ABSTRACT
PURPOSE: Radiodermatitis is a side effect of radiation therapy. Evidence-based interventions to minimize severity or delay progression are important for clinical care. This guideline intends to support individuals with cancer, clinicians, and others in decisions regarding radiodermatitis treatment. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation was convened to develop a national clinical practice guideline for the management of radiodermatitis. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines were followed. The Cochrane Collaboration risk-of-bias tool was used, and certainty of the evidence was assessed using the GRADE approach. A quantitative and narrative synthesis of the evidence was completed. FINDINGS: The panel agreed on eight recommendations and made a conditional recommendation for deodorant/antiperspirant. Aloe vera and oral curcumin had knowledge gaps and were recommended only in the context of a clinical trial. The panel suggested against emu oil, calendula, and nonsteroidal interventions. IMPLICATIONS FOR NURSING: This guideline summarizes evidence-based interventions for the management of radiodermatitis to guide clinical care. SUPPLEMENTARY MATERIAL CAN BE FOUND AT HTTPS: //bit.ly/2GEwJtT.
Subject(s)
Neoplasms , Radiodermatitis , Humans , Radiodermatitis/drug therapy , Radiodermatitis/etiologyABSTRACT
In today's environment, organizational delivery systems must produce high-quality, efficient, and cost-effective services. Central to restructuring care delivery is the evolving role of the nurse practitioner (NP) and the integration of the role as part of the health care workforce. The NP Care Model was designed and introduced to the organizational workforce in a medical center to coordinate, manage, and monitor the outcomes of high-risk patients with chronic disease efficiently. This program focused specifically on patients with heart failure who were discharged to home and identified to be at high-risk for early readmissions. The Healthy Heart Initiative prograrr coordinated by the NP addressed targeted causes of rehospitalization (lifestyle, medication and diet noncompliance, and lack of self-care disease management). The program objective of improved financial performance were met by reducing the 30-day readmission rate. Operational effectiveness and quality patient outcomes were met through the design and implementa tion of the NP Care Model, and overall patient reported satisfaction.
Subject(s)
Cooperative Behavior , Nurse Practitioners , Models, NursingABSTRACT
The focus of this study was to assess the feasibility and clinical implementation of a standardized assessment for chemotherapy-induced peripheral neuropathy (CIPN) by registered nurses in patients undergoing neurotoxic chemotherapy. A total of 24 registered nurses from 4 different institutions were enrolled into the study. A pre- and posttest design was used to assess changes in nurses' attitudes, knowledge, and perceived skill in CIPN assessment. Using selected data collection instruments, nurses performed standardized assessments during the course of chemotherapy treatments. Patient-reported symptoms, vibratory sensation, deep-tendon reflexes, and touch were collected at three time points during chemotherapy treatment. Results indicated there was no statistically significant change in knowledge of chemotherapy-induced peripheral neuropathy from baseline to the end of the study. However, this finding may be due to poor internal consistency noted among the items of the Nurse Knowledge and Attitudes CIPN Assessment. Implementation of a standardized subjective and objective nursing assessment of CIPN was feasible with a total mean feasibility score of 3.76 (range 0-5) with each individual item scoring between 3.35 and 3.91. The intervention did improve pretest and posttest confidence in performing assessment for CIPN (p = .003).