Outpatient Nurses Research Articles

Perspectives on Palliative Care in Cancer Clinical Trials: Diverse Meanings from Multidisciplinary Cancer Care Providers.

Palliative care (PC) is often misunderstood as exclusively pertaining to end-of-life care, which may be consequential for its delivery. There is little research on how PC is operationalized and delivered to cancer patients enrolled in clinical trials. We sought to understand the diverse perspectives of multidisciplinary oncology care providers caring for such patients in a teaching hospital. We conducted qualitative semistructured interviews with 19 key informants, including clinical trial principal investigators, oncology fellows, research nurses, inpatient and outpatient nurses, spiritual care providers, and PC fellows. Questions elicited information about the meaning providers assigned to the term "palliative care," as well as their experiences with the delivery of PC in the clinical trial context. Using grounded theory, a team-based coding method was employed to identify major themes. Four main themes emerged regarding the meaning of PC: (1) the holistic nature of PC, (2) the importance of symptom care, (3) conflict between PC and curative care, and (4) conflation between PC and end-of-life care. Three key themes emerged with regard to the delivery of PC: (1) dynamics among providers, (2) discussing PC with patients and family, and (3) the timing of PC delivery. There was great variability in personal meanings of PC, conflation with hospice/end-of-life care, and appropriateness of PC delivery and timing, particularly within cancer clinical trials. A standard and acceptable model for integrating PC concurrently with treatment in clinical trials is needed.

Bacteriological Hazard Analysis in Minimally Processed Shellfish Products Purchased from Korean Seafood Retail Outlets

Bacteriological Hazard Analysis in Minimally Processed Shellfish Products Purchased from Korean Seafood Retail Outlets

A survey of direct care and patient education provided by outpatient nurses to patients wearing a leg cast for the first time

A survey of direct care and patient education provided by outpatient nurses to patients wearing a leg cast for the first time

Research and application of outpatient triage safety management

The authors introduced the development and application of an outpatient triage safety management system for hospitals. The system consists of the triage queue module, fast track module for prioritized special outpatients and subsequent outpatients, vital signs data recording module, assessment module for high fall risk outpatients, and high risk outpatient transfer module. These functions enable outpatient triage nurses to focus on pre-examination, safety factor identification, and high risk outpatient transfer, thus shortening outpatient queue time and high risk outpatient transfer to emergency, and lower adverse events. With this system, nursing safety management becomes more scientific, standardized and systematic, enabling optimized nursing staff efficiency and fine management of nursing care. Key words: Safety management; Nursing informationization; Nursing safety; Outpatient nursing care

Learning from near misses: Addressing nursing chemotherapy verification fatigue.

70 Background: Administration of chemotherapy is high-risk, requiring multiple safety checks, including pre-treatment laboratory value verification by nursing. A recent series of near misses in our event reporting system highlighted that nurses verified chemotherapy orders with pending pre-treatment or abnormal labs, such as grade 2 hyperbilirubinemia and grade 4 neutropenia. Such laboratory results would normally require holding or modifying planned treatment doses. Methods: Nurses treating patients in the outpatient chemotherapy infusion units were surveyed regarding barriers to pre-treatment lab verification. A team of clinicians, nurses, and pharmacists outlined a process map of the order verification process from acknowledging patient assignment and looking at patient oncologic history to sending the physician order to pharmacy. Pharmacists collected baseline data by tracking near-miss incidents. Results: The survey response rate of outpatient treatment nurses was 18 of 32 (56%). Nurses ranked inconsistent notation of treatment criteria in orders, long lab processing time, and patient frustration with a long wait as the most common barriers to lab verification. At baseline, in six non-consecutive weeks from August-October 2016, 31 of 947 (3%) orders were inappropriately verified by nursing in which pre-treatment lab results were pending or lab results did not meet parameters in the chemotherapy order. The team’s aim is by February 1, 2017, to reduce the number of chemotherapy orders sent to pharmacy without proper lab verification by 50%. Conclusions: Chemotherapy verification fatigue, specifically pre-treatment lab near misses, was identified as an area for improvement from recent patient safety reports. Barriers for nurses include inconsistent notation of treatment criteria in orders, long lab processing time, and patient frustration with a long wait. Interventions are underway to improve nursing adherence to pre-treatment lab verification.

Construction of a Training System for SCU Nurses who Began to Support Endovascular Treatment for Acute Ischemic Stroke

Purpose: In recent years, shortening the time from onset to recanalization has been shown to markedly affect the outcome of acute ischemic stroke. In our hospital, in order to shorten the time to recanalization at night hours with staff shortage, stroke care unit (SCU) nurses supported the outpatient clinic nurses during endovascular treatment from preparation to introduction. We hereby report the contents and results of the training we conducted toward the SCU staff.

Nursing care of difficulty in decannulation of PICC in 1 case of very low birth weight infant

Objective To summarize the nursing experience of 1 case of very low birth weight infant decannulation difficult in PICC. Methods The nursing key points included: full assessment analysis decannulation difficult reason, consult the PICC catheter outpatient health nurses, give magnesium sulfate hydropathic compress, mucopolysaccharide polysulfate cream local besmear outside, sanyrene outside, at the same time give low-molecular-weight heparin calcium injection subcutaneous injection such as anticoagulant active treatment and nursing. Results After 7 days,the infant left axillary mass dispel, PICC pull out smoothly. Conclusions Decannulation difficult of very low birth weight infant requires full evaluation, multidisciplinary cooperation and specialist consultation, can give targeted personalized nursing safety smooth tube drawing, is worthy of reference for clinic. Key words: Nursing care; Very low birth weight infant; Catheterization, central venous; Decannulation difficulty

Protection behaviors for cytotoxic drugs in oncology nurses of chemotherapy centers in Shiraz hospitals, South of Iran.

Context:The use of antineoplastic agents for the treatment of cancer is an increasingly common practice in hospitals. As a result, workers involved with handling antineoplastic drugs may be accidentally exposed to these agents, placing them at potential risk for long-term adverse effects. This study aimed to determine the occupational protection status of clinical nursing staff exposed to cytotoxic drugs.Subjects and Methods:The study was designed as an analytic descriptive survey. The research settings took place in six centers of chemotherapy in Shiraz, Iran. The participants were 86 nurses who worked in oncology units and administered cytotoxic drugs. Data were collected using a questionnaire and a checklist which was developed by the investigators to determine occupational protection status of clinical nursing staff exposed to cytotoxic drugs. Percentage calculations and the independent samples t-test were used to see the general distribution and analysis of data. To statistically analyze of the data, SPSS software (version 16) was applied.Results:The mean age of participants was 30.52 ± 6.50 years and 66.27% of the nurses worked on inpatient oncology wards. The mean practice score was 21.1 ± 3.76 that ranged from 12.5 to 31. The independent samples t-test showed the outpatient nurses were weaker in practice (17.2 ± 2.52) in comparison with university hospitals (23.35 ± 3.02, P < 0.001). Occupational protection status of clinical nursing staff exposed to cytotoxic drugs especially during administration and disposal of medicines was poor and rarely trained with this subject and was observed under the standard conditions.Conclusions:There is deficiency in the understanding and related protection practices of clinical nursing staff vocationally exposed to cytotoxic drugs. It is recommended that all clinical nursing staff should receive full occupational protection training about these matters and the authorities provide standard conditions of oncology wards.

The Integration of Perianesthesia Certified Nurses into an Ambulatory Specialty Treatment Center

In 2013, the Ambulatory Surgical Center Post Anesthesia Care nurses assumed responsibility for recovering pediatric patients receiving general anesthesia in our Proton Therapy Center (PTC). The Proton Therapy Center is a freestanding ambulatory center with a three bay recovery area. Due to staffing, Magnet and Joint Commission requirements, it was determined that Certified Post Anesthesia Care nurses would be the preferred providers of nursing care. Certified nurses practice in accordance with ASPAN standards and practice recommendations in the care of the anesthetized pediatric patient population. The perioperative nurses who were volunteering to transition to the Proton Center were mostly adult outpatient PACU nurses with previous pediatric recovery experience, but limited knowledge and experience in Radiation Oncology.

Practice and evaluation of cardiovascular disease (CVD) nursing clinics

Objective By carrying out cardiovascular nursing clinic practice, to explore nursing clinic management system construction and working mode. Methods A total of 187 patients with cardiovascular diseases who went to the cardiovascular nursing clinics were chosen to undertake the cardiovascular nursing clinic service between May 2014 and May 2015 with the work content and process evaluated. Results Through cardiovascular nursing clinic nursing practice, disease constitution of patients undergoing cardiovascular care specialist outpatient service and the demand for care clinics sorting were identified, as well as the importance and necessity of construction of cardiovascular nurse clinics, and cardiovascular specialist out-patient nurses working mode, working content, etc. Conclusions Cardiovascular nursing clinic should be developed as soon as possible in China; Scientific clinic working mode, professional appointment of nursing standard and standardization of the management method are the basic guarantee of nursing specialist outpatient service. Key words: Cardiovascular disease; Specialist nursing; Nursing clinic

Stress Levels of Nurses in Oncology Outpatient Units

Oncology nursing is often a source of substantial stress for nurses. Many nurses, particularly novice nurses, have inadequate preparation to care for patients at the end of life and their families. Unless nurses prevent or manage work-related stress by using effective coping strategies, oncology nursing staff will continue to suffer from burnout and compassion fatigue. The purpose of this article is to identify stress levels and stressful factors of nurses working in oncology outpatient units and to explore coping behaviors for work-related stress of oncology staff nurses in outpatient units. A descriptive, cross-sectional design was used to identify stress levels and stressful factors for outpatient oncology nurses, investigate differences in stress levels among nurses' demographic characteristics, and explore coping behaviors of the nurses. Study participants (N = 40) included RNs and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and a demographic questionnaire. The highest sources of stress were workload and patient death and dying. Demographic variables of age and work experience in nursing showed a significant positive relationship to work-related stress scores. The three most frequently used coping behaviors were verbalizing, exercising or relaxing, and taking time for self. Continuing education programs on stress management are highly recommended. Outpatient oncology nurses should be nurtured and supported through tailored interventions at multiple levels to help them find effective coping strategies and develop self-care competencies. Although younger and less experienced nurses had lower mean stress scores than older and more experienced nurses, the continuing education programs and tailored interventions would be helpful for all oncology nursing staff.

Providing an Educational Intervention to Inpatient Transplant Nurses about BMT Survivorship: Can it Change Knowledge and Perspective?

Inpatient BMT RNs take care of patients at their sickest. Although early post-transplant mortality is low, the majority of patients who succumb early die in the hospital. The nurses that care for these patients expressed distress over the perceived high mortality and questioned the value of BMT. They needed information about long-term survival and QOL in BMT survivors to gain perspective. Managers from an inpatient BMT unit asked RNs from the Long-Term Follow-Up (LTFU) program to deliver an educational intervention. The LTFU program supports approximately 6,000 BMT survivors from an NCCN-designated academic center with free telephone consultation for life. The LTFU RNs developed a class to facilitate a change in perspective, validate inpatient nursing work, and emphasize the importance of the nursing role across the continuum. A survey was conducted prior to the intervention to determine baseline knowledge about BMT survivorship. A series of three sessions was taught by LTFU RNs to inpatient nursing staff. The curriculum covered: the lived experience of BMT survivors, factors influencing transplant-related morbidity and mortality, the LTFU role in supporting survivors, and the value of the inpatient nursing role for survivors. Questions and comments from the survey were included in developing the curriculum. The format was narrative-based, including five patients’ stories, one from each decade of transplantation, against a backdrop of the history of BMT. A post-survey will measure change in knowledge and perspective. The educational intervention was well-received by the inpatient staff and managers. The survey results will be analyzed and findings interpreted against a background of current literature and practice. Inpatient BMT nursing is a high-intensity, fast-paced nursing specialty that can be mentally and emotionally demanding. In our system, inpatient and outpatient nurses are employed separately, and there is no established mechanism to provide inpatient RNs with survivorship information. This model of bridging inpatient staff experience with the knowledge of long-term BMT patient outcomes may prove beneficial to other sites, affirming the nurses’ work in the acute phase of BMT treatment.

在宅療養支援に対する外来看護師の役割認識

在宅療養支援に対する外来看護師の役割認識

Assess the practice regarding safety measures used by nurses while handling Chemotherapy drugs

Background : In a recent study of outpatient nurses, participants reported significant unintended skin and eye exposure to chemotherapy (Friese, et al., 2011). In this study, the author concludes that the overall rate of exposure decreases when nurses report adequate staffing and resources (2011). This implies that nurse-patient ratios and workplace demands contribute to the problem of mishandling chemotherapy. Therefore, these results implicate the need for adequate staffing and resources as well as increased staff compliance to established practice standards in order to better protect oncology nurses. Other contributing factors identified in system failures that result in an unsafe work environment include lack of awareness of personal and public risks of exposure, poor communication, and direct interruptions and/or distractions while preparing to administer medications (Ashley, et al., 2011). Objectives : To assess the practice regarding safety measures used by nurses while handling chemotherapy drugs. Method : In this Study the structured checklist was used to see the practice regarding safety measures used by nurses while handling chemotherapy drugs. Result : Assessment of nurses practice while handling chemotherapy drug shows that Majority of samples 56 (56%) were having poor practice while handling chemotherapy drugs and 44% of nurses were having good practice while handling chemotherapy drugs, Maximum score was 6 and minimum score was 1. Conclusion : After the detailed analysis, this study leads to the following conclusion that assessment of nurses' practice while handling chemotherapy drug. Majority of samples were having poor practice while handling chemotherapy drugs.

Design and Outcome of a Certification Preparation Program for Outpatient Nurses.

This article presents the design, implementation, and outcomes of a certification preparation program for nurses working in an outpatient clinic. A nurse educator designed curriculum using the Certified Breast Care Nurse test blueprint. Nurse administrators provided the resources and the staff coverage to allow all staff members to attend the sessions without disruption to patient care. This outpatient center has achieved and sustained 100% certification among eligible nurses over the past 5 years.

Nurses' views on patient self-management: a qualitative study.

To unravel outpatient nurses' views on the role of people with chronic conditions in self-management, nurses' own support role and to establish how these views relate to nurse-led self-management interventions. Providing self-management support is a core task of nurses in outpatient chronic care. However, the concept of self-management is interpreted in different ways and little is known about nurses' views on patients' role in self-management and nurses' own support role. Qualitative design. Individual semi-structured interviews were held in 2012-2013 with outpatient nurses at a university medical hospital in the Netherlands. After transcription, data-driven codes were assigned and key elements of views and experiences were discussed in the research team. Finally, insights were merged to construct and characterize types. Twenty-seven nurses were interviewed. The analysis identified three divergent views on self-management support: adhering to a medical regimen; monitoring symptoms; and integrating illness into daily life. These views differ with respect to the patient's role in self-management, the support role of the nurse and the focus of activities, ranging from biomedical to biopsychosocial. The first two were mainly medically oriented. Nurses applied interventions consistent with their individual views on self-management. Nurses had distinct perceptions about self-management and their own role in self-management support. Social and emotional tasks of living with a chronic condition were, however, overlooked. Nurses seem to lack sufficient training and practical interventions to provide self-management support that meets the integral needs of patients with a chronic condition.

Clinical competency in child maltreatment for community nurses in Taiwan.

The purpose of this cross-sectional study was to examine aspects of competency in child abuse among community nurses in Taiwan. A sample of 650 community nurses were recruited from public health centres (PHC) and outpatient clinics in Southern Taiwan. A structured questionnaire with five subscales, knowledge, skills, empowerment, team collaboration and self-reflection was developed and used for data collection. A total of 588 questionnaires were returned and used for analysis. Nearly 20% of community nurses reported having an acquaintance with a maltreatment history. Only 4.6% had experience of reporting a case of child abuse. Most nurses reported strong skills and abilities (empowerment, team collaboration and self-reflection). Outpatient clinic nurses scored higher in four subscales than the PHC nurses. Nurses who had a history as a victim or had reporting experience claimed better clinical competency. Unfortunately, community nurses had limited knowledge in child abuse. The findings support the development of continuing education programmes on child abuse for community nurses.

Prediction by Clinicians of Quality of Life for Children and Adolescents with Cardiac Disease

To determine whether clinicians could reliably predict health-related quality of life (HRQOL) for children with cardiac disease, the level of agreement in predicted HRQOL scores between clinician sub-types, and agreement between clinician-predicted HRQOL scores and patient and parent-proxy reported HRQOL scores. In this multicenter, cross-sectional study, a random sample of clinical summaries of children with cardiac disease and related patient and parent-proxy reported HRQOL scores were extracted from the Pediatric Cardiac Quality of Life Inventory data registry. We asked clinicians to review each clinical summary and predict HRQOL. Experienced pediatric cardiac clinicians (n = 140), including intensive care physicians, outpatient cardiologists, and intensive care, outpatient, and advanced practice nurses, each predicted HRQOL for the same 21 pediatric cardiac patients. Reliability within clinician subspecialty groups for predicting HRQOL was poor (intraclass correlation coefficients, 0.34-0.38). Agreement between clinician groups was low (Pearson correlation coefficients, 0.10-0.29). When comparing the average clinician predicted HRQOL scores to those reported by patients and parent-proxies by Bland Altman plots, little systematic bias was present, but substantial variability existed. Proportional bias was found, in that clinicians tended to overestimate HRQOL for those patients and parent-proxies who reported lower HRQOL, and underestimate HRQOL for those reporting higher HRQOL. Clinicians perform poorly when asked to predict HRQOL for children with cardiac disease. Clinicians should be cognizant of these data when providing counseling. Incorporating reported HRQOL into clinical assessment may help guide individualized treatment decision-making.

Increasing Compliance in BMT Patients by Creating a Patient Education Binder

Newly diagnosed cancer patients with hematological disorders such as leukemia and lymphomas are for the most part diagnosed and quickly initiated on treatment. Information is constantly thrown at the patient from the moment he or she is diagnosed, often without being absorbed by the patient. These patients usually are initiated on chemotherapy and if warranted are headed to transplant. The patient education binder will allow the patient to collect all the information regarding disease and treatment in an organized manner divided into pertinent sections. Recognizing this is a stressful time, the binder will serve as a tool to ease anxiety. The binder will be started during the patient's initial diagnosis and follow the patient to end of recovery. The binder will contain useful information, which can assist patients during treatment. The nurses caring for the patient will review the material with the patient, checking off each section of the binder; thus nurses will be aware of any material needing reinforcement. Prior to initiating patient education, a small group of nurses were explained purpose of binder, division of binder, and checklist teachings. A small sample of newly diagnosed AML patients and transplant patients were chosen, and the binder was initiated at the beginning of treatment. A survey was conducted after patient was discharged regarding effect of the binder during patient’s stay. Outpatient nurses were also explained the purpose of the binder and importance of having the patient bring the binder to each visit. At this time no current patient education binders exist in the institution. There are other institutions where patient education binders are currently being used. Outcome measurement is easing of anxiety, compliance, and patient understanding of illness, medications, and treatment, assessed post discharge with a patient survey. Creating this binder could ultimately set forth a trend where all hospitals create a patient education binder to ease patient anxiety and increase compliance. Nurses and collaborative physicians can work together to ensure patient is compliant with binder, increasing patient education.

HSCT Education: Bridging the Gap

Topic Significance & Study Purpose/Background/ Rationale: In 2014 the HSCT program at the academic medical center became a member of the NMDP. This brought the challenge of ensuring that those whowould be trusted to care for these patients have the proper knowledge and skill base to be successful. A review of strategies was undertaken to effectively meet the educational needs of staff caring for HSCT patients across settings. Methods, Intervention, & Analysis: The leadership team, in conjunction with the HSCT staff, identified an opportunity to enhance knowledge among staff nurses in both the inpatient and ambulatory care setting. The goal: prepare staff to care for this complex patient population and to improve relationships between inpatient and ambulatory nurses and to enhance continuity of care. A multi-disciplinary education plan was created involving various venues and formats to address these goals. Initially a multi-day intensive educational offering was provided in collaboration with an external expert. These sessions covered topics from diseases treated by HSCT, indications for each type of transplant, and the basics of HLA typing. Internal experts including nurses and pharmacists offered additional sessions, focusing on care of the allogeneic transplant patient. An HSCT physician offers informal bi-weekly sessions that address just-in-time clinical issues. Finally in an effort to support staff preparing for the bone marrow transplant certified nurse exam (BMTCN) a study group is offered on a monthly basis. Findings & Interpretation: Approximately 75% of staff have attended the sessions with ongoing session being offered to meet the needs of new staff and those who did not participate in the initial sessions. Feedback from staff has been positive: “These sessions were great” and “It was really neat to meet the outpatient nurses.” Discussion & Implications: In addition to increasing knowledge and confidence of nurses, this program has increased communication and cohesiveness among the nursing staff. This program will be continued and expanded to meet the needs of nurses throughout the organization caring for HSCT patients.