Oncology Ward Research Articles

The Moderated Mediating Effects of Nutrition and Physical Activity Between Fatigue and Quality of Life in Childhood Cancer Survivors

The aim of this study was to investigate the associations between nutrition, physical activity, fatigue, and quality of life (QoL) among childhood cancer survivors. The specific purpose was to examine whether nutrition mediated and physical activity moderated the relationship between fatigue and QoL in this population. A pooled sample of 120 childhood cancer survivors was recruited at pediatric oncology wards and ambulatory settings between August 2020 and May 2021. We collected data on participants' demographic characteristics, fatigue, nutritional status, physical activity, and QoL. We then adapted Hayes Process Macro to examine the mediating and moderating effects of nutrition and physical activity on the relationship between fatigue and QoL. In models adjusted for age and sex, (1) the simple mediation analysis identified the mediating effect of nutrition on the relationship between fatigue and QoL; and (2) the mediation and moderation analysis identified that the direct effect of nutrition between fatigue and QoL was significant when adding (a) physical activity and (b) fatigue×physical activity. There were significantly decreasing trends in physical activity at 1 standard deviation below the mean and at the mean, but not at 1 standard deviation above the mean. Our findings demonstrate that nutrition mediated and physical activity moderated the relationship between fatigue and QoL. This highlights an opportunity to enhance QoL among childhood cancer survivors through healthy lifestyle interventions. To ensure that future interventions address children's needs and promote the greatest impact, such interventions should include nutrition and physical activity components that involve nurses, pediatric oncology physicians, nutritionists, and physical therapists.

The German version of the body image scale: Validation and item response analysis in cancer patients

ObjectiveTo translate the cancer-specific Body Image Scale (BIS) into German and assess its psychometric properties. MethodsThe BIS was translated in accordance with current guidelines. In a prospective, cross-sectional two center study (psychosocial counselling center for cancer patients Leipzig, oncological inpatient ward Berlin), we assessed composite reliability and factor structure using confirmatory factor analysis. Additional item response theory (IRT) modelling was performed. Convergent validity was assessed via correlation with the Body Appreciation Scale (BAS) as well as psychological symptom burden (PHQ-9, GAD-2 and Distress Thermometer). Discriminant validity was assessed via demographic and clinical group comparisons. Results677 patients participated (response rate 78%). Composite reliability was 0.95 and the one-factor structure was confirmed (standardized root mean square residual = 0.051, average variance extracted ≥50%, no indications of local dependence). In IRT models, all items had a discriminating power above the established threshold of b = 0.5 and relatively high “difficulty” parameters (b = 0.89–2.06). The BIS was negatively correlated with the BAS (rho = −0.62, p < 0.001) and positively with psychological symptom burden (e.g. PHQ-9: rho = 0.49, p < 0.001). Patients who were younger, female, had undergone chemotherapy, radiotherapy or surgery and those who were distressed by fatigue, their appearance or sexual problems had significantly higher BIS scores. ConclusionThe German version of the BIS is a valid tool to assess BID in patients with cancer that is now available for clinical or research contexts.

Medication errors in an oncology inpatient setting in India-Audit by clinical pharmacists.

Good clinical practices and strict vigilance are needed, especially for patients receiving chemotherapy. Regular audits using a specially developed tool need to be conducted in the oncology wards to identify lapses in the use of chemotherapy drugs. Observational study was conducted in the adult and paediatric oncology inpatient settings in an Indian tertiary care hospital for a period of 2.5 years. It was an audit of case files of chemotherapy patients for their drug prescriptions, medication reconciliation records and adverse drug reports. Data was presented as frequencies and percentages. 1.3% medication errors and 0.23% adverse drug reactions were reported during the study period. Majority were transcription (38%) and drug reconstitution errors (29%) and were either in the near-miss or no-harm category. Medication errors were found in the oncology wards, but due to the vigilance of clinical pharmacists, none of the patients were harmed as a consequence of these errors.

Hospice preference of the family decision-makers for cancer patients in China: an exploratory study

BackgroundThe reasons for hospice underuse in China need exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference for healthcare at the end-of-life stage of care, and the predictors of hospice preference.MethodsThis was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference for healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and multivariable logistic regression were conducted to analyze the data.ResultsOnly 46.0% of the participants have heard of hospice care. Most participants (78.2%) reported no introduction to hospice care from their doctors. More than half of the participants (58.2%) did not have a preference for healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on preferring healthcare at the end-of-life stage (adjusted OR = 14.346, 95%CI 7.219–28.509, p < 0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (adjusted OR = 0.180, 95%CI 0.052–0.617, p = 0.006). Another family member being cared for at home had a significant impact on the participants’ hospice preference (adjusted OR = 2.739, 95%CI 1.159–6.470, p = 0.022).ConclusionThe end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the patients’ families. Additionally, the impact of the at-home care burden on the hospice choice of families with cancer patients requires further study.

High Expression of Inflammatory Cytokines and Chemokines in Human T-lymphotropic Virus 1-Associated Adult T-cell Leukemia/Lymphoma

Background: Human T-cell lymphotropic virus type 1 (HTLV-1) is the etiological agent of adult T-cell leukemia/lymphoma (ATLL) without any specific antiviral. Objectives: This study aimed to evaluate the expression level of inflammatory chemokines and pro-inflammatory cytokines in ATLL patients, asymptomatic carriers (ACs), and healthy individuals to assess the role of these inflammatory markers in ATLL pathogenicity. Methods: This study was conducted from May 2021 to August 2022. The ATLL blood samples were collected from the oncology wards of Imam Khomeini, Shariati, and Imam Hossein hospitals, in Tehran, Iran. The blood samples of ACs and normal control subjects were collected from blood donors referred to blood transfusion centers of Tehran and Alborz provinces, Iran. RNA extraction, complementary DNA (cDNA) synthesis, and real-time polymerase chain reaction (PCR) were done in targeted sample groups to investigate the correlation and expression rate of C-C motif chemokine ligand 3 (CCL3), C-C motif chemokine ligand 4 (CCL4), C-X-C motif chemokine ligand 8 (CXCL8), interleukin 23 subunit alpha (IL-23A), and interleukin 17 A (IL-17A). Results: A total of 30 samples were collected from 3 groups. The CCL3, CCL4, CXCL8, and IL-17A messenger RNA (mRNA) expression levels were significantly upregulated in the ATLL groups. There was a significant difference between CCL3 expression between the ACs and ATLL groups. In addition, CCL4 and CXCL8 expression levels were more significant in the ATLL group than in the normal control group. The IL-17A expression level significantly increased between groups. The IL-23A expression levels had no significant differences between the ATLL, ACs, and normal control groups. Conclusions: This study showed significant upregulation of pro-inflammatory cytokines and chemokines mRNAs in HTLV-1–associated ATLL compared to the ACs and normal control groups. Conducting more experiments to investigate the therapeutic effect of chemokines/cytokines in ATLL is essential.

The demands of caregivers of children with acute lymphoblastic leukaemia in different therapy stages and the exploration of possible interventions: A longitudinal investigation survey at a Tertiary Medical Institution.

To describe the demands of family caregivers of children with ALL at different therapy stages and explore the possible interventions to address their care demands. A longitudinal investigation study. A total of 157 family caregivers of children treated in the Haematological oncology ward of a tertiary medical hospital in China between March and December in 2020 were included in this study. The Comprehensive Needs of Caregivers of Cancer Patients and Families Taking Care of Children Scale was used to investigate the family caregivers of children with ALL. The family caregivers completed the questionnaire accompanied by a researcher within two weeks of each therapy stage, which included the induction, consolidation and continuation stages. Family caregivers of children with ALL had many demands that varied based on the stage of therapy. Family caregivers in the induction therapy stage needed more information about their children's disease, having the highest score in information demands (35.60 ± 5.85). The family caregivers in the consolidation therapy stage needed more information on symptom management and socio-economic support, having the highest score in care and support demands (36.14 ± 5.12). The family caregivers in the continuation therapy stage (including interim and maintenance therapy stages) focused more on their own and the children's social adaptation, so they scored the highest for psychosocial demands (35.96 ± 5.69). Family caregivers of children with ALL had different demands that varied based on the stage of therapy. Medical personnel should be aware of the primary needs of family caregivers at different therapy stages to provide early interventions and support based on their demands, ultimately improving the physical and mental condition of family caregivers and the quality of care.

A Quality Improvement Project for Reducing Work-Related Stress of Nurses in Converting an Oncology Ward Into a Designated COVID-19 Ward During the COVID-19 Pandemic

The community spread of SARS-CoV-2 occurred during the COVID-19 pandemic in May 2021 in Taiwan. Due to the large number of COVID-19 patients, demand for healthcare capacity had also increased. In response to the massive influx of patients with COVID-19 in our hospital, a designated COVID-19 ward was established. In addition, the oncology ward was also quickly transformed into a designated COVID-19 ward that shared staff and work schedules with the originally designed COVID-19 ward during the pandemic period. The process of setting up the ward, training personnel, and providing independent care to COVID-19 patients and the period of professional cooperation with medical staff from the infectious disease ward caused great burden and pressure on nurses. The objective of this study was to reduce the work-related stress index from 20.2 to 15. Cross-training and in-service courses were implemented to assist the oncology nurses to learn nursing care for patients with COVID-19. Five solutions were discussed and implemented in a timely manner. The interventions included the unifying the logistical flows between wards, optimizing ward environments, providing education and training on COVID-19, launching a new communication platform to facilitate discussions and gather various opinions, and implementing flexible scheduling. The stress index score declined from 20.2 to 8.2 on the stress and anxiety to viral epidemics-9 scale. The findings of this study may be referenced to assist nurses and nursing managers when making preparations to transform oncology wards into designed COVID-19 wards.

Factors Affecting Psychological Burnout in Nurses Caring for Terminal Cancer Patients.

This study aimed to investigate the impacts of end-of-life care competency and ethical dilemmas on psychological burnout in nurses who care for terminal cancer patients. A cross-sectional study of 160 nurses who cared for terminal cancer patients was conducted. The participants were recruited from the hospice-palliative care wards, hematology or oncology wards, or intensive care units of three general hospitals in a single metropolitan area. Data were collected using a self-administered survey to assess end-of-life care competency, ethical dilemmas, psychological burnout, and general sociodemographic characteristics. Data were analyzed using descriptive statistics, the independent t-test, analysis of variance, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows (version 26.0). Psychological burnout was significantly correlated with end-of-life care competency (r=-0.23, P=0.003) but not with ethical dilemmas. The results of the hierarchical linear regression analysis indicated that end-of-life care competency (β=-0.280, P=0.010) and ethical dilemmas (β=0.275, P=0.037) were significant predictors of psychological burnout, after adjusting for age, religious status, clinical experience, and unit type. The current study's findings demonstrate that end-of-life care competency and ethical dilemmas are crucial factors that affect psychological burnout in nurses who care for terminal cancer patients. Substantive education programs must be developed to improve nurses' competencies in end-of-life care and ethical dilemmas to decrease psychological burnout.

Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020.

A large clonal outbreak caused by vancomycin-resistant Enterococcus faecium (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as vanB VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.

Evaluation of the Effect of Grape Seed Extract (GSE) on Oral Mucositis in Patients with Head and Neck Radiotherapy History- A Randomized Clinical Trial

Background: Mucositis is one of the most important complications of radiotherapy. Some factors such as type of treatment and degree of patient sensitivity affect mucositis occurrence. Objective: This research was implemented to evaluate the effect of grape seed extract on radiation-induced mucositis. Methods: This research is a double-blinded randomized clinical trial implemented on 78 patients undergoing head and neck radiotherapy in the oncology ward of Imam Reza Hospital of Tabriz. The patients were randomly divided into 2 groups, the intervention, and the control group. Each group included 39 patients. The intervention group used 2% grape seed extract mouthwashes and the control group used placebo mouthwashes. The mouthwashes were used 3 times a day for 2 weeks. For statistical analysis of collected data, SPSS 20 software was applied. Results: The results showed that according to the Friedman test, on the 10th and 14th days, mucositis grade and incidence had a significant difference between the intervention and control groups. Conclusions: The findings indicated that grape seed extract mouthwash in preventing radiation-induced mucositis was more effective than a placebo. Thus, this agent can be recommended as an appropriate medication to eliminate oral mucositis symptoms.

Investigating the prevalence of depression in children and adolescents with cancer admitted to the oncology ward of Besat Hospital in Sanandaj

Introduction: Depression in children with cancer can complicate the course of the disease and cause many problems in the treatment process. Aim: The aim of this study was to determine the prevalence of depression in children and adolescents with cancer. Method: This study was a descriptive cross-sectional study. Forty children with cancer admitted to the oncology ward of Besat Hospital, Sanandaj, with an age range of 7- 17 years in 2016, who were selected and assessed using a demographic information checklist and the Children's Depression Inventory (Kovacs, 1979). After collecting data, the data were analyzed by SPSS-20 software using descriptive statistical tests and chi-square. Results: The 15% of the subjects had depressive symptoms and 47.5% were on the verge of depression. The prevalence of depression was 21.1% in girls and 9.5% in boys (p=0.54), and there was no significant difference in terms of cancer type (p=0.99), treatment method (p=0.81) and demographic indicators (p&gt;0.05). Conclusion: Due to the relatively high prevalence of depression in this group of patients, it is recommended that the necessary screenings be performed to identify and refer patients with depression to psychiatric or psychological clinics to receive appropriate and timely treatment to help improve the quality of life of these patients and their families.

Outcome of Hospitalized Cancer Patients with Hypernatremia: A Retrospective Case-Control Study.

Hypernatremia (&gt;145 mmol/L) is a relatively rare event, and the data regarding its role in the outcome of inpatients on an oncology ward are weak. The aim of this study was to describe the prevalence, prognosis, and outcome of hospitalized cancer patients with hypernatremia. We performed a retrospective case-control study of data obtained from inpatients with a solid tumor at the St. Claraspital, Basel, Switzerland, who were admitted between 2017 and 2020. The primary endpoint was overall survival. Hypernatremia was found in 93 (3.16%) of 2945 inpatients bearing cancer or lymphoma. From 991 eligible normonatremic control patients, 93 were matched according to diagnosis, age, and sex. The median overall survival time (OS) of patients with hypernatremia was 1.5 months compared to 11.7 months of the normonatremic controls (HR 2.69, 95% CI 1.85-3.90, p &lt; 0.0001). OS of patients with irreversible compared to reversible hypernatremia was significantly shorter (23 versus 88 days, HR 4.0, 95% CI 2.04-7.70, p &lt; 0.0001). The length of hospital stay was significantly longer for the hypernatremic than for the normonatremic group (p &lt; 0.0001). Significantly more patients with hypernatremia died in the hospital (30.1% versus 8.6%, p &lt; 0.001). These results suggest hypernatremia to be associated with an unfavorable outcome and a very short OS.

Characteristics of Lymphoma Patients Experiencing Unplanned Readmissions at a Large Academic Medical Center

Background: Patients with lymphoma frequently experience hospital readmissions. Yet, limited data exist describing hospital readmissions in the lymphoma population. In this study, we sought to identify additional patient-specific characteristics associated with unplanned readmissions in patients with lymphoma at our institution. Methods: We conducted a retrospective, single-center study of patients with lymphoma who were age >18 and discharged from medical oncology wards from January-December 2019 (index admission). We categorized patients as having high-risk medications per the Institute for Safe Medication Practices, potentially inappropriate medications (PIMs) for older patients (age 65+) per the American Geriatric Society Beers Criteria, and polypharmacy and major polypharmacy as 5 or more and 10 or more scheduled medications on the discharge medication list, respectively. We performed univariate logistic regression to assess the association of with having an unplanned readmission within 30 days of discharge from index admission. The following factors, selected for clinical relevance, were assessed: age; gender; race; marital status; Charlson comorbidity score; lymphoma diagnosis and related parameters (stage, LDH, prior treatment ECOG PS); index hospitalization reason, duration, discharge disposition and prior healthcare utilization; activities of daily living (ADL) status; Morse fall score; laboratory values at time of discharge; discharge medication list; 30-day readmission status and readmission reason if applicable. Results: We included 207 patients (mean age 63.9 years, 38.6% female, 83.1% white race, 56.8% partnered), 65 (31.4%) of whom experienced a 30-day unplanned readmission. Patients experiencing a 30-day unplanned readmission were more likely to have ECOG PS >2 (36.9% vs 14.2%, p<0.001), higher age-adjusted IPI score (score 0, 3.3% vs 7.8%; score 1, 23.3% vs 35.7%; score 2, 55.0% vs 47.8%; score > 3, 18.3% vs 8.7%; p=0.012), received CAR T-cell therapy (9.2% vs 2.1%, p=0.032), index length of stay >5 days (55.4% vs 33.1%, p=0.003), been discharged to a skilled nursing facility (12.3% vs 3.5%, p=0.023), albumin <3.5 g/dL (78.5% vs 52.1%, p<0.001), and sodium <135 mEq/L (18.5% vs 8.5%, p=0.041). Patients discharged home were less likely to have a 30-day unplanned readmission (56.9% vs 76.8%, p=0.004). Age, sex, marital status, Charlson comorbidity score, aggressive versus non-aggressive lymphoma diagnosis, prior lymphoma treatment, discharge home with services or to inpatient rehabilitation, Morse fall score, bowel and/or bladder continence, independence in feeding or bathing, neutropenia (ANC<1.5 k/mcL), and Hgb <10 g/dL were not significantly associated with increased likelihood for unplanned readmission. Among medication-related factors, we found that patients with major polypharmacy on the index admission discharge medication list had a higher likelihood for unplanned readmission (56.9% vs 37.3%, p=0.009). Patients with discharge medication lists with polypharmacy (90.8% vs 81.7%, 00, long-acting opiates (10.8% vs 4.2%, p=0.082), and/or anticoagulants (26.2% vs 15.5%, p=0.071) had a higher likelihood for unplanned readmissions, but these differences did not reach statistical significance. Presence of PIMs was not associated with readmission. Conclusions: In this relatively large cohort of patients with lymphoma, we identified several risk factors for unplanned hospital readmissions. We found associations among unplanned readmissions and impaired performance status, receipt of prior CAR T therapy, higher age-adjusted IPI score, discharge location (home, skilled nursing facility, etc), lower albumin and sodium levels, as well as major polypharmacy on the discharge medication list. Future directions include further efforts to identify lymphoma patients at high risk for hospital readmissions and developing readmission prevention strategies in those patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Hybrid Harmony Search for Stochastic Scheduling of Chemotherapy Outpatient Appointments

This research deals with the same-day chemotherapy outpatient scheduling problem that is recognized as a leading strategy to pursue the objective of reducing patient waiting time. Inspired by a real-world context and different from the other studies, we modeled a multi-stage chemotherapy ward in which the pharmacy is located away from the treatment area and drugs are delivered in batches. Processes in oncology wards are characterized by several sources of uncertainty that increase the complexity of the problem; thus, a stochastic approach was preferred to study the outpatient scheduling problem. To generate effective appointment schedules, we moved in two directions. First, we adopted a late-start scheduling strategy to reduce the idle times within and among the different stages, namely medical consultation, drug preparation and infusion. Then, since the problem is NP-hard in the strong sense, we developed a hybrid harmony search metaheuristic whose effectiveness was proved through an extended numerical analysis involving another optimization technique from the relevant literature. The outcomes from the numerical experiments confirmed the efficacy of the proposed scheduling model and the hybrid metaheuristic algorithm as well.

Improving sepsis screen in patients with suspected neutropenic sepsis in the acute oncology ward

Background: Patients with suspected neutropenic sepsis should have appropriate sepsis screen tests upon admission. Our acute oncology ward admits patients from different departments and these patients should have the full sepsis screen performed as part of their investigation of sepsis. Unfortunately, these patients do not have a completed sepsis screen upon arrival to the ward. In most cases, these sepsis screen tests have been requested on TrackCare but are not physically done or collected on the system.

The Viewpoints of Hospitalized Patients with Cancer Regarding Their Nutritional Challenges in Hospital: A Phenomenological Study

Background: Complications of anti-cancer therapies can lead to inadequate nutrient intake, indigestion and deficiency of nutrients. The present study aims to better understand the nutritional challenges of hospitalized patients with cancer.&#x0D; Methods: The participants were patients referred to the oncology ward of the hospital who were selected by the maximum diversity sampling of patients with various cancers. Semi-structured interviews were conducted to collect data and continued until data saturation with 20 participants. Inductive content analysis was applied to interpret data using MAXQDA 2018 software.&#x0D; Results: The views of hospitalized patients with cancer regarding the nutritional complications were explored in four main themes, including "Inefficiency in patient food management”, “The need for care and support of the treatment team”, “Problems due to the consequences of the disease”, “Patients' strategies in conditions of dissatisfaction with the hospital food environment”. The sub-themes included "Dissatisfaction with the hospital food environment”, “Neglect of patients' specific conditions”, “Problem with the characteristics of hospital food”, “Uncertainty of the responsible person/people”, “Lack of continuous communication between the treatment team and patients”, “Patients’ need to consult with the treatment team”, “Patients’ concerns”, “Disease side-effects”, “Chemotherapy side effect”, and “Dissatisfaction of food and environment".&#x0D; Conclusion: It is necessary to obtain a comprehensive understanding of patients' needs by a treatment team, including physicians, nurses, and nutritionists by establishing appropriate communication with the patients and nutrition education from the time of diagnosis and treatment.

Evaluation of the Moral Distress Intensity and Its Relationship with the Quality of Work Life among Nurses Working in Oncology Wards in Shiraz, Southwest of Iran.

Moral distress defined as an incident that prevents the appropriate functioning of individuals in spite of having the required knowledge. Nurses are commonly exposed to moral distress while doing their professional roles, which can influence the quality of their work life. The present study aimed to assess the relationship between the moral distress intensity and work life quality amongst nurses. In this descriptive-correlational study, 180 nurses working in oncology wards were selected through census based on inclusion criteria (associate or higher degrees, having at least six months of clinical work experience, and not suffering from anxiety disorders). The data were collected using Corley's questionnaire (2001) and Brooks' investigation of work life quality of nurses (2001). Then, the data were entered into the SPSS 22 software and were analyzed using the Independent Sample t-test, One-way ANOVA, and Pearson's correlation coefficient. The nurses' mean scores of moral distress and work life quality were 136.63 ± 27.39 and 133.83 ± 25.40, respectively. The results revealed a negative significant relationship between the nurses' moral distress and work life quality (P < 0.001) (r = -0.53). There was also a significant difference between the nurses' sex and work life quality (P < 0.05). Identifying the moral distress intensity and work life quality of nurses and proper planning from the authorities can improve job satisfaction in nurses and resulting to higher quality of care.

Explaining the Process of Spiritual Adjustment in Parents of a Child with Cancer: A Qualitative Study.

Introduction: Having a child with cancer impacts the family members and reduces their quality of life. Considering the fact that spirituality creates tranquility, hope for the future, and acceptance of the disease, this study aimed to explain the process of spiritual care in parents of a child with cancer. Methods: This study was carried out using a qualitative method and grounded theory approach. The setting of this research was oncology and radiotherapy wards, governmental oncology clinics and pediatric hospitals. Using purposive and theoretical sampling method, 22 participants (eight mothers, three fathers with childhood cancer experience and 11 individuals working in oncology departments of different Iranian pediatric hospitals) were selected and individual and semi-structured interviews were conducted. Results: The data analysis led to the creation of a core variable of "bridge towards spirituality" which included five main categories of "unstable situation", "spirituality," "crossing rocky path", "multi-dimensional support", and "rethink". Conclusion: Due to the significant impacts of a child's cancer on parents and the fact that people's spiritual needs increase in critical and stressful situations, paying attention to the spirituality process is essential for managing the conditions created by the child's disease and help parents through developing a comprehensive program of spiritual care in health care centers. Spiritual care is currently absent in the health care system of Iran, which necessitates attention to this issue in the parents of children with cancer.

Nurses' Perceived Challenges in the Management of Hospitalized Cancer Patients in a Comprehensive Cancer Center in Southeastern Nigeria.

Nurses' challenges in poor-resource countries like Nigeria have been understudied. This study determined nurses' perceived challenges in management of hospitalized cancer patients in a comprehensive cancer center in southeast of Nigeria. The descriptive study included 133 registered nurses working in medical-surgical and oncology wards. A 37-item questionnaire included seven (7) questions on socioeconomic, 16 questions related to nurse's knowledge, and 14 questions related to cancer treatment and the hospital facility. A significant challenge was defined as a mean score of more than 3 in a Likert scale 5 points. Challenges included a shortage of nurses (inadequate numbers of skilled nurses in oncology and other wards with mean±sd score (4.73±0.58), lack of continuing education on current trends in the management of cancer (4.03±0.45), and lack of oncology trained nursing experts for job mentoring (4.24±0.77). Others were managing patients facing chemotherapy related side-effects (3.06±2.12), high cost of treatment borne by cancer patients (4.41±0.68) and exorbitant hospital bills (4.72±0.48), non-availability of drugs (4.09±0.87) and institutional policy bottlenecks affecting subsidizing treatment costs (4.09±0.84). Cancer care affected mainly by inadequate and functional equipment (4.24±0.55), and with no staff remuneration (4.53± 0.85). Nurses' Perceived Challenges were related to professional, institutional, and those related to patient.

Moral distress and moral injury and their interplay as a challenge for leadership and management: The case of Croatia.

We aim to investigate the interplay between moral distress and moral injury among nurses working in palliative and oncology wards and to assess its impact on nursing leadership. The past 2 years have been particularly challenging for nurses and nursing leaders in Croatia. The coronavirus disease pandemic and the subsequent earthquakes in the country significantly impacted the work of nurses. Moral distress has been well-known to nursing professionals, but recent studies warn about cofounding it with moral injury and their possible intercorrelation, deserving more attention from an empirical perspective. We conducted quantitative cross-sectional research in palliative and oncology wards in 11 Croatian health care facilities on 162 nurses, using a questionnaire and paper/pencil method over 6 months (1 January 2021 to 1 July 2021). The questionnaire consisted of three parts: sociodemographic data, a Measure of moral distress for health care professionals and Moral injury symptoms scale for health care professionals. The research protocol was approved by the Ethics committee of the Catholic University of Croatia under no. 1-21-04. The findings of our study demonstrated that the current average levels of moral distress might be characterized as low, but the moral injury symptoms are severe. The results of our study bring interesting novel insights, such as the strong correlation between moral distress and moral injury, but also in terms of nurses' decision to leave or consider leaving their position. The nurses who experience higher levels of moral distress experience severe symptoms of moral injury, while nurses who score higher in moral distress and moral injury have left, considered or consider leaving their positions. This study highlighted the need to pay attention to the emerging phenomenon of moral injury that has been unaddressed and overshadowed by moral distress, their intercorrelation, and the importance of addressing them timely and adequately within health care organizations with their leadership and management. These findings provide a significant insight that may assist nursing managers and leaders to act and respond in time to develop various prevention and mitigation measures and help resolve situations leading to moral distress or moral injury.