Understanding the Current State of Pediatric Oncology Nursing Quality Measurement in Free-Standing Children’s Hospitals Across the United States (229-2)

The impact of nursing care on patient outcomes has been demonstrated in adult and pediatric settings but limited attention has been given to standardized measurement of pediatric oncology nursing care.

With advances in pediatric cancer therapy, patients may be offered multiple treatment modalities which require intensive nursing support. To provide high quality care for these complex patients with evolving needs, pediatric oncology nurses require specialized skills, knowledge and appropriate resources. Given the gap in current literature addressing the impact of nurse sensitive measures that impact the quality of nursing care across the pediatric oncology continuum, the first step was to identify these potential measures. The ability to identify key performance measures and to articulate their value in the delivery of nursing care is central to improving the quality of the patient/family/employee experience in this highly complex and specialized environment. Using process measures allows for greater understanding of the extent to which clinical care is following best practice.

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Primary Caregivers’ Knowledge Attitudes and Beliefs toward Palliative Care for Children with Cancer (235-3)

Parents of children with cancer perform a myriad of caregiving tasks related to Pediatric Palliative Care (PPC) along the illness trajectory. Yet, their knowledge, attitudes and beliefs (KAB) toward PPC remain underexplored, especially in Low and Middle Income Countries (LMICs) where care relies heavily on the family. A better understanding of parent KAB would inform effective strategies to support the integration of PPC into the care of children with cancer and their families.

The purpose of this two-phase multicenter study among primary caregivers of children with cancer in Lebanon was to examine their KAB toward PPC in order to uncover areas for improvement, to determine factors associated with KAB, and identify primary caregivers’ PPC tasks in caring for their children with cancer.

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Improving the Efficiency and Efficacy for Patients in Sickle Cell Crisis in the Outpatient Setting (229-3)

The unpredictability of sickle cell crisis leads to same-day add-on visits where the patient is reliant on the provider of the day. Due to the lack of consistent providers, the interpretation of the patient’s pain can be influenced by a lack of understanding on how to properly manage it based on previous encounters. Read more...

Do Parents Protect Themselves When Administering Home Oral Chemotherapy to Children with Acute Lymphoblastic Leukemia? (235-1)

As part of cancer treatment, parents of children with cancer are expected to administer multiple medications to their child in the home setting (Landier et al., 2016). Safe practices in delivering oral chemotherapy are an essential part of the education of parents of children with cancer (Rodgers et al., 2018). Little is known about what parents actually do in the home setting to protect themselves from exposure when administering oral chemotherapy.

 

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Association of Health Literacy with Comprehension of Key New Diagnosis Education Concepts in Parents/Caregivers of Children with Cancer (235-2)

Parents/caregivers of children newly diagnosed with cancer are expected to adequately care for their child at home upon hospital discharge, which entails understanding how to manage medication schedules, recognize key signs and symptoms, and access care emergently (Landier et al., 2016). Read more...

A Collaborative Approach to the Development of Specialized Nursing Education in a Lower Middle-Income Country (Ghana) (229-1)

Children with cancer in low- and middle-income countries are four times more likely to die of the disease than those in high income countries. Expert nurses are critical to a successful pediatric oncology program, yet few opportunities exist for nurses across Ghana to receive specialized education. Read more...

Wearing Two Hats: Professional Boundaries When Balancing Direct Care and Research Roles (223-3)

Nursing care, whether in the clinical or research context, is guided and directed by the ANA Code of Ethics for Nurses. The Code of Ethics is based on the ethical principles of beneficence, nonmaleficence, autonomy and justice. These principles can serve to guide nurses as they navigate what may seem to be competing roles of direct-care nurse and nurse intervenor. This presentation will describe: 1) role conflicts that may present when the nurse functions as both care provider and intervenor as part of a research study and 2) strategies for managing role conflict.

Learning Objectives:

• Describe role conflicts that may present when direct care nurses including advance practice nurses serve as intervenors in randomized clinical trials.
• Identify key ethical principles that the nurse must always consider when providing care either in the clinical or research context.
• Outline strategies to manage role conflicts that may present when direct care nurses serve as intervenors in randomized clinical trials.

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Pediatric Oncology Safety Simulation (223-2)

Pediatric Oncology patients are at high risk for rapid deterioration given their severity of illness, toxicity of interventions and associated immunosuppression. Pediatric Oncology focused escalation of care for patients experiencing clinical deterioration continues to present significant challenges within healthcare. At the current institution a two-year review of inpatient and outpatient oncologic emergencies was evaluated, and a comprehensive Oncology Safety Simulation Program was developed.The Oncology Safety Simulation Program has offered a hands on multi-disciplinary approach to educating physicians, nurse practitioners, nurses and pharmacists on safe practices during Oncology medical emergencies. Outcome data has been tracked to evaluate attendees' satisfaction and attendees' evaluation of their ability to utilize the education to change practices at the bedside. Data has been tracked with regards to use of intramuscular epinephrine administration during anaphylaxis and time to implementing the sepsis protocol during a sepsis workup. The simulation process development timeline will be reviewed, outcome data will be shared and latent safety effects will be reviewed.

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Insurance and Neighborhood Opportunity Predict Adverse Events in Children with Acute Lymphoblastic Leukemia (217-1)

Our prior research uncovered potential socioeconomic (SE) risk factors for two adverse events that impact children hospitalized with acute lymphoblastic leukemia (ALL): hyperglycemia and severe sepsis. That research, however, was limited to only two measures of SE status, insurance source and median neighborhood income. Composite indices of neighborhood social and economic stability are useful in gleaning understanding of pathways between a child’s immediate environment and health outcomes. Yet, there is little reporting of the best way to measure these aspects of a child’s environment in pediatric oncology nursing research.

This study was a side-by-side comparison of three measures of SE status: insurance source, area deprivation and neighborhood child opportunity. The study goal was to determine each one’s utility as risk a predictor of hyperglycemia and serious infections, two outcomes our team has shown are potentially influenced by SE factors.

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HSCT for MPS disorders (Hunters and Hurlers), (217-2)

Hematopoietic Stem Cell Transplant (HSCT) is best known as a treatment modality for hematologic malignancies, some solid tumors, and various autoimmune disorders. It is lesser known as a means to halt progressive symptoms in certain chromosomal inherited disorders such as Hunters and Hurlers disease. Patients with Hunters and Hurlers are born with an inherited x-linked chromosomal disease where sugar molecules are unable to be broken down and digested by the body causing both physical and mental disabilities. There is no cure for these diseases but HSCT is an intensive therapy that has shown promise with these diagnoses, helping to stop progression of symptoms of disease.

Two case studies of children who underwent HSCT at our center, one for Hunter’s and one for Hurler’s, will be presented from both a medical and psychosocial standpoint. How these children first presented, how HSCT affect their disease, the complications they underwent during their HSCT, and the complex psychosocial aspects of receiving chemotherapy as well as an extended hospitalization.

Learning Objectives:

• The learner will describe the role of Hematopoietic Stem Cell Transplant in the treatment of non-malignant diseases.
• Identify conditioning regimens and their unique complications for non – malignant diseases.
• The learner will describe the psychosocial needs of hematopoietic transplant patients and their families when they undergo a complex regiment such as HSCT.

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