Predictors of Hospitals' Nonachievement of Baseline Nursing Standards for Pediatric Oncology

The cancer nursing workforce in Australia: a national survey exploring determinants of job satisfaction

BACKGROUND

To maintain and improve the quality of the cancer nursing workforce, it is crucial to understand the factors that influence retention and job satisfaction. We aimed to investigate the characteristics of cancer nurses in Australia and identify predictors of job satisfaction.

METHODS

We analysed data from an anonymous cross-sectional survey distributed through the Cancer Nurses Society Australia membership and social media platforms from October 2021 to February 2022. The survey was compared to national nursing registration data. Data were analysed with non-parametric tests, and a stepwise, linear regression model was developed to best predict job satisfaction.

RESULTS

Responses were received from 930 cancer nurses. Most respondents (85%) described themselves as experienced nurses, and more than half had post-graduate qualifications. We identified individual, organizational, and systemic factors that contribute to job satisfaction and can impact in workforce shortages. The findings include strategies to address and prioritize workforce challenges. There were 89 different titles for advanced practice nursing roles. Managing high workload was a reported challenge by 88%. Intention to stay less than 10 years was reported by nearly 60%; this was significantly correlated with job satisfaction and age. Significantly higher scores for job satisfaction were associated with those who had career progression opportunities, career development opportunities, adequate peer support and a clearly defined scope of role. Conversely, job satisfaction scores decreased the more people agreed there was a lack of leadership and they had insufficient resources to provide quality care.

CONCLUSION

Cancer nurses are critical to the delivery of cancer care however, the workforce faces multiple challenges. This study provides an understanding of the Australian cancer nursing workforce characteristics, their roles and activities, and highlights important considerations for retaining nurses in the profession.

Paediatric oncology nursing education and training programmes: a scoping review protocol

INTRODUCTION

The care of children with cancer is a highly specialised field which requires well-educated, trained and dedicated nurses to provide high-quality care. In low/middle-income countries, the survival rate of children with cancer is low as compared with that of high-income countries due to the limited number of specialised oncology healthcare professionals, especially nurses. To address this problem, a number of paediatric oncology education and training programmes have been developed for nurses. The objective of this scoping review is to describe the existing literature focusing on paediatric oncology nursing education and training programmes; to map the content, delivery methods, duration and mode of assessment.

METHODS

The review will include articles published in English, from 2012 to 2022, that describe a paediatric oncology nursing education programme, from any setting. The review will follow Joanna Briggs Institute methodology for scoping reviews guidelines. A systematic search of literature will be performed in CINAHL, Dimensions, Embase, PubMed and Scopus. A two-stage standardised screening process will be employed to evaluate eligibility of the articles. All abstracts that will be considered relevant will be reviewed in full text form by the two reviewers independently. Conflicts will be resolved by consensus of all reviewers through a meeting. Data will be extracted by two independent reviewers using a developed data extraction tool. The results will be reported in extraction tables and diagrams with a narrative summary.

ETHICS AND DISSEMINATION

This scoping review is part of the multiphase study which obtained ethical clearance from College of Medicine Research Ethics Committee in Malawi and Human Research Ethics Committee of the University of Witwatersrand, South Africa. The scoping review will be published in a peer reviewed journal. The findings will also be presented at national and international conferences.

TRIAL REGISTRATION NUMBER

https://doi.org/10.17605/OSF.IO/X3Q4H.

Impact of hospital characteristics on implementation of a Pediatric Early Warning System in resource-limited cancer hospitals

Background

Pediatric Early Warning Systems (PEWS) aid in identification of deterioration in hospitalized children with cancer but are underutilized in resource-limited settings. Proyecto EVAT is a multicenter quality improvement (QI) collaborative in Latin America to implement PEWS. This study investigates the relationship between hospital characteristics and time required for PEWS implementation.

Methods

This convergent mixed-methods study included 23 Proyecto EVAT childhood cancer centers; 5 hospitals representing quick and slow implementers were selected for qualitative analysis. Semi-structured interviews were conducted with 71 stakeholders involved in PEWS implementation. Interviews were recorded, transcribed and translated to English, then coded using a priori and novel codes. Thematic content analysis explored the impact of hospital characteristics and QI experience on time required for PEWS implementation and was supplemented by quantitative analysis exploring the relationship between hospital characteristics and implementation time.

Results

In both quantitative and qualitative analysis, material and human resources to support PEWS significantly impacted time to implementation. Lack of resources produced various obstacles that extended time necessary for centers to achieve successful implementation. Hospital characteristics, such as funding structure and type, influenced PEWS implementation time by determining their resource-availability. Prior hospital or implementation leader experience with QI, however, helped facilitate implementation by assisting implementers predict and overcome resource-related challenges.

Conclusions

Hospital characteristics impact time required to implement PEWS in resource-limited childhood cancer centers; however, prior QI experience helps anticipate and adapt to resource challenges and more quickly implement PEWS. QI training should be a component of strategies to scale-up use of evidence-based interventions like PEWS in resource-limited settings.

Establishing nursing-sensitive quality indicators for pediatric oncology: An international mixed methods Delphi study

INTRODUCTION

Nursing-sensitive indicators (NSIs) measure factors influencing nursing care quality and patient outcomes. Established NSIs reflect general and select specialty nursing practices. However, a core set of NSIs for international pediatric oncology nursing practice does not currently exist. Without valid and reliable quality indicators, the impact of nursing care on children and adolescents with cancer cannot be effectively measured and improved. The purpose of this study was to develop a preliminary core set of NSIs for international pediatric oncology nursing that would be important, actionable, and feasible to measure across varied resource settings and countries.

DESIGN/METHODS

A multiphase sequential mixed methods research design, intersected with a classical Delphi method, was utilized. Through purposive snowball sampling, 122 expert pediatric oncology nurses from 43 countries participated. Round One: Panelists identified five potential NSIs and constructs. Open-ended responses were coded and categorized through descriptive content analysis and integrated into the next round. Round Two: Panelists selected their top 10 NSIs and constructs and ranked them by importance to patient care quality. Mean importance scores were calculated through reverse scoring; the top 10 NSIs and constructs were integrated into the next round. Round Three: Panelists ranked the top 10 NSIs and constructs by order of importance for this particular population, then rated each NSI/Construct for actionability and feasibility of measurement by Likert-scale. Rounds Two and Three were analyzed using descriptive statistics. Mixed methods meta-inferences were derived from the integration of Rounds One and Three findings.

RESULTS

Eighty-five (70%) panelists from 38 countries completed all Delphi survey rounds. The preliminary core set of NSIs and constructs identified by the expert panel, and ranked in order of importance, were as follows: safe chemotherapy administration and handling, infection prevention/control, pediatric oncology nursing orientation program, early warning score system/recognition of patient deterioration, chemotherapy/biotherapy education/course, pain assessment/management, symptom assessment/management, patient and family education, palliative/end of life care, and continuing nursing education/competency. All NSIs and constructs were rated as actionable; all but palliative/end of life care were rated as feasible to measure. Each of the 10 NSIs and constructs were nominated in Round One by at least one expert panelist from low- and middle-income and high-income countries, and at least one panelist from the Americas.

CONCLUSION

Preliminary core NSIs and constructs provide insight into common attributes of international pediatric oncology nursing practice that are important, actionable, and feasible for quality measurement.

CLINICAL RELEVANCE

NSIs have the potential to drive quality improvement, guide comparison with other institutions, promote knowledge-sharing, and advance pediatric oncology nursing outcomes around the world. These NSIs and constructs may also be relevant to other pediatric and adult oncology settings.

Essential core competencies for scope of practice of paediatric oncology nurses in Latin America: a scoping review protocol

INTRODUCTION

Nurses comprise the largest group of health workers globally and are essential to the provision of care necessary for delivering curative therapy to children with cancer. In high-income countries, previous studies of the nurse workforce have shown an association between patient morbidity and mortality and nursing-related factors such as staffing, education and the nursing practice environment. There is currently limited evidence available to define the scope of essential core competencies for paediatric oncology nursing (PON) practice internationally and specifically in Latin America. Clearly defined essential core competencies contribute to establishing nurses' scope of practice within clinical practice, education and research settings. Here, we aimed to map and synthesise the available evidence on the scope of PON practices in the context of clinical practice, educational training and research settings in Latin America.

METHODS

A scoping review (ScR) protocol is reported, adhering to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols statement and guided by The Joanna Briggs Institute. MEDLINE/PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, Science Direct and Latin American and Caribbean Health Sciences Literature, plus additional sources: The ProQuest Dissertation & Theses Global, The British Library, Google Scholar, medRXiv, ClinicalTrials.gov and WHO-ICTRP will be searched. No date or language restrictions will be employed. Two independent researchers will conduct all the steps of this ScR. The findings will be presented through tables, charts, narrative summaries and assessed based on the outcomes. The search strategy will be updated in May 2022. The expected completion date for this ScR is November 2022.

ETHICS/DISSEMINATION

This protocol does not require ethical approval. The dissemination plans comprise peer-reviewed publication and conference presentations, to be shared with International Oncology Societies/International Nursing Societies and advisory groups to inform discussions on future research. We expect that our results will be of interest to nurse professionals, especially, PON and nurse scholars concerned with this particular issue.

Pediatric Oncology Nursing Research in Low- and Middle-Income Countries: Exemplars from Three Regions

OBJECTIVE

This study examined the status of pediatric oncology nursing research in three low- and middle-income countries (LMICs) as examples across three World Health Organization regions: East Africa, Eastern Mediterranean region, and Latin America.

DATA SOURCES

Published literature was identified from Google Scholar, PubMed, Scielo, Virtual Health Library, and reference lists of some articles.

CONCLUSION

The experiences of the three LMIC pediatric oncology nurses illustrate the situation of nurse research in their setting and identify relevant published literature. The authors highlight the challenges for nurses to conduct research (eg, lack of training, mentors, funding, and opportunities). Local evidence to inform nursing practice in LMICs is needed. Recommendations for ameliorating the situation include increased advanced practice nurse education, physician and hospital support, funding, and protected time.

IMPLICATIONS FOR NURSING PRACTICE

Pediatric oncology nursing practice is culturally and context-driven and requires locally acquired evidence to support best practices. Only when sufficient, sustainable, and local nursing research training and education is available in LMICs, will this evidence be generated. Nursing research training (eg, master's and PhD programs), funding, and protected time are three key steps to guide and motivate staff nurses as well as academic nurses to participate in research that informs the care of children and adolescents with cancer across all countries and not only those with significant resources.

Contributions of Pediatric Oncology Nursing to Advance Care and Reduce Disparities Among Children and Adolescents with Cancer: Introduction

OBJECTIVE

Highlight examples of pediatric oncology nursing's accomplishments during the past 2 decades with attention to specialized practice, patient/family education, research/evidence-based practice, and advocacy and how these efforts can be leveraged to reduce disparities in the cure and care of children and adolescents with cancer.

DATA SOURCES

Review of currently published literature, guidelines, and websites documenting pediatric oncology nursing's contributions.

CONCLUSION

Over the past 20 years, the collective work of pediatric oncology nurses across the world has improved the care of children with cancer and their families and brought attention to areas of disparities.

IMPLICATIONS FOR NURSING PRACTICE

Although work remains to reduce disparities, current evidence from nursing science and practice is available to address disparities and guide advocacy efforts for children and their families as well as the nurses who care for them.

Survey identifies need for subspecialized pediatric hematology/oncology nursing education in nine Еurasian countries

Background. In 2018, Eurasian Alliance in Pediatric Oncology (EurADO) members identified pediatric hematology/oncology nursing education as a regional priority. In most participating Eurasian countries, pediatric hematology/oncology nursing is not recognized as a subspecialty; thus, subspecialized education offerings may be limited. A working group of nurse leaders was formed to set nursing priorities to advance pediatric cancer nursing and subspecialized education in the region. As an initial project, members determined a need to develop a train-the-trainer course for regional implementation to improve nurses’ subspecialty knowledge.

Purpose/Objective. A needs assessment was conducted to evaluate Eurasian nurses’ pediatric hematology/oncology education needs to inform the development of a pediatric hematology/oncology nursing train-the-trainer course in Eurasia.

Design/Methods. From August to September 2019, a paper-based needs assessment was disseminated in English and Russian to working group members for dissemination to pediatric cancer nurses in their hospitals. Items included multiple choice, yes/no, Likert-type scale and open-ended questions. Questions assessed participant demographics, subspecialty education topics of interest and perceived high-risk issues for nurses and patients.

Results. Responses were received from 233 nurses representing 13 hospitals in 9 countries. Priority topics of interest included overview of pediatric cancers and treatment, chemotherapy administration and side effects, oncologic emergencies and vascular access. Nurses reported that patients in their settings were at high-risk for infection, depression/psychological issues, treatment-related side effects and complications. Perceived high-risk areas for nurses included stress/burnout, high workloads/short-staffing, hazardous drug and blood borne pathogen exposure and limited equipment.

Conclusion. Survey findings reveal a lack of subspecialty pediatric hematology/oncology education opportunities for nurses practicing in Eurasian hospitals. The Eurasia Pediatric Hematology/Oncology Nursing Course was developed based on survey results and is currently being implemented across centers in the region.