ABSTRACT
Background The incidence of childhood cancer is rising worldwide, with acute lymphoblastic leukemia being the most commonly diagnosed form. These young patients are immunocompromised and susceptible to infections. In addition, chemotherapy and radiation therapy often cause oral mucositis as a side effect. Given these challenges, nurses play a crucial role in delivering special care to these vulnerable children. Material and methods A study design utilizing a one-group pretest-posttest approach was implemented on 45 children, aged one to 12 years, who were undergoing chemotherapy and experiencing oral mucositis. Demographic information, including age, gender, diagnosis, chemotherapy cycle, and length of therapy, was collected. A customized intervention, which involved the application of an oral regimen, oral health practices, health education for caregivers, and observation, was administered by nursing staff using the APHO (Application of an Oral Regimen, Practicing Oral Health, Health Education to Caregivers, and Observation) protocol for a period of seven days. Both pre-intervention and post-intervention assessments were conducted to determine the effectiveness of the APHO nursing intervention. The assessment tool used to assess the effectiveness of APHO intervention was using a standardized scale given by the World Health Organization grading scale for oral mucositis. Result An analysis was conducted utilizing both descriptive and inferential statistics. Before the intervention, those children in grade 2 were in grade 1 after the intervention, and the children in grade 1 before the intervention were in grade 0 after the intervention. The health education provided to the caregivers was significantly effective. Notably, there was a significant decrease in the oral mucositis grade of the children by one level in all instances, indicating that the APHO nursing intervention was remarkably effective. Thus, promoting the use of APHO nursing intervention can lead to positive outcomes in children afflicted with oral mucositis. Conclusion APHO nursing intervention has shown remarkable effectiveness among children with mucositis. As a result, promoting continuous APHO intervention in children with mucositis can help enhance in prevention and management.
ABSTRACT
BACKGROUND AND OBJECTIVES: Close monitoring of patients in the first 2 hours after cesarean delivery (CD) is crucial. Delays in shifting of the post-CD patients led to a chaotic environment in the postoperative ward, suboptimal monitoring, and inadequate nursing care. Our aim was to increase the percentage of post-CD patients shifted from transfer trolley to bed within 10 minutes of arrival in the postoperative ward from a baseline of 64% to 100%, and to maintain that rate for more than 3 weeks. METHODS: A quality improvement team including physicians, nurses, and workers was constituted. Problem analysis revealed lack of communication among the caregivers as the main cause of delay. The percentage of post-CD patients shifted from trolley to bed within 10 minutes of being wheeled into the postoperative ward out of the total number of post-CD patients transferred from the operation theater to the postoperative ward was taken as the outcome indicator for the project. Multiple Plan-Do-Study-Act cycles based on the Point of Care Quality Improvement methodology were undertaken to achieve the target. Main interventions were: 1) written information of patient being transferred to operation theater for CD sent to the postoperative ward; 2) stationing of a duty doctor in the postoperative ward; and 3) keeping a buffer of 1 vacant bed in the postoperative ward. The data were plotted weekly as a dynamic time series chart and signals of change were observed. RESULTS: Eighty-three percent (172 out of 206) of women were shifted in time by 3 weeks. After Plan-Do-Study-Act 4, the percentages kept improving leading to a median shift from 85.6% to 100% after 10 weeks post-initiation of the project. Sustainment was confirmed by continuing observations for 6 more weeks to ensure that the changed protocol was assimilated in the system. We found that all women were shifted within 10 minutes of their arrival in postoperative ward from trolley to bed. CONCLUSION: Providing high-quality care to patients must be a priority for all health care providers. High-quality care is timely, efficient, evidence based, and patient-centric. Delays in transfer of postoperative patients to the monitoring area can be detrimental. The point of Care Quality Improvement methodology is useful and effective in solving complex problems by understanding and fixing the various contributory factors one by one. Reorganization of processes and available manpower without any extra investment in terms of infrastructure and resources is pivotal for long term success of a quality improvement project.
