Haematology Nurses Research Articles

The Hospital at Home program: no place like home.

The treatment of children with cancer is associated with significant burden for the entire family. Frequent clinic visits and extended hospital stays can negatively affect quality of life for children and their families. Here, we describe the development of a Hospital at Home program (H@H) that delivers therapy to pediatric hematology, oncology, and blood and marrow transplant (bmt) patients in their homes. The services provided include short infusions of chemotherapy, supportive-care interventions, antibiotics, post-chemotherapy hydration, and teaching. From 2013 to 2015, the H@H program served 136 patients, making 1701 home visits, for patients mainly between the ages of 1 and 4 years. Referrals came from oncology in 82% of cases, from hematology in 11%, and from bmt in 7%. Since inception of the program, no adverse events have been reported. Family surveys suggested less disruption in daily routines and appreciation of specialized care by hematology and oncology nurses. Staff surveys highlighted a perceived benefit of H@H in contributing to early discharge of patients by supporting out-of-hospital monitoring and teaching. The development of a H@H program dedicated to the pediatric hematology, oncology, or bmt patient appears feasible. Our pilot program offers a potential contribution to improvement in patient quality of life and in cost-benefit for parents and the health care system.

Striving for good nursing care: nurses' experiences of do not resuscitate orders within oncology and hematology care.

Within oncology and hematology care, patients are sometimes considered to have such a poor prognosis that they can receive a do not resuscitate order from the physician responsible, stipulating that neither basic nor advanced coronary pulmonary rescue be performed in the event of a cardiac arrest. Studies on do not resuscitate decisions within oncology and hematology units, focusing on the specific role of the nurse in relation to these decisions, are scarce. The aim of this study was to investigate hematology and oncology nurses' experiences and perceptions of do not resuscitate orders, in order to achieve a deeper understanding of the nurses' specific role in these decisions. A qualitative, descriptive methodology with individual semi-structured interviews was used. A total of 15 nurses from eight hematology/oncology wards in four hospitals in Sweden were interviewed individually. In accordance with national regulations, an ethical review was not required for this study. The research followed international guidelines for empirical research, as outlined in the Helsinki Declaration. The nurses strived for good nursing care through balancing harms and goods and observing integrity and quality of life as important values. Experienced hindrances for good care were unclear and poorly documented decisions, uninformed patients and relatives, and disagreements among the caregivers and family. The nurses expressed a need for an ongoing discussion on do not resuscitate decisions, including all concerned parties. In order to provide good nursing care, nurses need clear and well-documented do not resuscitate orders, and patients and relatives need to be well informed and included in the decisions. To increase the understanding for each other's opinions within the medical team, regular ethical discussions are required.

Factors influencing nurses' attitudes toward death

Studies on nurses' attitudes to caring for terminally ill patients indicate that death and dying create fears and anxieties for health-care providers. To identify nurses' most common attitudes toward death and the sociodemographic, professional, and training factors that significantly affect those attitudes. This was a descriptive correlational study with a sample of 360 nurses from the internal medicine, oncology, hematology, and palliative care departments of five health institutions in Lisbon (response rate 70.6% of all nurses). Data were collected using a sociodemographic and professional questionnaire (QSDE) and the Portuguese versions of the Death Attitude Profile-Revised (DAP-R) scale and the Adult Attachment Scale (AAS). Older nurses (P<0.0001) and nurses with more work experience (P<0.0001) had higher escape acceptance. Female nurses had higher religious acceptance (P<0.0001). Medicine, oncology, and hematology nurses had significantly higher fear attitudes (P<0.01), avoidance of death attitudes (P<0.0001), and escape acceptance attitudes (P<0.0002) than palliative care nurses. This study contributes to a better understanding of the factors that underlie nurses' attitudes toward death. This may be useful for creating relevant and effective pre- and post-graduate nursing training.

The Multidrug‐Resistant Bacteria Attitude Questionnaire: validity and understanding of responsibility for infection control in Swedish registered district, haematology and infection nurses

To assess the discriminative and construct validity of the Multidrug-Resistant Bacteria Attitude Questionnaire and to study registered nurses' knowledge of, behaviour toward and emotional responses to patients with multidrug-resistant bacteria in relation to how they understand their own, managers' and politicians' responsibility for adherence to preventive measures for infection control. Multidrug-resistant organisms are a global problem and an essential topic in healthcare regarding patient safety improvement. Descriptive and correlational cross-sectional survey. Data were collected in a non-random sample consisting of 397 registered nurses; district, haematology or infection registered nurses. One-way analysis of variance and independent t-tests were used for comparisons and a principal component analysis was performed. Discriminative and construct validity were supported, as the infection registered nurses generally had higher scores on knowledge, behaviour and emotional response, compared with district registered nurses and haematology registered nurses and the three-factor solution was confirmed. Registered nurses with higher scores on knowledge and emotional response attributed greater responsibility to themselves and to politicians. The Multidrug-Resistant Bacteria Attitude Questionnaire was translated using a forward-back translation process. The questionnaire has adequate psychometric properties. Insufficient knowledge of, behaviour toward and emotional response to patients with multidrug-resistant bacteria were described, but the registered nurses did estimate their own responsibility for adherence to preventive measures for infection control as being great or very great. There is a considerable need to improve knowledge, behaviour and emotional response regarding infection prevention measures among healthcare workers. The hospital management are responsible for such improvements and the Multidrug-Resistant Bacteria Attitude Questionnaire is useful in identifying such needs, as it has adequate psychometric properties and is able to discriminate between groups. Evaluation among healthcare workers may indicate where to situate additional training, as this is of clinical significance for safe care.

Supporting the Need for Home Care by Mothers of Children With Hemophilia

This research is a descriptive study that took place in Turkey and was intended to determine the difficulties experienced by mothers of children with hemophilia in maintaining their care at home and establishing appropriate interventions. Research data were collected using a survey prepared by the researchers after reviewing the existing literature. The survey contained 2 sections: (a) questions about the mothers' sociodemographic data and (b) 5 questions about the difficulties that mothers with hemophiliac children experience. Mothers were observed to have not received education about accidents and first aid and were afraid that their child would have an accident (55%); they experienced difficulty finding medications (75%); they felt they needed healthcare personnel during medication administration (85%); and they were sad that their child was ill (80%). Pediatric haematology nurses should strive to educate mothers with hemophiliac children about the disease and how to deal with accidents, first aid, and medication administration; home care services should be organized and made available for all hemophiliac children and their families.

Defining the scope of haematology nursing practice in Europe

Purpose The changing role of haematology nurses has never been mapped systematically which makes it difficult to plan practice development initiatives in a strategic manner. Method A survey was conducted to gain insight into the role of European haematology nurses and identify their learning needs. Results Two hundred and seventy one questionnaires were completed by nurses from 25 countries, most of who were unit-based clinical nurses (116, 43%), had 10 years or more of experience in haematology (56%) and no specialist qualification (65%). The most common professional activities undertaken involved the detection and management of side effect. Respondents believe that they are well trained, possess good communication skills and play a key role within the multidisciplinary team. However, a small but significant number of nurses indicated that they had a limited role to play in patient education (42%) and only 38% (102) agreed that they played an important role in facilitating patient choice. Lack of time, limited course availability and staff shortages are perceived as key barriers to developing practice. Conclusions Nurses are most interested in receiving further education about graft versus host disease and late effects of treatment. The knowledge component of the questionnaire revealed numerous deficits. Demographic factors such as role and experience had a significant influence on responses.

4177 Agreement of French nurses with euthanasia for end-of-life cancer patients: focus on haematology and oncology hospital nurses

To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia.ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile.This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses.Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician – assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically.Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization.

Exploring haematology nurses’ perceptions of specialist education’s contribution to care delivery and the development of expertise

The role that educational preparation may play in the delivery of care and the development of expertise is a point of some debate [Manley, K., Garbett, R., 2000. Paying Peter and Paul reconciling concepts of expertise with competency for a clinical career structure. Journal of Clinical Nursing 9 (3), 347; King, L., Macleod Clark, J., 2002. Intuition and the development of expertise in surgical ward and intensive care nurses. Journal of Advanced Nursing 37(4), 322-329; Bonner, A., 2003. Recognition of expertise: an important concept in the acquisition of nephrology nursing expertise. Nursing & Health Sciences Journal 5, 123-131; Dunphy, B.C., Williamson, S.L., 2004. In pursuit of expertise. Advances in Health Sciences Education 9, 107-127]. Though education is a concept that may be universally valued, it may be more difficult to clearly discern the significance it has for practitioners who are developing their expertise. This research project employed an interpretive phenomenological design to explore the perceptions of specialist haematology nursing staff on the extent to which specialist education contributes to care delivery and the development of expert practice. A non-representative purposive sample of qualified nurses who had undertaken specialist education in haemopoiesis and work in specialist haematology participated in a focus group and semi-structured interviews. The report concludes that, for these specialist practitioners, specialist educational input had a beneficial impact on their levels of knowledge and confidence. Further to this, involvement in higher education had enabled them to become more active in the learning process. Perhaps the key finding of the study was the assertion by respondents that specialist educational input had enabled them to develop their specialist practice to a level that experience alone could not achieve.

Missed opportunities: Nursing insights on end‐of‐life care for haematology patients

There is now extensive consumer research to indicate that patients with haematological malignancies are not receiving appropriate or timely referrals to the palliative system. This paper begins to explore the issue from the professional perspective by presenting findings from haematology nurses on their experience with terminal care. The nursing insights have been gathered through open-ended interviews with a national sample of nurses with extensive experience in haematology in both public and private hospitals throughout Australia. The findings resonate with the previous consumer research in that all the acute care nurses affirmed that it is their belief, based on their professional experience, that patients from these diagnostic groups typically die in the acute ward dealing with escalating technology and invasive treatments. For some, the statements could be qualified by the satisfaction that they worked in a haematology unit, aware of the death-denying issues, trying to address the problem. Others, caught in a 'refractory' subculture (i.e. a subculture with a negative perception of palliative care), outlined the factors driving the lack of integration for their specific hospital. The focus of the discussion of findings is on the latter.

Improving haematology care in Wales.

Care for patients with a malignant haematological disorder in Wales has been revised significantly since the mid-1990s. Recommendations from expert groups stated that a uniformly high standard of care should be provided as close to the patient's home as possible and variations in practice that had been causing concern and distress to patients and their families be reduced. The All Wales Haematology Nurses Group was established to promote and disseminate standards and guidelines that would contribute to achieving these aims. The basis for the group's work was transformational leadership and collaborative practice. Work is ongoing and the group is planning to consolidate achievements to date through country-wide audit and professional education.