Home infusion teaching practices at federally funded hemophilia treatment centers in the United States of America

The role of the specialist nurse in comprehensive care for bleeding disorders in Europe: An integrative review

INTRODUCTION

Managing bleeding disorders (BDs) is complex, requiring a comprehensive approach coordinated by a multidisciplinary team (MDT). Haemophilia nurses (HNs) play a central role in the MDT, frequently coordinating care. As novel treatments bring change to the treatment landscape, ongoing education and development is key. However, understanding of the roles and tasks of HNs is lacking.

AIM

The EAHAD Nurses Committee sought to identify and describe the roles and tasks of the European HN.

METHODS

A five-step integrative review was undertaken, including problem identification, literature search, data evaluation, data synthesis and presentation. Relevant literature published from 2000 to 2022 was identified through database, hand and ancestry searching. Data were captured using extraction forms and thematically analysed.

RESULTS

Seven hundred and seventy-seven articles were identified; 43 were included. Five main roles were identified, with varied and overlapping associated tasks: Educator, Coordinator, Supporter, Treater and Researcher. Tasks related to education, coordination and support were most frequently described. Patient education was often 'nurse-led', though education and coordination roles concerned both patients and health care practitioners (HCPs), within and beyond the MDT. The HN coordinates care and facilitates communication. Long-term patient care relationships place HNs in a unique position to provide support. Guidelines for HN core competencies have been developed in some countries, but autonomy and practice vary.

CONCLUSION

As the treatment landscape changes, all five main HN roles will be impacted. Despite national variations, this review provides a baseline to anticipate educational needs to enable HNs to continue to fulfil their role.

Nurse-led education of people with bleeding disorders and their caregivers: A scoping review

INTRODUCTION

People with bleeding disorders (PwBd) and their caregivers face many challenges in developing viable self-management strategies for living with the condition. Nurse-led education can support them to overcome these challenges. However, it is often unclear what educational needs are addressed, how nurses educate PwBd and what didactic concepts they follow.

AIM

To gain deeper insights into nurse-led patient education in haemophilia care and provide a basis for a more systematic and evidence-based approach to this task.

METHODS

A scoping review methodology was used. A systematic search for relevant publications on this topic was conducted in various databases between November 2020 and April 2021. Data sets were analysed following the PRISMA-ScR-checklist and using content analysis.

RESULTS

Of 588 studies identified, 23 sources of evidence met the inclusion criteria. The educational needs of PwBd and their families are extensive, multifaceted, and variable but rarely assessed systematically. These needs were met at certain times throughout their lifetimes. Nurse-led education differed in content, duration, and modality, including interventions such as information, consultation and instruction. An improvement in treatment-oriented self-management and self-efficacy was the most reported outcome. The didactic concepts on which the educational interventions were based were rarely specified.

CONCLUSIONS

There is a lack of systematic approaches in assessing and addressing the educational needs of PwBd and their caregivers. High variability was found in the literature regarding nurse-led patient education in haemophilia care. This suggests that more research is needed on this topic - not least on the interventions' conceptual foundations and impact models.

Development of a Self-Assessment Tool for the Nontechnical Skills of Hemophilia Teams

BACKGROUND AND OBJECTIVES

The treatment of chronic illnesses requires health care professionals (HCPs) to master several nontechnical skills to meet patient care needs. This article aims to describe the rationale and the inductive process through which a self-assessment tool for the nontechnical skills of hemophilia teams was conceived, developed, and tested.

METHODS

Starting from an explorative analysis of hemophilia HCP work experiences, the process followed 3 phases: an in-depth analysis of hemophilia HCP skills; the questionnaire development; and a pilot study.

RESULTS

Using the voice of HCPs as a starting point, the tool proved to be able to identify precise cross-professional and intercultural challenges as well as related required and/or acquired skills in the hemophilia field.

CONCLUSION

The proposed tool may contribute to providing HCPs with strategic knowledge to successfully perform everyday practices, to improve the effectiveness of hemophilia teams and the care model adopted by their centers, and to implement intercultural research in this field. It may be used to propose ad hoc training courses targeted by challenge, in order to fill the major gaps reported by the teams, or targeted by medical specialty or country (and therefore health care system) specificity.

Haemophilia home care: A qualitative evaluation study of the Be Involved infusion program

INTRODUCTION

In Canada, patients with haemophilia can receive health care through a limited number of specialized haemophilia treatment centres. Treatment of this X-linked bleeding disorder through self-infusion of factor replacement is common; however, some individuals with haemophilia require additional infusion support from medical professionals. While provincially funded outreach clinics and telehealth are available, pharmaceutical companies that supply factor have developed novel home infusion programs wherein registered nurses assist/manage factor administration in the patients' homes.

AIM

The current qualitative evaluation explored the real-world effectiveness and impact of the Be Involved (Pfizer Canada) home infusion service, from provider, program end-user and needs analysis perspectives.

METHODS

Qualitative interviews with patients and caregivers who had used Be Involved (n = 7) and Be Involved Staff (n = 8) provided important insights and recommendations for program improvement initiatives. Also included were needs assessments of potential end-users (n = 11) as a means to making program adjustments.

RESULTS

The inductively derived findings revealed Be Involved as a highly valued, though key specialized service providing significant assistance to a small number of haemophilia patients. Augmenting traditional services, the program was endorsed as easing the burden of haemophilia care, while the Be Involved nurses were affirmed as highly effective and critical to the program's success. A lack of program promotion and awareness was evident - limiting uptake, amid communication and systems delivery challenges.

CONCLUSIONS

The current evaluation findings inform our recommendations for, and brief discussion of, the need for stronger promotional strategies and improved communication lines to increase the reach and efficiencies of the Be Involved program.

A survey of characteristics and current educational needs of hemophilia treatment centers within Asia Pacific

BACKGROUND

Poor disease understanding and gaps in expertise regarding hemophilia care have been identified at all levels in Asia Pacific. Continued education for involved healthcare professionals (HCPs) is crucial for improved delivery.

OBJECTIVES

To identify training and educational needs of hemophilia HCPs in Asia Pacific.

METHODS

Clinicians working at hemophilia treatment centers (HTCs), identified from the World Federation of Hemophilia Directory, were contacted by the Asia Pacific Hemophilia Working Group (APHWG). An electronic survey was sent to 161 centers from 15 countries for which HTC identification was complete to assess HTC characteristics, educational status, and needs. Responses were stratified by national economic capacity.

RESULTS

From March 23 to June 6, 2016, clinicians from 58 HTCs completed the survey. Most reported availability of specialists to serve core patient requirements, although availability of trained nurses and geneticists was low in lower-middle income countries (LMICs). Although 98.3% of HTCs had laboratory facilities, 8.8% do not participate in any quality assessment schemes. The most common limitations of current initiatives were infrequency and lack of local language content. Education is currently mostly received via internet, particularly among LMICs and upper-middle income countries (UMICs), though there is strong preference for meetings. Main barriers to receiving education were funding and time constraints. Unique priority topics were musculoskeletal management, quality of life and management by non-hematologists (high-income countries), inhibitor management and research (UMICs), and outcomes assessment (LMICs).

CONCLUSION

In Asia Pacific, training programs should be tailored according to unique needs of differing economic capacities and resource settings.