. Further studies are needed to evaluate concurrent validity.

Effects of Implementing Standardized Organizational Interventions on Drug Therapy Management (DTM): A Quasi-Experimental Study.

SUMMARY: Background. Interruptions occurring during the drug preparation and administration have a documented effect on patients' safety. However, literature has paid little attention to show how the introduction of a set of standardized organizational interventions, based on the combination of the current evidence, could reduce the number of interruptions occurring during drug therapy management. For this reason, this study used the most recent evidence to combine a set of standardized organizational interventions, and it was aimed to assess the effect of those interventions on the number of interruptions occurring during drug therapy management (Hypothesis a) and the overall duration of the therapy administration (Hypothesis b). Methods. A quasi-experimental study was performed, using pre- and a post- organizational implementation data collections in a single Italian center. The data collections were related to the interruptions and 40 shifts were randomly selected for both pre- and post-phase, respectively on December 2016 and February 2017. The standardized organizational interventions were implemented using the current evidence on this topic. Results. The standardized organizational interventions decreased the interruptions in the post-implementation phase, but those had not an effect on the duration of the therapy administration. Conclusions. This study represented an updated evidence, which describes the effect of a standardized and evidence-based set of organisational interventions' implementation on drug therapy management. Our results suggest a number of hints for managers and future researches. Managers should keep into account the usefulness of those interventions, while future researches with experimental designs are needed to provide harder evidence on this topic.

Adaptation and preliminary testing of the registered nursing forecasting (RN4CAST) nurse survey for use in the ambulatory chemotherapy setting.

PURPOSE: This study aimed to adapt the Registered Nurse Forecast (RN4CAST) nurse survey making it appropriate to assess the working environments of ambulatory chemotherapy nurses, specifically focusing on care left undone. METHOD: A two-phase approach was used. Firstly, cognitive interviews were conducted to adapt role specific sections of the RN4CAST nurses survey. The interviews were analysed to assess comprehension, retrieval, judgement and response processes to create the RN4CAST-chemotherapy assessment tool (CAT) survey. Secondly, a single centre feasibility study was undertaken to assess acceptability of the RN4CAST-CAT survey in an ambulatory chemotherapy setting. Results of the feasibility study were analysed using descriptive statistics and compared with routinely collected patient experience data. RESULTS: The cognitive interviews (n=6) resulted in important amendments to the RN4CAST-CAT. Response rate to the feasibility study was acceptable at 57% (n=12) and item completion rate was good (on average only 1 response missing per item). On average nurses looked after nine patients per shift, administered seven chemotherapy treatments and worked an hour and 10 min over their contracted time. Main areas of care left undone were related to verbal communication with patients and assessing patient comorbidities and toxicities. CONCLUSIONS: We were able to adapt the RN4CAST to make it suitable for use in the ambulatory chemotherapy setting. Our study offers preliminary evidence that the RN4CAST-CAT and methodology are feasible and acceptable within the ambulatory chemotherapy setting. Larger scale testing is now required and if validated the RN4CAST-CAT has the potential to provide useful insights into the impact of nursing workload on staff experience, patient care and outcomes on ambulatory chemotherapy settings.

Nursing process for a patient with needle phobia: a case study.

OBJECTIVES: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. METHODS: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. RESULTS: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. FINAL CONSIDERATIONS: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.

La adherencia al tratamiento farmacológico en las consultas enfermeras de atención primaria: observar y comprender / Adherence to pharmacological treatment in nurses primary care consultations: observe and understand

La falta de adherencia al tratamiento farmacológico es un problema prevalente en la práctica clínica, especialmente en el tratamiento de enfermedades crónicas. Las enfermeras de Atención Primaria tienen un papel importante en la identificación del cumplimiento terapéutico y la detección de las dificultades del paciente, así como para evitar fracasos terapéuticos y tasas de hospitalización, disminuir costes sanitarios y mejorar la calidad de vida de los pacientes. El objetivo general del estudio es describir las situaciones y dificultades observadas en las consultas enfermeras de atención primaria en el abordaje del tratamiento farmacológico en el paciente crónico, con la finalidad de elaborar una guía y un protocolo de actuación. MÉTODOS: Estudio cualitativo mediante la técnica de observación participante realizado en 2018, en cinco consultas enfermeras de tres Áreas Básicas de Salud del Alt Penedès (Barcelona). El análisis de los datos se realizó con el programa WeftQda versión 1.0.1. RESULTADOS: Surgieron tres dimensiones y siete subdimensiones: adherencia al tratamiento farmacológico, educación para la salud y gestión del tiempo en las consultas. CONCLUSIONES: Se identificaron diferentes predictores que interfieren en la adherencia al tratamiento farmacológico; entre ellos, la gestión de medicamentos genéricos, la dificultad de seguir el tratamiento farmacológico a largo plazo y la complejidad de muchos tratamientos crónicos. Cabe destacar la dificultad de comprensión del tratamiento y la dificultad del registro. Uno de los puntos fuertes de las enfermeras de atención primaria es la proximidad con el paciente

The lack of adherence to drug treatment is a prevalent problem in clinical practice, especially in the treatment of chronic diseases. Primary Care nurses have an important role in identifying therapeutic compliance and in detecting patient difficulties, avoiding therapeutic failures, hospitalization rates, reducing healthcare costs and improving patients' quality of life. The general objective of the study is to describe the situations and difficulties observed in the nurses consultations of primary care in the approach of the pharmacological treatment in the chronic patient; the purpose is to be able to elaborate a guide and an action protocol. METHODOLOGY: Qualitative study using the participant observation technique carried out in 2018, in 5 nurses consultations of three Basic Health Areas of Alt Penedès (Barcelona). The data analysis was performed with the WeftQda program version 1.0.1. RESULTS: Three dimensions and seven subdimensions emerged: adherence to drug treatment, health education and time management in the consultations. CONCLUSIONS: Different predictors have been identified that interfere with adherence to pharmacological treatment, including the management of generic medications, the difficulty of following long-term pharmacological treatment and the complexity of many chronic treatments. Note the difficulty of understanding the treatment and the difficulty of registration. One of the strengths of primary care nurses is the proximity to the patient, which gives them better patient knowledge and facilitates the approach to treatment adherence

A work system analysis of the medication administration process in a Norwegian nursing home ward.

Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process.

Occupational Exposure in Health Care Personnel to Antineoplastic Drugs and Initiation of Safe Handling in Hong Kong: A Literature Review.

Despite the benefits for patients as cancer treatment, antineoplastic drugs may cause adverse effects not only in patients but also in health care personnel. Apart from minor symptoms, antineoplastic agents can cause serious health problems. However, protection from occupational exposures to antineoplastic drugs varies between pharmacy staff and nurses. While protection used for pharmacy staff are more advanced, personal protective equipment seems to be the only protection for most nurses around the world. Exposure can never be totally prevented, but it should be minimized at all costs. Guidelines and recommendations have been published; however, these guidelines do not have legal enforcement power. This article aims to provide a literature review on the occupational exposure of health care personnel to antineoplastic drugs and to reflect the current status in Hong Kong.

Dilution is no solution.

Some nurses continue to routinely dilute I.V. push medications, a practice associated with a high risk of errors. This article reviews correct practices for administering I.V. push medications.

A Lean Approach to Improve Medication Administration Safety by Reducing Distractions and Interruptions.

BACKGROUND: Medication errors are potentially avoidable incidents that can lead to harm. Medications are often administered under challenging conditions, which creates opportunities for distractions and interruptions. PURPOSE: The aim of this study was to reduce the number of interruptions and distractions experienced by nurses during the medication administration process. METHODS: A Lean approach was used to value stream map the process, devise solutions, and measure the impact of the change. RESULTS: Sources of distraction and interruption were identified. Through collaboration the medication administration process was standardized, and a purpose-built medication administration room was developed. Frequency of interruptions and distractions from all sources was reduced. CONCLUSIONS: Value stream mapping the process enabled the identification of non-value-added activities that were threats to the integrity of the process. Standardizing the medication administration process and creating a safe space to facilitate the process successfully reduced interruptions and distractions from all sources.

Chemotherapy appointment scheduling and daily outpatient-nurse assignment.

Chemotherapy planning and patient-nurse assignment problems are complex multiobjective decision problems. Schedulers must make upstream decisions that affect daily operations. To improve productivity, we propose a two-stage procedure to schedule treatments for new patients, to plan nurse requirements, and to assign the daily patient mix to available nurses. We develop a mathematical formulation that uses a waiting list to take advantage of last-minute cancellations. In the first stage, we assign appointments to the new patients at the end of each day, we estimate the daily requirement for nurses, and we generate the waiting list. The second stage assigns patients to nurses while minimizing the number of nurses required. We test the procedure on realistically sized problems to demonstrate the impact on the cost effectiveness of the clinic.

Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study.

Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.

Diagnósticos de enfermagem associados a qualidade de vida de mulheres com câncer de mama em quimioterapia / Nursing diagnostics associated with the quality of life of women with breast cancer in chemotherapy / Diagnósticos de enfermería asociados a la calidad de vida de mujeres con cáncer de mama en quimioterapia

Objetivo: Identificar diagnósticos de enfermagem em mulheres com câncer de mama em quimioterapia por meio do mapeamento cruzado dos problemas de saúde com a taxonomia NANDA-I. Método: Estudo descritivo transversal realizado com cinco enfermeiros e 75 mulheres com câncer de mama em quimioterapia, desenvolvido em três fases: levantamento dos problemas de saúde por meio de instrumentos de avaliação da qualidade de vida relacionada à saúde; mapeamento cruzado dos problemas de saúde com características definidoras, fatores relacionados, fatores de risco e títulos diagnósticos; validação do mapeamento por juízes. Resultados: Foram identificados 24 problemas de saúde associados a 13 diagnósticos de enfermagem. Oito foram identificados, com índice de validade de conteúdo ≥ 0,8. Conclusão: O estudo permitiu realizar o mapeamento de diagnósticos de enfermagem a partir de problemas de saúde identificados, por meio de instrumentos de qualidade de vida, em mulheres com câncer de mama em tratamento quimioterápico

Objective: To identify nursing diagnoses in women with breast cancer in chemotherapy through the cross-mapping of health problems with the NANDA-I taxonomy. Method: A cross-sectional descriptive study carried out with five nurses and 75 women with breast cancer in chemotherapy, developed in three phases: survey of health problems by health-related quality of life assessment instruments; cross-mapping of health problems with defining characteristics, related factors, risk factors and diagnostic titles; validation of mapping by judges. Results: 24 health problems associated with 13 nursing diagnoses were identified. Eight were identified, with content index validity ≥0.8. Conclusion: The study allowed the mapping of nursing diagnoses from identified health problems, through quality of life instruments, in women with breast cancer under chemotherapeutic treatment

Objetivo: Identificar diagnósticos de enfermería en mujeres con cáncer de mama en quimioterapia a través del mapeo cruzado de los problemas de salud con la taxonomía NANDA-I. Método: Estudio descriptivo transversal realizado con cinco enfermeros y 75 mujeres con cáncer de mama en quimioterapia, desarrollado en tres fases: levantamiento de los problemas de salud por medio de instrumentos de evaluación de la calidad de vida relacionada a la salud; el mapeo cruzado de los problemas de salud con características definidoras, factores relacionados, factores de riesgo y títulos diagnósticos; validación del mapeo por jueces. Resultados: Se identificaron 24 problemas de salud asociados a 13 diagnósticos de enfermería. Ocho fueron identificados, con índice de validez de contenido ≥0,8. Conclusión: El estudio permitió realizar el mapeo de diagnósticos de enfermería a partir de problemas de salud identificados, por medio de instrumentos de calidad de vida, en mujeres con cáncer de mama en tratamiento quimioterápico

Administração de medicamentos por via enteral: o saber e a práxis da enfermagem frente a resposta terapêutica / Administration of medicines through enteral: nursing knowledge and praxis in view of the therapeutic response / Administración de medicamentos a través de enteral: conocimiento de enfermería y praxis en vista de la respuesta terapéutica

Trata-se de um estudo descritivo de abordagem quantitativa. Teve como objetivos identificar e discutir o conhecimento da equipe de enfermagem na administração de medicamentos por via enteral quanto a resposta terapêutica na práxis da assistência de enfermagem. Foi realizado em quatro instituições hospitalares públicas, nas cidades de Cabo Frio e em Arraial do Cabo, no Estado do Rio de Janeiro, Brasil. Os sujeitos foram 103 profissionais da enfermagem, entre eles: enfermeiros, técnicos de enfermagem e auxiliares de enfermagem dos setores de clínica médica e cirúrgica. Os dados foram coletados no período entre fevereiro a abril 2019, através de questionário semiestruturado, e realizada a análise estatística descritiva dos dados. As implicações farmacêuticas, legais e técnicas do fornecimento de medicamentos via enteral não são amplamente compreendidas pela equipe de enfermagem. Verificou-se a necessidade de recomendar aos Conselhos de Enfermagem a elaboração de manuais e/ou protocolos com o intuito de evitar possíveis eventos adversos na administração de medicamentos por via enteral, aumentando a segurança e a eficácia da terapêutica em questão, auxiliando na redução de danos ao paciente.(AU)

Nursing process for a patient with needle phobia: a case study / Proceso de enfermería para paciente con fobia a las agujas: estudio de caso / Processo de enfermagem para paciente com fobia de agulha: estudo de caso

ABSTRACT Objectives: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework. Methods: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear. Results: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear. Final Considerations: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.

RESUMEN Objetivos: informar sobre un caso clínico de fobia a las agujas derivado en paro cardiorrespiratorio, describir los resultados de un plan de atención orientado a diagnósticos de miedo y ansiedad, sobre referencial del Modelo de Adaptación de Roy. Métodos: estudio de caso observado en ambulatorio de quimioterapia de Rio de Janeiro. El trabajo profesional estuvo orientado por el proceso de enfermería, respaldado por utilización de instrumentos evaluadores de la red venosa, ansiedad y miedo. Resultados: el Modelo de Adaptación de Roy ofreció la propuesta de intervenciones de enfermería que le faciliten al sujeto estudiado adaptación a los estímulos externos e internos disparadores del síncope vasovagal. Los instrumentos indicaron que el catéter semiimplantado es el dispositivo de acceso venoso más adecuado, resultando en mejoras de los niveles de ansiedad y miedo. Consideraciones Finales: una vez realizadas las actividades de enfermería, la ansiedad disminuyó y el paciente obtuvo mayor autocontrol del miedo.

RESUMO Objetivos: reportar um caso clínico de fobia de agulha que culminou em parada cardiorrespiratória e descrever os resultados de um plano assistencial voltado aos diagnósticos de medo e ansiedade, tendo como referencial o Modelo de Adaptação de Roy. Métodos: estudo de caso, desenvolvido em ambulatório de quimioterapia do Rio de Janeiro. A atuação profissional foi orientada pelo processo de enfermagem e subsidiada pelo uso de instrumentos de avaliação da rede venosa, ansiedade e medo. Resultados: o Modelo de Adaptação de Roy facultou a proposição de intervenções de enfermagem que permitiram ao sujeito do estudo uma adaptação aos estímulos externos e internos desencadeadores de síndrome vasovagal. Os instrumentos indicaram a escolha de um cateter semi-implantado como dispositivo de acesso venoso adequado que resultou na melhora dos níveis de ansiedade e medo. Considerações Finais: após o desenvolvimento das atividades de enfermagem, a ansiedade diminuiu e o paciente obteve maior autocontrole do medo.