Nurse navigators work throughout the health system, yet vary in function. Our team consists of seven oncology nurse navigators in an outpatient setting adjacent to a satellite community hospital. The ...oncology nurse navigator's role is to identify and remove barriers to care and serve as a point of contact for patients throughout their cancer journey. Clear communication with the patient and healthcare team is vital for navigators to provide high quality, team-based care. Currently, standardized documentation for oncology nurse navigators is not yet established. Therefore, it was essential to develop an electronic medical record (EMR) intake form to document the initial contact as a communication tool to close the loop with the patient's healthcare team. The purpose of this project was to describe the impact of the Oncology Nurse Navigator Intake Form: initial contact with the patient; assessment; identification of high risk patients; patient/ caregiver education provided; resources and referrals provided. The nurse navigators identified a need for standardized documentation for the team. For six months, the nurse navigators developed and trialed a SmartPhrase™ documentation option after initial contact with new patient referrals. A nurse navigator working with a patient with any oncology disease could utilize this form. During our monthly navigator meetings, our team would review the Intake Form. Overall, the navigator group has found the SmartPhrase™ to be efficient for documentation, and can pull data for navigator metrics. Evaluation of the SmartPhrase™ documentation will be further enhanced by receiving feedback from clinic providers and nurses. Development and use of the Navigator Intake Form has been successful and easily adaptable in documenting patient care needs throughout their cancer trajectory. The initial contact a nurse navigator makes with the patient and their caregivers is vital to establishing easy access into the healthcare system. Additionally, it is valuable for the nurse navigator to communicate with the team the patient's barriers at pivotal points throughout their treatment plan. This innovative project contributes towards building a framework for standardized nurse navigator documentation within an EMR. It showcases the integral connection of nurse navigation within the healthcare team, as well as a navigator's contribution towards enhancing a cancer patient's care.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Chemotherapy desensitization allows patients with a drug hypersensitivity reaction to safely receive their preferred line of therapy. Historically this treatment was given exclusively in the ...inpatient setting. Patients were either admitted to an inpatient bed or treated in infusion chairs on inpatient oncology. Upon review, it was estimated that approximately 40-50% of these treatments would be safe and appropriate for administration in the ambulatory setting. The purpose of this program was to safely transition the administration of chemotherapy desensitization treatments from inpatient oncology to the ambulatory oncology setting. Weekly meetings were initiated with multidisciplinary teams to identify the process for transition, including workflows, potential barriers and communication. Education, training and shadowing opportunities were provided for ambulatory nurses and the basics of cardiac monitoring were revisited as this practice was new to the ambulatory setting. Following implementation, weekly calls were initiated and email communications are ongoing. After completion of 17 months, over 300 chemotherapy desensitization treatments have been administered in the outpatient setting, which accounts for approximately 45-50% of all desensitizations administered. The patient experience has been improved as patients are able to complete their treatment without a required overnight inpatient stay. The program has resulted in hundreds of inpatient bed days saved, positively affecting inpatient capacity constraints. There has also been decreased treatment delays due to lack of inpatient space and an increased utilization of inpatient infusion chairs for other treatments. Fifteen nurses in ambulatory were trained on administration of desensitization and the program continues to expand. Education and training were collaboartive between inpatient and ambulatory nursing. Use of cardiac monitoring required additional education and training for ambulatory staff. Ambulatory nurses enjoy administering this type of treatment and being able to offer this service to patients. This program highlights that chemotherapy desensitizations can be safely administered in the ambulatory setting.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity states that nurses have a critical role to play in achieving the goal of health equity, but they need robust education, ...supportive work environments, and autonomy. The report goes on the say: "The ultimate goal is the achievement of health equity in the United States built on strengthened nursing capacity and expertise." Nurses represent the largest segment of the healthcare workforce, are considered the most trustworthy of all professions and play an invaluable role on the frontlines of care in our schools, hospitals, community health centers, long-term care facilities, and other places. Their perspective and influence must be felt more at decision-making tables. The Nurses on Boards Coalition's (NOBC) mission is to "improve the health of communities and the nation through the service of nurses on boards and other bodies". Building healthier communities in America requires the involvement of more nurses on corporate, health-related, and other boards, panels, and commissions. NOBC is committed to increasing nurses' presence and influence. In 2020, the Coalition registered more than 10,000 nurses serving on boards. There is now a focus on measuring the impact of nurses serving in board roles. A simultaneous goal is to help provide the opportunity for nurses education and advancement in leadership roles, by providing resources, identifying new opportunities, and facilitating mentorship of nurses on all levels of the experience spectrum. To that end both a Board Competency Model and Board Readiness Model have been developed and available to help guide nurses toward their leadership goals. As written in the Future of Nursing 2020-2030 report (recommendation #6) "All public and private health care systems should incorporate nursing expertise in designing, generating, analyzing, and applying data to support initiatives focused on social determinants of health and health equity using diverse digital platforms, artificial intelligence, and other innovative technologies." There is a call to action for all nurses to serve in leadership roles at every level of the spectrum. NOBC and our 25 plus member organizations want to provide all nurses with the tools and opportunities they require to improve the health of the nation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Chemotherapy patients are a vulnerable population that require specialized care from a multidisciplinary team. They endure increased stress levels due to diagnosis, side effects, and time away from ...work. Higher wait times lead to increased stress and time away from work. Chemotherapy regimens are complex, long and formatted differently than all other orders. The orders take longer to process, review, prepare and administer than other drugs given in a hospital setting. The in-patient setting does not administer chemotherapy as often as an out-patient infusion center and typically takes longer to administer the drugs. The purpose of this study was to determine the effects of nurse-led/coordinated weekly multidisciplinary review of inpatient chemotherapy regimens to identify causes for delayed door-to-drug administration turn-around times. Nurse-directed multidisciplinary in-patient chemotherapy reviews were implemented by the inpatient chemotherapy coordinator. Participants included the MD or APRN, MD office, nursing staff, pharmacy, charge nurse, case manager, dietician, vascular access team, and music therapist. At the weekly sessions, chemotherapy regimens were reviewed and turnaround times from door-to-drug administration were calculated. The cause of any delays were identified and categorized as 'Avoidable' and 'Unavoidable'. Avoidable delays were addressed by the group for process improvement. At implementation of the program the door-to-drug turnaround times averaged 12 hours, 23 minutes. Of the 'Unavoidable' causes for delays, 70% were due to the chemotherapy orders, 19% were related to nursing, and 11% were due to pharmacy delays. The turnaround times following initiation of the weekly rounds averaged 4 hours, 53 minutes, representing a 60% reduction. Weekly nurse-led multidisciplinary reviews identifying chemotherapy delays led to the reduction of door-to-drug turnaround times by 60%. The entire process of chemotherapy administration in the in-patient setting is reviewed in real time on a weekly basis by the in-patient chemotherapy navigator/coordinator. Process improvements are made based on all delays and errors found. This leads to a decreases in turnaround times, decrease in errors, and decrease in patient stress to to wait times. Out-patient navigation and coordination is common practice. In-patient navigation/coordination of chemotherapy regimens is not as common. The role serves a bridge/liaison between the in-patient and out-patient settings.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
A comprehensive cancer center, located in the southeast, is actively engaged in establishing a network of strategic partnerships across the country with the intent of promoting access to specialized ...oncology expertise and offering patients novel clinical trial opportunities closer to home. Prior to COVID-19, due diligence/quality assessments of potential partners were completed on-site requiring multiple interdisciplinary teams to travel to the institution. With the onset of the pandemic, business travel was suspended, predicating the need to rapidly transition to a new assessment strategy. There was an immediate need to design and implement a comprehensive alternative that would concurrently facilitate the assessment processes while meeting the rigorous demands of quality assurance needed to move forward with a potential partner relationship. Multidisciplinary collaborative teams to include nursing, pharmacy, medical oncology, surgical oncology, radiation oncology, radiology, pathology, cancer support services, research and quality representatives met over several months to redesign assessment processes and transition to a virtual methodology. Teams utilized videos of key elements and virtual discipline specific assessment meetings to serve as a surrogate for the on-site strategy. Supportive tools were developed to provide the potential partner with additional guidance needed to navigate the process. Two virtual health-system assessments were then completed with overall success and client satisfaction. Efforts resulted in improved efficiency and process effectiveness, significant savings of travel and personnel time, and broader engagement by both parties. The need to manage all elements of the assessment process virtually fundamentally altered the way the institution viewed this essential element in the potential partner evaluation process. Video production was felt to be time consuming for the partner including details such as hazardous drug compounding, management of patient infusion areas, and clinic workflows. Challenges were also encountered in developing initial relationships due to the lack of in-person contact. Therefore, once COVID travel limitations are lifted, it is anticipated that future partner assessments will likely be a blended strategy of virtual and in-person visits which will both efficiently assess quality while building initial interpersonal relationships. Development of a new strategy for data gathering and management of the quality assessment process has allowed the organization to broaden its perspective, enhance efficiency, and thoughtfully seek new ways of learning.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
The world is rapidly changing, and the world of education is moving right along with the rest of the world. On demand learning, remote education, and technology driven educations are becoming a norm, ...which means nursing education has to keep up with the educational trends to best teach nurses to care for patients in these changing times. This kind of innovation led University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center (HGG) Department of Professional, and Patient Education strive to offer an OnDemand version of a live chemotherapy course required for staff orientation. UPMC HGG is comprised of outpatient cancer centers across Pennsylvania, Ohio, New York, and Maryland. UPMC HGG along with UPMC hospitals across the region offer a quarterly live course on chemotherapy with a test and UPMC certification for our healthcare professionals when the course is completed. Problems arise when a nurse is hired in between the quarterly courses making the staff member unable to administer chemotherapy until they have completed the course. The course director for the quarterly Chemotherapy and Biotherapy courses reached out to the UPMC Center for Continuing Education in the Health Sciences (GGHES) team to see if it was possible to make a completely on demand course within the system. The GGHES team agreed an on demand course would be an asset. Along with the GGHES team, the course director for the Chemotherapy and Biotherapy course began the process to build this new education module. Recordings were made from all lectures within the chemotherapy class to maintain consistency in learning and added to the new course. Pre-course and post-course instructions were made and recorded for the on demand course along with certificate and evaluation. The new OnDemand Chemotherapy course was ready to be tested. Several UPMC HGG nurse mangers, educators and nurses were recruited to evaluate the course for content and ease. All feedback was positive, and the program is set to begin in September 2021.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Expanding Oncology Research is a focus strategy for the oncology units. The inpatient facility does not have an established research unit, patients are placed in one of the four specialized oncology ...departments. Nursing works in collaboration with research staff to evaluate protocols, participate in Epic order set builds, and determine patient placement based on the needs of the patient. Due to the increase in patient volume and number of research trials, patient placement on specific units for treatment was becoming difficult. Nursing and research staff needed a way to quickly work together to meet patient needs. The purpose of this project was to work collaboratively in creating a standard workflow to ensure patients received quality care, clinical staff have resources available, and trial requirements were met. A monthly nurse research collaboration meeting was initiated that identified processes that needed to be established. Interventions included creating a Teams site for collaboration, SharePoint site for research materials and patient admission lists, and utilizing Forms for clinical feedback on barriers. Documents include standard research flow chart, protocol assessment, protocol assignment, patient scheduling, level of care determination, expectations, escalation guide, consistent in-service format, use of Epic Beacon template, and how to update binders on the unit. Streamlining the processes have assisted in working collaboratively with the research department and nursing leadership team. Clinical nurses have seen standardization in in-service documents and education. Barriers that have been reported by clinical staff have been related to Epic builds and pharmacy workflows. Other identified concerns are the lack of an established process with new hires in both nursing and research in utilizing the documents or finding resources available. Restrictions with distancing due to the covid pandemic has also brought to light a need for virtual education or refreshers. As new charge nurses are trained, gaining access to the admission list or knowledge of where to find the list remains a challenge. The team has made progress in establishing processes and resources for nursing and research staff to utilize. We have work to do in creating a process that will ensure all new employees receive education on where to locate resources, what is available, and adding a research pharmacist to the team.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
In an NCI-designated Comprehensive Cancer Center, the introduction of a registered nurse liaison (NL) has significantly impacted the order review process for oncology, non-oncology, and supportive ...treatment plans. Prior to the implementation of this role, unsigned treatment plans were addressed by the charge nurse on the appointment day. This resulted in multiple phone calls to the provider leading to patient delays which may negatively affect patient safety and experience. The purpose of the NL role is to ensure proactive review that orders are signed and dated for the appropriate treatment plan, consent is verified, and resulted labs are within treatment parameters. A multidisciplinary team consisting of nursing, physicians, and pharmacy convened to develop a workflow for treatment plan order review. New cancer center guidelines and email communications were sent to referring providers regarding the need to sign orders three days prior to scheduled Infusion. Prior to implementation, nursing staff completed a baseline two week audit to capture the number of daily unsigned orders. During the pilot, two NLs reviewed approximately 150 treatment plans per day for order completeness, 3-4 days prior to the scheduled appointment. For each patient with unsigned orders, the provider was notified via a documented telephone encounter and courtesy page. The pilot results demonstrated steady improvement in the percentage of signed orders and reduction of provider pages and same day appointment cancellations. Average unsigned orders decreased from pre-implementation (n= 1,234) at 15.2% to 7.2% during the pilot (n=1633). Pre-implementation (n=181), 43% of providers signed their orders without a same day call compared to the pilot (n=119) at 57.1%. An additional impact was the reduction of same day cancellations from 15% to 11% which is the gold standard for the size of our cancer center. The implementation of the NL improved the order review process, resulting in better utilization of nursing time, and promoting efficient patient flow and access by reducing avoidable delays and same day cancellations. The NL is a comprehensive role that can assist other infusion centers experiencing patient delays related to same day unsigned orders.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, OILJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Aims
To investigate how nursing experts and experts from other health professions understand the concept of rationing/missed/unfinished nursing care and how this is compared at a cross‐cultural ...level.
Design
The mixed methods descriptive study.
Methods
The semi‐structured questionnaires were sent to the sample of 45 scholars and practitioners from 26 countries. Data were collected from November 2017–February 2018.
Results
Assigning average cultural values to participants from each country revealed three cultural groups: high individualism‐high masculinity, high individualism‐low masculinity and low individualism‐medium masculinity. Content analysis of the findings revealed three main themes, which were identified across cultural clusters: (a) projecting blame for the phenomenon: Blaming the nurse versus blaming the system; (b) intentionality versus unintentionality; and (c) focus on nurses in comparison to focus on patients.
Conclusion
Consistent differences in the understanding of missed nursing care can be understood in line with the nation's standing on two main cultural values: individualism and masculinity.
Impact
The findings call for scholars' caution in interpreting missed nursing care from different cultures, or in comparing levels and types of missed nursing tasks across nations. The findings further indicated that mimicking interventions to limit missed nursing care from one cultural context to the other might be ineffective. Interventions to mitigate the phenomenon should be implemented thoughtfully, considering the cultural aspects.
目的
调查护理专家和其他医疗卫生专家如何理解定量护理、过失护理和未完成护理的概念以及跨文化层面是如何比较这些概念的。
设计
混合方法描述性研究。
方法
这些半结构化的问卷被发送给了实验对象——来自26个国家的45位学者和医生。搜集了从2017年十一月至2018年二月的数据。
结果
将平均文化价值观分配给各个国家的参与者,从而得到了三个文化群体:高个人主义‐高男子气概、高个人主义‐低男子气概以及低个人主义‐高男子气概。调查结果的内容分析揭示了三个跨文化群体认同的主题:(a)将这一现象归咎于谁:责备护士还是责备系统;(b)故意还是无意;以及(c)关注护理人员还是关注病人。
结论
对过失护理理解的一致差异可以理解为与国家长期的两种主要文化价值观有关:个人主义和男子气概。
影响
研究结果呼吁学者们谨慎解释不同文化背景下的过失护理或者是比较各国过失护理任务的程度和类型。研究结果进一步表明一个文化环境模仿另一个文化环境限制过失护理的干预措施可能是无效的。考虑到文化差异,应当谨慎采取干预措施来缓和这种现象。
