A Qualitative Study of Midlevel Nurse Managers' Perspectives of Scholarly Inquiry.

OBJECTIVE: This study explored the key characteristics and needs of midlevel nurse managers (MLNMs) who support and engage clinical nurses (CNs) in scholarly inquiry. BACKGROUND: Healthcare organizations expect CNs to participate in scholarly inquiry, incorporating evidence-based interventions to improve outcomes and safety. How the MLNM supports and engages CNs in scholarly inquiry remains unclear. METHODS: Twelve semistructured interviews of MLNMs occurred at several facilities in the mid-Atlantic region utilizing the institutional review board-acknowledged protocol. Theme interpretation utilized inductive analysis. RESULTS: Four recurrent themes emerged from the interviews related to the value of scholarly inquiry: 1) securing organizational resources to promote scholarly inquiry; 2) knowledge and experience in scholarly inquiry; 3) actions supporting scholarly inquiry; and 4) the value of scholarly inquiry within the organization. CONCLUSIONS: Senior nursing leadership and healthcare organizations must recognize the value and provide the infrastructure to support scholarly inquiry. Infrastructure includes education, dedicated time, access to expertise, and resources.

Moral Injury and Moral Resilience in Health Care Workers during COVID-19 Pandemic.

Background: The 2019 coronavirus (COVID-19) pandemic placed unprecedented strains on the U.S. health care system, putting health care workers (HCWs) at increased risk for experiencing moral injury (MI). Moral resilience (MR), the ability to preserve or restore integrity, has been proposed as a resource to mitigate the detrimental effects of MI among HCWs. Objectives: The objectives of this study were to investigate the prevalence of MI among HCWs, to identify the relationship among factors that predict MI, and to determine whether MR can act as buffer against it. Design: Web-based exploratory survey. Setting/Subjects: HCWs from a research network in the U.S. mid-Atlantic region. Measurements: Survey items included: our outcome, Moral Injury Symptoms Scale-Health Professional (MISS-HP), and predictors including demographics, items derived from the Rushton Moral Resilience Scale (RMRS), and ethical concerns index (ECI). Results: Sixty-five percent of 595 respondents provided COVID-19 care. The overall prevalence of clinically significant MI in HCWs was 32.4%; nurses reporting the highest occurrence. Higher scores on each of the ECI items were significantly positively associated with higher MI symptoms (p < 0.05). MI among HCWs was significantly related to the following: MR score, ECI score, religious affiliation, and having ≥20 years in their profession. MR was a moderator of the effect of years of experience on MI. Conclusions: HCWs are experiencing MI during the pandemic. MR offers a promising individual resource to buffer the detrimental impact of MI. Further research is needed to understand how to cultivate MR, reduce ECI, and understand other systems level factors to prevent MI symptoms in U.S. HCWs.

Using Evidence to Prepare Non-Oncology Nurses for Cancer Survivor Care.

BACKGROUND: Growing increases in current and projected cancer survivors demands a workforce that can safely meet their health care needs spanning a lifetime. The literature lacks sufficient evidence regarding the knowledge needed by non-oncology nurses who care for cancer survivors in settings not designated for cancer care. This study identified this oncology knowledge and perceived barriers. METHOD: The Cancer Nursing Curriculum Survey was completed by a national pool of 302 oncology and 313 medical-surgical nurses who rated the depth and importance of 33 cancer concepts needed by non-oncology nurses for cancer survivor care. RESULTS: Concept means for depth and importance were similar between both groups, with importance rated higher. Major concepts focused on symptom management. Barriers included lack of time, knowledge, and access to resources. CONCLUSION: The findings indicate the understanding of knowledge needed by non-oncology nurses for survivor care and provide a first step to design continuing education to address needs. J Contin Educ Nurs. 2018;49(1):12-18.

Managing oncology neutropenia and sepsis in the intensive care unit.

Neutropenic sepsis results as a post-cancer treatment complications and is considered an oncologic emergency. Neutropenic sepsis can result in mortality, especially if it is not identified at an early stage. Septic syndrome is the leading cause of nonrelapse mortality in patients with hematologic malignancies and solid tumors. Therefore, intensive care unit (ICU) nurses must possess a thorough understanding of cancer treatments, hematopoiesis, neutropenia, sepsis, risk factors, and the ability to perform a comprehensive assessment of the oncology patient. Each of these components plays a vital role in the patient's overall management following treatments with chemotherapy, radiation, and stem cell transplantation. The ICU nurse who encompasses this understanding will be able to identify neutropenic sepsis in a timely manner. The early identification of neutropenic sepsis will enable the ICU nurse to expeditiously implement preventive treatment and management to prevent mortality.

Patient adherence with oral oncolytic therapies.

OBJECTIVES: The use of oral chemotherapy has increased substantially. This adds a level of complexity beyond that of traditional intravenous chemotherapy. This article discusses challenges and strategies to meet patient needs. DATA SOURCES: Research and peer-reviewed journal articles. CONCLUSION: Adherence is a challenge for oral chemotherapy. A systematic approach serves as the best way to facilitate a comprehensive oral chemotherapy plan. IMPLICATIONS FOR NURSING PRACTICE: Nurses' knowledge is required to support and monitor patient adherence. Nurses must master effective utilization of resources to monitor and positively impact successful patient outcomes.

Standardization of chemotherapy administration: a multidisciplinary process utilizing electronic learning vignettes.

This study describes oncology nurses' knowledge of new chemotherapy safety standards and satisfaction with education using simulated electronic learning vignettes. A quasi-experimental longitudinal, one-group pretest-posttest design was used to examine satisfaction and chemotherapy errors over time. Findings showed the mean number of error scores differed significantly across time points, indicating follow-up should occur to reinforce new standards. Nurse educators also may require more education about innovative educational strategies.

Implementation of the American Society of Clinical Oncology and Oncology Nursing Society chemotherapy safety standards.

Chemotherapy involves an intricate, high-risk, multidisciplinary process of prescribing, dispensing, and administering complex multimedication regimens with narrow therapeutic indices. Chemotherapeutic agents also require safe-handling precautions for patients and healthcare providers. In addition, a number of chemotherapy and targeted therapies have expanded to nononcology populations. This complexity demands standardization of chemotherapy practice for all healthcare providers to ensure safe outcomes. This article describes one organization's multidisciplinary effort to standardize chemotherapy practice according to the American Society of Clinical Oncology and Oncology Nursing Society's 31 safety standards for chemotherapy administration. The article also describes how the organization integrated and developed standards of practice using interdisciplinary approaches. The educational processes used during implementation and the lessons learned are discussed to assist healthcare providers involved in standardizing chemotherapy administration. The article equips healthcare professionals with a multidisciplinary process for high-quality clinical standards of practice that may reduce errors and ensure safety.

Filling the gaps: immersing student nurses in specialty nursing and professional associations.

The national nursing shortage demands innovative strategies to attract students to the nursing profession. This article provides a potential solution for recruiting and retaining nurses for specialty areas of nursing as well as professional nursing associations by pairing student nurses with professional nurses who belong to nursing associations. An immersion program such as the one described in this article provides a strategy that addresses the nursing work force shortage and professional association membership. The experiential knowledge gained through this type of program may advance the profession throughout the country.

Breast cancer overview.

The words, "you have breast cancer," is possibly one of the most devastating statements an individual could image hearing from his or her physician even though breast cancer is the most common cancer among women. The diagnosis bears a significant amount of anxiety and fear in regards to treatment and overall survival. However, research has increased healthcare professionals' knowledge on the benefits of early screening, diagnosis, and treatments, which has steadily reduced the death rate from breast cancer over the past 20 years. Physicians are better able to predict how particular breast cancers will react to treatment; therefore, they are able to choose more effective treatment options based on these findings. The goal of this article is to highlight the incidence, staging and diagnostic studies, types, treatments, and follow-up of breast cancer dispelling some of the common societal stigmas and unfounded fears surrounding this diagnosis.