Multiple Myeloma: Validation of the Values and Preferences Elicitation Questionnaire- Cure and Survival Preference Scale (VPEQ-CSPS).

BACKGROUND: With the emergence of many novel therapies, the treatment decisions for multiple myeloma (MM) are increasingly guided by concerns of quality of life, achievement of cancer-free remission, living a longer overall survival, and a relentless search for a cure; however, the impact of various decision-making factors on patients' actual therapy choices and the patients' desire for cure and survival is mainly unknown. The lack of a valid and reliable measure for uncovering patients' preferences for cure and survival makes it more challenging to put this factor into the actual treatment decision equation. PURPOSE: This study examined the psychometric properties of the Values and Preferences Elicitation Questionnaire-Cure and Survival Preference Scale (VPEQ-CSPS) instrument. METHODS: The VPEQ-CSPS instrument was deployed using an anonymous Qualtrics online survey to patients diagnosed with MM within the network of International Myeloma Foundation online patient support groups across the United States. One hundred seventy-four (N = 174) valid responses were obtained and used to examine the validity and reliability of the VPEQ-CSPS. RESULTS: Exploratory factor analysis (EFA) revealed a Kaiser-Meyer-Olkin value of 0.72 indicating excellent sample adequacy. A statistically significant Bartlett's test of sphericity (P < .001) indicated significant correlations among the variables of the dataset to conduct the EFA. The internal consistency coefficients indicated adequate reliability of the instrument with Cronbach's alpha value at 0.80. The EFA and parallel analysis revealed the 5-item VPEQ-CSPS as a valid and reliable unidimensional scale that can be used by oncology clinicians to elicit their patient's preferences for cure and survival. This new instrument has the potential to contribute to the achievement of shared decision-making for myeloma treatment decisions.

Cultural Competence of Student Registered Nurse Anesthetists in Illinois.

This study examined the level of perceived cultural competence of student registered nurse anesthetists (SRNAs) in Illinois and made educational recommendations. A descriptive, cross-sectional study was completed using the Clinical Cultural Competency Questionnaire (CCCQ) to evaluate the perceived level of cultural competence among SRNAs in Illinois. Four domains of clinical cultural competency--knowledge, skills, attitudes (awareness), and encounters--were evaluated and reported. The survey response rate was 16.7% (N=57). A significant positive correlation was observed between cultural knowledge and age (P=.03). There was a significant difference in cultural knowledge between students attending a nurse anesthesia program in suburban Northeastern Illinois and students attending a large, urban university in the city of Chicago, with CCCQ knowledge mean rank scores of 38.44 and 13.77, respectively. The overall level of perceived clinical cultural competence of SRNAs was low: mean (SD)=3.13 (0.54); range=2.17 to 4.89. The authors concluded that SRNAs need additional cultural education and training in their program of study to enhance their perceived level of cultural competence and to deliver culturally competent anesthesia care. The desire to become culturally competent coupled with deficient levels of cultural knowledge among SRNAs merits further work.

Stress and Coping: A Literature Review of Everyday Stressors and Strategies to Cope in Pediatric Patients With Cancer.

Although cancer survival rates are improving, pediatric patients with cancer still face numerous stressors. Using an integrative approach, a literature review was conducted to identify stressors and synthesize effective coping strategies among pediatric patients with cancer. The CINAHL® Complete, ProQuest, and PubMed® databases were searched for relevant studies using key terms. Eight studies were included in the final analysis. Three factors contributing to everyday stressors of pediatric patients with cancer and four major coping categories were identified.

Examining effective communication in nursing practice during COVID-19: A large-scale qualitative study.

AIM: The aim of this study was to conduct a primary examination of the qualitative communication experiences of nurses during the first wave of the COVID-19 pandemic in the United States. BACKGROUND: Ambiguity in ever-evolving knowledge on how to provide care during COVID-19. Remaining safe has created a sense of urgency, which has in turn created the need for organizations to quickly alter their operational plans and protocols to support measures that increase capacity and establish a culture of safe care and clear communication. However, no known study has described communication in nursing practice during COVID-19. METHODS: Utilizing qualitative descriptive methodology, semi-structured interviews were conducted with 100 nurse participants from May to September 2020 and recorded for thematic analysis. The consolidated criteria for reporting qualitative studies (COREQ), a 32-item checklist, were used to ensure detailed and comprehensive reporting of this qualitative study protocol. FINDINGS: Study participants shared descriptions of how effective communication positively impacted patient care and nursing practice experiences during the first wave of the COVID-19 pandemic. The thematic network analyses identified the importance of effective communication across three levels: (1) organizational leadership, (2) unit leadership and (3) nurse-to-nurse communication. Within this structure, three organizing themes, essential to effective communication, were described including (a) presence, (b) education and (c) emotional support. CONCLUSION: Examining existing crisis communication policies and procedures across healthcare organizations is imperative to maintain highly relevant, innovative, and data-driven policies and strategies that are fundamental to preserving quality patient care and supporting optimal nursing practice. IMPLICATIONS FOR NURSING POLICY AND HEALTH POLICY: Effective communication is critical to support nurses through extended periods of crisis. COVID-19 represents a unique contemporary challenge to the nursing workforce given the high stress and prolonged strain it has created for both human and healthcare supply resources. There is value in nurses' presence at local, unit level and organizational leadership levels to convey critical information that directly informs leadership decision-making during unprecedented emergencies such as the COVID-19 pandemic.

How to Prevent Endotracheal Tube Cuff Overinflation: "5 for 25".

Adverse effects associated with elevated endotracheal (ET) tube cuff pressures above 25 cm H2O include postoperative throat pain and tissue ischemia. Anesthesia practitioners' current methods of cuff pressure estimation are often inaccurate. This quantitative, quasi-experimental quality improvement project evaluated the incidence of ET tube cuff overinflation before and after an educational intervention that recommended the use of a 5-mL over 10-mL syringe for cuff inflation. Cuff pressures were measured at 2 hospitals within a large academic health system. The mean ET tube cuff pressure before education was 46.8 cm H2O and after education was 27.1 cm H2O (P=.001). The postintervention average cuff pressure using a 10-mL syringe was 36.8 cm H2O vs 21.1 cm H2O when providers used a 5-mL syringe (P=.039). The relationship between syringe size and cuff pressure was significant (P=.001) with a positive Pearson correlation of 0.471. The ET tube cuff pressures were reduced by 42% after the intervention. Average cuff pressures when providers used a 5-mL syringe were 55% lower than with use of a 10-mL syringe. No critically high postintervention pressures were recorded when a 5-mL syringe was used. The authors recommend 5-mL syringes be used for inflation of an ET tube cuff.

Care Delivery and Treatment Decision Making: Bioethical and Nursing Considerations During and After the COVID-19 Pandemic.

BACKGROUND: The disruption in the supply chain of resources and interruptions in cancer treatments caused by the pandemic presented tremendous challenges to the healthcare system. OBJECTIVES: This article describes the National Academy of Medicine-defined states of medical and nursing care delivery for which local plans should be drawn and the shifting and evolving systems framework that can guide decisions to optimize the crisis standards of care. METHODS: A case study is presented to describe the process of shifting the state of medical and nursing care delivery and bioethical nursing considerations during the pandemic and beyond. FINDINGS: An evolving and shifting systems framework for crises rooted in deontology, principlism, and the ethics of care model provide meaningful guidance for establishing priorities for patient care.

Shared Decision-Making Competency: Provider-Specific Factors in Hematology-Oncology Clinical Practice.

A computerized database search was performed using PubMed®, CINAHL®, and EBSCOhost to identify provider-specific factors associated with shared decision-making (SDM) competency among direct patient care providers in hematology-oncology practice. Personal factors included being female or older in age and having higher education. Years of clinical experience, nonclinical experiences, institutional support for SDM, administrative support for SDM training and education, and cultural competence were also reported as having a positive correlation with SDM competence among care providers. Future research is needed to identify core SDM competencies in the interprofessional hematology-oncology care setting.

Comprehensive Reentry Policy for Student Registered Nurse Anesthetists With Substance Use Disorder.

Substance use disorder (SUD) is a common problem in anesthesia. Although there are SUD policies in place for practicing anesthetists, there were no known studies before this inquiry discussing reentry policies specific to the student registered nurse anesthetist (SRNA). The purpose of this research was to describe key stakeholders' knowledge and perspectives surrounding policies for reentry into academic programs in Illinois for SRNAs with SUD and to create a comprehensive structured policy template for SRNAs with SUD. The theoretical framework for this research was based on the Biopsychosocial Theory. Between November 2017 and January 2018, qualitative interviews, using a semistructured interview guide, were conducted with anesthesiologists and Certified Registered Nurse Anesthetists (CRNAs) from throughout Illinois (n = 4). The interviews were audiorecorded, transcribed, and analyzed using thematic analysis. All participants stated that they did not have a policy in place to address SRNAs with SUD, yet 50% (2/4) reported knowing a student who had experienced SUD. Institutions that educate and use SRNA services should have a comprehensive reentry policy in place, which includes an option for SRNAs recovering from SUD to reenter their educational program. A policy template is provided for use by academic anesthesia programs.

Art Therapy: A Literature Review of Efficacy in Improving Psychosomatic Symptoms in Patients With Cancer.

A high percentage of patients with cancer receive a comorbid diagnosis of anxiety, depression, or another psychological disorder. However, research evaluating the efficacy of art therapy as an intervention to alleviate these symptoms is limited. Art therapy can offer psychosomatic symptom relief among patients with cancer, but more rigorous and randomized controlled clinical trials are warranted to strengthen evidence-based research supporting its clinical utility.

Liquid Biopsy: A Tool for the Diagnostic and Prognostic Evaluation of Cancers.

Liquid biopsy is defined as the process of obtaining material for pathologic examination and analysis from body fluids. Liquid biopsy has been intensively researched for its clinical application in patients with solid malignancies, including melanoma and colon, breast, and lung cancers. This will become a standard and routine tool for the diagnostic and prognostic evaluation of all cancer types. This article provides an overview of liquid biopsy, its uses in cancer management, and its implications for nursing practice.

Pediatric Palliative Care: A Literature Review of Best Practices in Oncology Nursing Education Programs.

Palliative care as a foundation for patient-centered care is not adequately covered in nursing curricula. This gap in education means that pediatric oncology nurses may lack necessary palliative care competencies to provide comprehensive care to patients. A literature review was performed to determine if nurses believe that they are prepared to provide clinical palliative care to pediatric patients and how pediatric palliative care best practices can be better integrated into nursing education programs. According to the literature review, studies suggest that providing pediatric palliative care education in nursing programs can build nurses' confidence and better prepare them to competently care for patients and families.

Shared Decision Making: Effects of an Online Education Session on Knowledge, Attitudes, Adaptability, and Communication Skills Among Nurses.

BACKGROUND: Shared decision making (SDM) is beneficial for interprofessional teams but also challenging to implement correctly. Oncology nurses are at the forefront of patients' treatment and, therefore, one of the most essential components of the SDM process. OBJECTIVES: The aim of this pilot study was to examine the effects of a one-hour web-based SDM education session on self-reported knowledge, attitudes, adaptability, and communication skills related to SDM among oncology nurses. METHODS: Using the ADDIE (analysis, design, development, implementation, and evaluation) theoretical framework, this study used a post-test-only, single-group, nonexperimental design. FINDINGS: This study provides preliminary evidence that a one-hour web-based SDM education session is acceptable and has positive effects on oncology nurses' self-reported knowledge, attitudes, adaptability, and communication skills. More research is warranted to validate these findings.

Shared Decision Making: Improving Patient Outcomes by Understanding the Benefits of and Barriers to Effective Communication.

Shared decision making (SDM) is a healthcare delivery model that mandates patient-centered care for clinical practice. Practicing SDM ensures that patients and family caregivers are engaged in making decisions about their care and treatment with healthcare providers. This article reviews the evidence on how nurses can influence the outcomes of cancer treatment decisions by using the SDM model.

Enteral and Parenteral Nutrition: An Integrative Literature Review on Nutrition in Pediatric Recipients of Hematopoietic Stem Cell Transplantation.

This article provides a summary of an integrative review on the efficacy of enteral nutrition (EN) and parenteral nutrition (PN) for meeting the nutrition and energy needs of pediatric patients following hematopoietic stem cell transplantation (HSCT). In addition, recommendations for clinical practice and research on nutrition supplementation for pediatric patients post-HSCT are included.

Role competency scale on shared decision-making nurses: Development and psychometric properties.

OBJECTIVES: This study aimed to develop a scale that can measure the role competency of oncology nurses during shared decision-making process. METHODS: A total of 226 oncology nurses who actively provide direct care to patients from inpatient and outpatient oncology units in the Midwest and Pacific Northwest completed the online or mail survey. Exploratory factor analysis and parallel analysis showed the multidimensionality of the role competency scale on shared decision-making nurses. RESULTS: The role competency scale on shared decision-making nurses revealed four dimensions: knowledge, attitudes, communication, and adaptability. The 22 items have excellent internal consistency with a Cronbach's alpha of 0.91. The four subscales also have adequate reliability with Cronbach's alpha >0.70 as well as greater than 0.70 Spearman-Brown's correlation coefficients in split-half reliability testing for each subscale. CONCLUSION: The new scale has the potential to be used as a clinical tool to assess the need for shared decision-making education and training in oncology nurses.

Biosimilars: Exploring the History, Science, and Progress.

BACKGROUND: Biosimilars provide opportunities for improving healthcare access and outcomes and reducing overall healthcare costs for patients with cancer. OBJECTIVES: The purpose of this article is to explore the history of biosimilars, regulatory pathways, and barriers to biosimilar approval. This article also aims to describe the patient and clinician barriers to biosimilars use and the progress that has been achieved since the first biosimilar approval in Europe in 2006 and in the United States in 2015. METHODS: A literature search was conducted to retrieve articles that are highly relevant to the history of biosimilars development and regulatory pathways in the United States, Europe, Asia, and Canada. Patient and clinician perspectives on safety issues and concerns regarding immunogenicity and bioequivalence that limit use of biosimilars are also included. FINDINGS: Patient and provider concerns regarding immunologic patient safety issues, such as immunogenicity, lack of comparability, and low biosimilarity, still exist. The clinical safety, efficacy, and tolerability of biosimilars are among the top concerns in patients, prescribers, and clinicians.

Bibliotherapy: Appraisal of Evidence for Patients Diagnosed With Cancer

An appraisal of the evidence on the efficacy of bibliotherapy on anxiety, distress, and coping in patients with cancer is lacking in the literature. Bibliotherapy is a self-help intervention using a variety of tools, such as self-help workbooks, pamphlets, novels, and audiobooks, to improve mental health. This review identified nine original research articles that examined bibliotherapy as an intervention to alleviate the psychological issues associated with a cancer diagnosis. Data synthesis from these studies provides preliminary evidence that bibliotherapy is an acceptable and beneficial adjunct therapy for patients with cancer experiencing anxiety, depression, and ineffective coping.

Perceived Knowledge and Attitudes of Certified Registered Nurse Anesthetists and Student Registered Nurse Anesthetists on Fire Risk Assessment During Time-out in the Operating Room.

Fire risk assessment remains separate from the universal protocol for surgical time-outs. A descriptive crosssectional design was used to examine the perceived knowledge and attitudes of Certified Registered Nurse Anesthetists (CRNAs) and student registered nurse anesthetists (SRNAs) on fire risk assessment during surgical time-outs. Modified knowledge and attitudes questionnaires were sent to approximately 1,600 active members of the Illinois Association of Nurse Anesthetists through an online survey. Data were analyzed using descriptive, t-test, analysis of variance, and point biserial correlation statistics. Most of the 140 study participants overwhelmingly reported positive attitudes toward fire risk assessment, but they had self-reported information needs in 11 areas of the operating room fire risk assessment questionnaire. Age, gender, years in practice, and highest education had no statistically significant correlation with knowledge and attitudes regarding fire risk assessment. The perceived knowledge deficits on fire risk assessment may hinder the CRNAs and SRNAs from adopting a tool such as a fire risk assessment checklist that is ready for implementation at their current place of employment. Additional studies are needed to identify the factors that facilitate integration of fire risk assessment using a checklist during surgical time-outs.

Decision Aids: Assisting Patients With Multiple Myeloma and Caregivers With Treatment Decision Making

A consolidated evaluation of resources on treatment decision aids (DAs) for multiple myeloma (MM) is lacking in the literature. This review identified 29 published DAs. Further analysis of these DAs revealed that the personal values and preferences of patients with MM are not well integrated into the development of these DAs, indicating the need for a more explicit shared decision-making model of MM care delivery. The development and testing of a web-based and individualized treatment DA will likely promote a shared decision-making process in clinical practice, improve patient satisfaction with treatment decisions, and decrease decisional regrets in patients newly diagnosed with MM.
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Bone Health, Pain, and Mobility: Evidence-Based Recommendations for Patients With Multiple Myeloma

BACKGROUND: About 85% of patients with multiple myeloma develop bone disease. In these patients, lytic bone lesions can cause fractures, poor circulation, blood clots, pain, poor mobility, and decreased quality of life.
. OBJECTIVES: This article presents consensus statements to guide nurses in the assessment and management of bone disease, pain, and mobility in patients with multiple myeloma at varying points in their disease trajectory.
. METHODS: Members of the International Myeloma Foundation Nurse Leadership Board reviewed previously provided recommendations, current recommendations based on literature review, and evidence-based grading.
. FINDINGS: Oncology nurses play a key role in maximizing bone health, minimizing skeletal injury, maximizing pain control, and improving quality of life in patients by enhancing patient mobility and safety. Clinician assessment accompanied by effective interventions reduces patient injury and optimizes functioning in patients with multiple myeloma.