Outcomes sensitive to nursing service quality in ambulatory cancer chemotherapy: Systematic scoping review

Quality of outpatient nursing care: a scoping review

to map national and international scientific literature on the quality of outpatient nursing care.

a scoping review guided by the Joanna Briggs Institute Collaboration, conducted across 12 databases and repositories. Only original articles evaluating the quality of outpatient nursing care were included. No restrictions were applied regarding time, methodology, or language. Data were mapped and organized through thematic and statistical descriptions of the articles. This review was registered on the Open Science Framework platform.

a total of 45 studies published between 1984 and 2021 were identified, resulting in 17 quality indicators for outpatient nursing care, grouped according to Donabedian's triad: four for structure, seven for process, and six for outcomes. The predominant area of care was oncology. Among the analyzed studies, 55.3% focused on patients. The most frequently cited indicators were continuing health education, service organization, communication, care coordination, and the nursing process.

the limited number of studies in this field, compared to other areas of nursing, highlights the underexploitation of the topic both nationally and internationally. Additionally, the diversity of identified indicators underscores the lack of standardization in these data.

BACKGROUND

(1) Few studies address the evaluation of outpatient nursing care quality.

BACKGROUND

(2) Quality indicators identify challenges in healthcare services.

BACKGROUND

(3) Publications on outpatient nursing care quality have increased since 2000.

BACKGROUND

(4) Most of the evaluated studies focused on outpatient patients.

BACKGROUND

(5) The most frequently cited quality indicator in the studies was Continuing Health Education.

Establishment and analysis of quality index system for pediatric tumor nursing

BACKGROUND

Nursing management considers nursing quality management at its core. Evaluation indexes of nursing quality not only control nursing quality, measure work enthusiasm, and judge the difference in nursing levels but also help nurses accurately understand the satisfaction degree of patients.

OBJECTIVE

To analyze pediatric tumor nursing quality evaluation indexes and establish a scientific and rigorous index system of children's nursing quality.

METHODS

  Based on the "structure-process-result" in this study, the Delphi method was used to carry out questionnaire investigations and opinion collection for domestic experts in pediatrics, pediatric oncology internal medicine, and pediatric oncology surgical care and clinical aspects two times. In addition, the Kendall coordination coefficient and analytic hierarchy process were used to determine the content of indicators at all levels, set the weight, and finally establish the quality index system of pediatric tumor nursing.

RESULTS

The response rate of 27 experts in the first round of the questionnaire was 100%, Ca0.77, Cs,0.73, Cr0.75, and the W value of the expert coordination coefficient was 0.315. In the second round of 27 expert consultations, the reply rate was 96%, Ca0.81, Cs0.80, Cr0.805, and the specialist coordination coefficient W value was 0.369. After two rounds of consultation, the importance evaluation scores of each indicator ranged from 3.31 to 4.88 and 3.29 to 5.00, respectively, and more than 94.7% of the indicators' importance evaluation scores were higher than 3.50. Finally, 3 Level-1 indicators, 12 Level-2 indicators, and 54 Level-3 indicators are established.

CONCLUSION

This study has established a simple, comprehensive, and scientific quality index system for pediatric tumor nursing, highlighted the characteristics of pediatric tumor nursing, and provided an evaluation system for specialized nursing of pediatric tumors to more standardized pediatric tumor nursing and contribute to the sustainable and scientific development of pediatric tumor nursing.

What Nursing-Sensitive Outcomes Have Been Investigated to Date among Patients with Solid and Hematological Malignancies? A Scoping Review

Nursing-sensitive outcomes are those outcomes attributable to nursing care. To date three main reviews have summarized the evidence available regarding the nursing outcomes in onco-haematological care. Updating the existing reviews was the main intent of this study; specifically, the aim was to map the state of the art of the science in the field of oncology nursing-sensitive outcomes and to summarise outcomes and metrics documented as being influenced by nursing care. A scoping review was conducted in 2021. The MEDLINE, Cumulative Index to Nursing and Allied Health, Web of Science, and Scopus databases were examined. Qualitative and quantitative primary and secondary studies concerning patients with solid/haematological malignancies, cared for in any setting, published in English, and from any time were all included. Both inductive and deductive approaches were used to analyse the data extracted from the studies. Sixty studies have been included, mostly primary (n = 57, 95.0%) with a quasi- or experimental approach (n = 26, 55.3%), conducted among Europe (n = 27, 45.0%), in hospitals and clinical wards (n = 29, 48.3%), and including from 8 to 4615 patients. In the inductive analysis, there emerged 151 outcomes grouped into 38 categories, with the top category being 'Satisfaction and perception of nursing care received' (n = 32, 21.2%). Outcome measurement systems included mainly self-report questionnaires (n = 89, 66.9%). In the deductive analysis, according to the Oncology Nursing Society 2004 classification, the 'Symptom control and management' domain was the most investigated (n = 44, 29.1%); however, the majority (n = 50, 33.1%) of nursing-sensitive outcomes that emerged were not includible in the available framework. Continuing to map nursing outcomes may be useful for clinicians, managers, educators, and researchers in establishing the endpoints of their practice. The ample number of instruments and metrics that emerged suggests the need for more development of homogeneous assessment systems allowing comparison across health issues, settings, and countries.

Nurse-led emergency department avoidance model of care for patients receiving cancer therapy in the ambulatory setting: a health service improvement initiative

AIMS

The Symptom and Urgent Review Clinic was a service improvement initiative, which consisted of the implementation and evaluation of a nurse-led emergency department (ED) avoidance model of care. The clinic was developed for patients experiencing symptoms associated with systemic anti-cancer therapy in ambulatory cancer settings.

METHODS

The clinic was implemented in four health services in Melbourne, Australia across a six-month period in 2018. Evaluation was by prospective data collection of the frequency and characteristics of patients who used the service, pre- and post-survey of patient reported experience, and a post-implementation survey of clinician engagement and experience.

RESULTS

There were 3095 patient encounters in the six-month implementation period; 136 patients were directly admitted to inpatient healthcare services after clinic utilization. Of patients who contacted SURC (n = 2174), a quarter (n = 553) stated they would have otherwise presented to the emergency department and 51% (n = 1108) reported they would have otherwise called the Day Oncology Unit. After implementation, more patients reported having a dedicated point of contact (OR 14.3; 95% CI 5.8-37.7) and ease of contacting the nurse (OR 5.5; 95% CI 2.6-12.1). Clinician reported experience and engagement with the clinic was highly favorable.

CONCLUSION

The nurse-led emergency department avoidance model of care addressed a gap in service delivery, while optimizing service utilization by reducing ED presentations. Patients reported improved levels of satisfaction with ease of access to a dedicated nurse and advice provided.

Ambulatory Care Nurse-Sensitive Indicators: A Scoping Review of the Literature 2006-2021

BACKGROUND/PURPOSE

Meeting recommendations that nurses should partner in leading health care change is hampered by the lack of ambulatory care nurse-sensitive indicators (ACNSIs). This scoping review was conducted to identify evidence regarding ACNSI identification, development, implementation, and benchmarking.

METHODS

Following the PRISMA-ScR reporting guide, we performed PubMed/MEDLINE, CINAHL, and Cochrane Library searches for the period January 2006 to March 2021.

RESULTS

Twelve of the 1984 articles from 6 countries met inclusion criteria. All focused on identifying, developing/pilot testing indicators, and included structure, process, and outcome indicators. Seven articles were level II and all were at least grade B quality. Leverage points involved leadership support, automated data extraction infrastructure, and validating links between nurses' roles/actions and patient outcomes.

CONCLUSIONS

While high-quality work is ongoing to identify clinically meaningful and feasible ACNSIs, knowledge in this field remains underdeveloped. Prioritizing this work is imperative to address gaps and facilitate national strategic health care goals.

Bundle for the prevention and management of complications of neutropenia in cancer patients

OBJECTIVES

to construct and assess bundle content for the prevention and management of complications in neutropenia in cancer patients.

METHODS

a methodological study developed in four stages: scoping review; bundle construction; material assessment by experts (developed according to Pasquali's psychometry); pilot test in a High Complexity Assistance Unit in Oncology. For content assessment, the Delphi technique was applied in two rounds and those items with Content Validation Coefficient (CVC)> 0.78 and agreement> 80.0% were considered valid. Data were analyzed using descriptive and inferential statistics.

RESULTS

all bundle requirements reached agreement between judges above 80.0%, in addition to statistically significant levels of assessment. At the end of the Delphi technique, bundle was significantly valid with CVC = 0.92 and CVC = 0.93, respectively.

CONCLUSIONS

bundle content proved to be valid and highly credible.

A qualitative evaluation of community and acute hospital nursing oncology services in Ireland

PURPOSE

Cancer patients are a particularly vulnerable population group, facing an increase in physical, mental, logistical and financial difficulties. This, as well as Ireland's increased focus on primary care with the Sláintecare health plan, led to the development of the Community Oncology Nursing Programme, where community nurses are trained to provide cancer care in the community. This paper sought to explore the lived experiences of the patients and nurses involved in this programme in order to examine its impact as well as determine facilitators and roadblocks for future development.

METHODS

A qualitative examination of the service was carried out by interviewing cancer patients receiving care as part of the programme as well as the nurses delivering care, both in the community and hospital day-ward. Thematic analysis was used.

RESULTS

Themes of improved patient experience, nurse-patient relationship, the importance of location and roadblocks to further implementation of the programme emerged. There was a universal belief that the programme offered benefits to the patient and improved their care in some manner.

CONCLUSIONS

The Community Oncology Nursing Programme has been well received by both nurses and patients. The service provided by community nurses as part of this programme offers benefits to patients and an improved cancer service.

Nursing-sensitive outcomes in adult inflammatory bowel disease: A systematic review

AIMS

To evaluate nursing activity through outcomes that are affected, provided, and/or influenced by nurses and defined as nursing-sensitive outcomes in adult IBD patients.

DESIGN

Systematic review without meta-analysis.

DATA SOURCES

PubMed, Embase, CINAHL, PsycINFO, and the Cochrane Library databases on August 2019.

REVIEW METHODS

Peer-reviewed articles published between 2000-2020 were reviewed. The outcome measures were contextualized and presented by OMERACT Filter 2.0.

RESULTS

Twenty-four studies were included. Eighteen nursing-sensitive outcomes were identified. These outcomes defined eight domains for health intervention, fitting into three core areas (resource use/economic impact, life impact, pathophysiological manifestations). Fifty-three measurement instruments were identified.

CONCLUSIONS

Through 53 measurement tools, with use of OMERACT framework, 18 nursing-sensitive outcomes in the main 3 core areas were identified, highlighting the multidimensional role of nursing. Further insights are to be carried out to define nursing outcomes included in IBD nursing intervention studies.

IMPACT

These results could serve as a cornerstone for further investigations and validation by a panel of experts to standardizing nursing activity in a multidisciplinary context.

Impact of advanced nursing practice through nurse-led clinics in the care of cancer patients: A scoping review

OBJECTIVE

This scoping review aims at exploring the effectiveness of nurse-led advanced practice for patients with cancer.

METHODS

This review followed the PRISMA extension for scoping reviews. Randomised controlled trials on cancer nurse-led clinics for patient outcomes, costs, service utilisation and other outcomes were included. Databases such as MEDLINE, CENTRAL, CINAHL, EMBASE and PsychINFO were searched based on MeSH terms. Thematic analysis was used to synthesise results of the included studies.

RESULTS

Seventeen articles were included, published between 2001 and 2019. There were methodological shortcomings with a number of the studies reviewed. Five themes were identified including (1) rationale for developing nurse-led clinics, (2) mode of delivery of nurse-led clinics, (3) the content of nurse-led clinics, (4) exploring patient outcomes and (5) satisfaction with nurse-led clinics.

CONCLUSIONS

The results support the effectiveness of nurse-led clinics in improving self-reported responses such as distress levels, satisfaction, quality of life, depressive symptoms, concerns and vomiting among cancer patients. Following a sound protocol for both the study and the reporting is recommended, and future studies should focus more on costs and effectiveness of different models of care administered by advanced practice nurses. Effectiveness of nurse-led clinics needs further evaluation with stronger trials and wider focus on nursing-sensitive clinical outcomes and costs.

A cost comparison study to review community versus acute hospital models of nursing care delivered to oncology patients

PURPOSE

Ireland's Sláintecare health plan is placing an increased focus on primary care. A community oncology nursing programme was developed to train community nurses to deliver care in the community. While the initial pilot was proven to be clinically safe, no cost evaluation was carried out. This study aims to compare the costs of providing cancer support services in a day-ward versus in the community.

METHODS

183 interventions (40 in day-ward and 143 in community) were timed and costed using healthcare professional salaries and the Human Capital method.

RESULTS

From the healthcare provider perspective, the day-ward was a significantly cheaper option by an average of €17.13 (95% CI €13.72 - €20.54, p < 0.001). From the societal perspective, the community option was cheaper by an average of €2.77 (95% CI -€3.02 - €8.55), although this was a non-significant finding. Sensitivity analyses indicate that the community service may be significantly cheaper from the societal perspective.

CONCLUSIONS

Given the demand for cost-viable options for primary care services, this programme may represent a national option for cancer care in Ireland when viewed from the societal perspective.

Development and implementation strategies of a nurse-led symptom self-management program in outpatient cancer centres: The Symptom Navi© Programme

PURPOSE

The Symptom Navi© Programme (SN©P) is a structured nurse-led intervention supporting symptom self-management in cancer patients. We describe the development and evaluation of the intervention, implementation strategy, and the evaluation of nurse training for the Symptom Navi© Pilot Study.

METHODS

The intervention was developed using multiple methods (e.g. literature synthesis, focus groups) to produce SN©P information leaflets (SN©Flyers in French and German) and standardised training for nurses to deliver semi-structured consultations. We evaluated the SN©P using online surveys, focus groups, interviews, and the Item-Content Validity Index (I-CVI). Nurse training was evaluated in relation to content, acceptability, and confidence in implementing the SN©P. We examined the association between scored on the Work-related Sense of Coherence (Work-SoC) scale and nurses' confidence in implementing the SN©P. Thematic analysis was used to analyse qualitative data. Quantitative data was descriptively analysed and the Kendall Tau test was employed for correlations.

RESULTS

Patients and health care professionals confirmed that SN©Flyers and semi-structured consultations facilitated symptom self-management. Nurses considered training content/format acceptable and appropriate and felt confident in implementing the SN©P. Overall Work-SoC scores were correlated with nurses' confidence in implementing the SN©P (r_π = .47, p = .04).

CONCLUSIONS

Health care professionals and cancer patients perceived the SN©P as a useful support. Successful implementation of the SN©P depends on centre-specific factors including time, resources and workflow.

CLINICAL TRIAL REGISTRY

NCT03649984 and SNCTP000002381.

Effectiveness of nursing interventions among patients with cancer: An overview of systematic reviews

AIMS AND OBJECTIVES

To explore nursing interventions used among patients with cancer and summarise the results of their effectiveness. The ultimate goal was to improve the quality of care and provide best evidence for clinicians to refer to while developing effective nursing interventions.

BACKGROUND

Nursing interventions refer to actions that nurses take with the aim of improving the well-being of people with cancer-related health and care needs. A plethora of systematic reviews has been conducted in this research area, although with scattered results. We conducted a comprehensive review to identify and summarise the existing evidence.

METHODS

This overview of systematic reviews adheres to the PRISMA guidelines. The PubMed, CINAHL, MEDLINE and Scopus databases were searched. Nine reviews reporting findings from 112 original studies published 2007-2017 met the selection criteria. The results of intervention effectiveness were analysed using descriptive quantification and a narrative summary of the quantitative data.

RESULTS

The effectiveness of educational nursing interventions was inconsistent on quality of life (QoL), attitudes, anxiety and distress, but positive on level of knowledge, symptom severity, sleep and uncertainty. Psychosocial nursing interventions had a significant effect on spiritual well-being, meaning of life, fatigue and sleep. Psychological nursing interventions reduced cancer-related fatigue. Nursing interventions supporting patients' coping had a significant impact on anxiety, distress, fatigue, sleep, dyspnoea and functional ability. Activity-based interventions may prevent cancer-related fatigue.

CONCLUSIONS

Nursing interventions achieved significant physical and psychological effects on the lives of patients with cancer. Multidimensional nature of interventions by combining different elements reinforces the effect. Priorities for future research include identifying the most beneficial components of these interventions.

RELEVANCE TO CLINICAL PRACTICE

Implementation of these nursing interventions into clinical practice is important to improve patients' knowledge and QoL as well as reducing various symptoms and side effects related to cancer and its treatment.

PATIENT SAFETY IN THE ADMINISTRATION OF ANTINEOPLASTIC CHEMOTHERAPY AND OF IMMUNOTHERAPICS FOR ONCOLOGICAL TREATMENT: SCOPING REVIEW

ABSTRACT Objective: to identify and synthesize the scientific evidence on cancer patient safety in the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Method: a scoping review, according to the Joanna Briggs Institute and to the recommendations of the PRISMA-ScR international guide. The research was conducted in five electronic databases, the Cochrane Library and eight catalogs of theses and dissertations. The inclusion criteria were the following: studies related to patient safety in the administration of antineoplastic and immunotherapeutic chemotherapy by nurses in places where cancer care occurs, published entirely in Portuguese, Spanish and/or English, with no time limit. The extracted data were analyzed and synthesized in narrative form. Results: a total of 14,444 records were retrieved and 47 studies were kept for review. Most publications (44.7%) had a qualitative approach, while 40.4% were quantitative and 14.9%, mixed. When summarizing the findings, the following themes emerged: Safety standards in parenteral administration of antineoplastic chemotherapy; Good practices for patient safety using oral antineoplastic therapy; Administration and safe handling of immunotherapies; Prevention and management of errors related to the administration of antineoplastic and immunotherapeutic chemotherapeutic agents. Conclusion: patients safety with cancer in the administration of antineoplastic therapy occurs when there is implementation of evidence-based protocols, continuing education of nurses and implementation of safety standards and processes, as a strategy to prevent errors in drug administration.

A nationwide survey of patient problem occurrence across different nursing healthcare sectors

AIM

The aim of this study was to determine the patient problems that nurses encounter in different clinical settings and the extent to which they report being able to influence those patient problems.

DESIGN

Exploratory online survey research.

METHOD

Data were collected through an online questionnaire. We prepared a 2 × 2 matrix to compare the rate of occurrence against the average level of reported influence. Descriptive statistics were used for the data analysis.

RESULTS

A total of 440 nurses working in different settings completed the questionnaire. Nurses report having the most influence on patient problems related to self-care, mobility and functions of the skin. Nurses experience less influence on problems with voice/speech and the tasks required for participation in work/employment.

Which priority indicators to use to evaluate nursing care performance? A discussion paper

AIMS

A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care.

BACKGROUND

Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard.

DESIGN

Discussion paper drawing on a systematic assessment of selected performance indicators.

DATA SOURCES

Previous works, based on systematic reviews of the literature published between 1990 - 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the specific evidence supporting 25 selected indicators, focusing on systematic syntheses, meta-analyses and integrative reviews.

IMPLICATIONS FOR NURSING

This study has identified a set of 12 indicators that have sufficient breadth and depth to capture the whole spectrum of nursing care and that could be implemented on a priority basis.

CONCLUSIONS

This study sets the stage for new initiatives aiming at filling current gaps in operationalization of nursing care performance. The next milestone is to set up the infrastructure required to collect data on these indicators and make effective use of them.

The Health Tourists' Satisfaction Level of Services Provided: A Cross-Sectional Study in Iran

Introduction:

Patient satisfaction with provided services is used as an indicator of health care quality. Patient satisfaction is defined as patient perception of provided care compared to expected care. This study was administered to evaluate the health tourists’ satisfaction of provided services in Lorestan University of Medical Sciences affiliated hospitals in 2015.

Method:

In this descriptive case study, 1800 (696 (54.4%) men and 812 (45.6%) women, 74.5 province native) patients were selected by random sampling from among the patients of Lorestan University of Medical Sciences affiliated hospitals in 2015 spring. The data collection instrument is a semi-structured questionnaire in this study. The questionnaire has 62 general and specific items. Each of the specific items is scaled on four points; satisfied, fairly satisfied, dissatisfied and O.K. In order to analyze the data both descriptive and inferential statistics were used.

Results:

Poldokhtar Imam Khomeini Hospital had the highest Level of satisfaction of 68 percent in all aspects (hoteling, discharge, paramedical, nurses, medical and admission) among the studied hospitals. Kuhdasht Imam Khomeini hospital had the lowest level of satisfaction of 53 percent. The overall satisfaction level in all hospitals was 61%.

Discussion and Conclusion:

Despite the shortcomings observed in different areas, the results of the present study are in an intermediate status compared to other studies. While treating patients, patient-centered issue and patients ‘need and preferences should be focused on to enhance health care quality. Considering Patients preferences not only are morally good but also lead to improved care and access to sustainable care practices. Therefore it is needed to drive organizational management approach toward the customer preferences management and needs.

Prevalence of cancer chemotherapy-related problems, their relation to health-related quality of life and associated supportive care: a cross-sectional survey

PURPOSE

The purpose of this study was to identify the treatment-associated problems that most impact on patients undergoing cancer chemotherapy, how problems relate to experiences of supportive care and variations in experience between cancer treatment centres.

METHODS

A survey administered to patients at six cancer centres in England explored variations of prevalence of 17 cancer chemotherapy-associated problems and associated supportive care. Problem items were identified as the most frequently experienced and severe when experienced in a scoping and consensus exercise. A health-related quality of life (HRQoL) measure, the EQ5D, was included to measure impact of problems.

RESULTS

A total of 363 completed questionnaires were returned (response rate 43 %, median 61 %). The most prevalent problem was 'tiredness/fatigued' (90 %), followed by 'changes in taste & smell' (69 %) and 'difficulty managing everyday tasks' (61 %). Significant variations in problem prevalence existed between centres, and some common problems were rarely reported in the literature. Regression analysis found that almost all problems were significantly associated with HRQoL, with social/emotional problems having as much impact on HRQoL as physical/psychological side effects of treatment. Greatest effect size was for difficulty managing everyday tasks. Respondents reported significant variations in supportive care between centres, with more supportive care received for physical/psychological problems than for social/emotional problems. Findings indicated that patients who received increased supportive care experienced less severe problems.

CONCLUSION

The most common and distressing chemotherapy-associated problems were identified. These problems are mitigated by quality supportive care. Routine measurement and monitoring of problem items and supportive care are warranted to facilitate benchmarking and service improvements both within and between cancer centres.

Development and testing of the patient-reported chemotherapy indicators of symptoms and experience: patient-reported outcome and process indicators sensitive to the quality of nursing care in ambulatory chemotherapy settings

BACKGROUND

Outcome indicators are increasingly advocated to demonstrate the impact of high-quality care; however, generic measures do not encompass outcomes relevant to specialist areas.

OBJECTIVE

The aim of this study was to develop an outcome measure (Patient-Reported Chemotherapy Indicators of Symptoms and Experience [PR-CISE]) for use in ambulatory chemotherapy settings and assess its feasibility, acceptability, and preliminary efficacy in clinical practice.

METHODS

Three areas were covered by PR-CISE--symptom management, safe medication administration, and experience of supportive care. Outcome selection was guided by review of evidence and reference groups of users, clinicians, and experts. Over 12 weeks, PR-CISE was distributed to patients receiving ambulatory chemotherapy at 10 cancer centers. Data were analyzed descriptively and with case mix adjustment using regression-based models.

RESULTS

There were 2466 responses. There was variability across centers in terms of symptom experience and support provided. Across the whole sample, 25% reported moderate or severe nausea; however, rates varied between centers (25%-75%). Similar results emerged for other symptoms. When asked about support for symptom management, 80% reported that chemotherapy nurses asked about and were aware of symptom severity and provided useful information/advice. Once again, there was substantial variability between centers. Unexplained variation remained after case mix adjustment, suggesting that differences may be "real" rather than caused by population differences. Stakeholders planned to make changes to care delivery based on data on their performance.

CONCLUSIONS

We successfully developed and tested indicators assessing the quality of care provided in ambulatory chemotherapy services.

IMPLICATIONS

Results show that monitoring outcomes demonstrate potential differences in care quality and provide a stimulus to improve the experience and health of patients.

Indicators for Evaluating the Performance and Quality of Care of Ambulatory Care Nurses

The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to evaluate the performance of nursing care in outpatient settings and to integrate those indicators into the theoretical framework of Dubois et al. (2013). We conducted a scoping review in three databases (CINAHL, MEDLINE, and EMBASE) and the bibliographies of selected articles. From a total of 116 articles, we selected 22. The results of our study not only enable that framework to be extended to ambulatory nursing care but also enhance it with the addition of five new indicators. Our work offers nurses and managers in ambulatory nursing units indicators potentially sensitive to nursing that can be used to evaluate performance. For researchers, it presents the current state of knowledge on this construct and a framework with theoretical foundations for future research in ambulatory settings. This work opens an unexplored field for further research.

Knowledge and practice among Hong Kong oncology nurses in the management of chemotherapy-induced nausea and vomiting

PURPOSE

To examine nurses' roles in the prevention and management of chemotherapy-induced nausea and vomiting (CINV), and to identify their related educational needs.

METHODS

This was a descriptive cross-sectional study with a self-reported survey completed by 103 oncology nurses caring for and administering chemotherapy to cancer patients in the department of oncology in three Hong Kong public hospitals. The survey was developed to identify key issues pertinent to the role of nurses in managing CINV. Data were collected from the following areas (a) demographics, (b) assessment of CINV, (c) CINV management and (d) barriers and facilitators to good CINV practice.

RESULTS

Only a third of respondents performed a CINV assessment before starting chemotherapy, and more than 40% reported that the use of a standardised assessment tool was uncommon. Nearly half recognised that they had inadequate knowledge of different aspects of CINV, but the majority could clearly state the most common pharmacological agents used to treat chemotherapy-induced nausea (88.3%) and vomiting (87.4%). The barriers respondents most frequently encountered in CINV prevention and management were lack of time and a heavy workload. Adopting a standardised CINV assessment tool and management protocol together with further professional training were identified as the major facilitators in improving CINV prevention and management.

CONCLUSIONS

Respondents perceived their knowledge of CINV prevention and management as inadequate. There is a need to adopt a standardised assessment tool, to develop a management protocol and to introduce further professional training to meet the expanding needs of both patients and nurses.