Certain types of cancer and treatment increase the risk of falls among cancer patients, particularly patients with hematologic cancer undergoing bone marrow transplant (BMT). Nurses are integral to ...preventing falls and maintaining patient safety. Understanding patients undergoing BMT fall risk factors may help nurses identify high fall risk patients and develop fall prevention interventions.
This systematic review aims to identify risk factors for falls among hospitalized adult patients receiving BMT treatment.
Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted by searching databases PubMed and CINAHL. Study quality was evaluated using the Crowe Critical Appraisal Tool form (v1.4).
An initial search yielded 829 articles; six were included for final review after removing duplicates and screening for inclusion criteria: specific to patients undergoing BMT, measure fall outcome, in hospital, and original research. The identified risk factors include age of 65 and older, leukemia diagnosis, days of diarrhea, incontinence of urine or stool, increased pulse rate, muscle weakness, hypnotic, anxiolytic medication, recent steroid use, allogenic transplant, and post-engraftment period.
Risk factors for falls among patients undergoing BMT are multifactorial and are related to muscle weakness, medication administration, pulse rate, type of transplant, age, engraftment period, and bathroom use.
Nurses providing care to patients undergoing BMT need to assess and increase nurse surveillance on allogeneic transplant patients, specifically those on anxiolytic, hypnotic, and steroid medications. Nurses providing care to patients undergoing BMT should implement more fall prevention strategies in patients undergoing BMT who develop diarrhea and urine or stool incontinence. Identifying specific patients undergoing BMT fall risk factors and applying multifaceted individualized fall prevention strategies has the potential to improve allogeneic transplant patient care and prevent fall-related complications.
During the height of the COVID pandemic, there was a decrease in oncology patients and an increase in COVID patients admitted to the oncology unit. During the first half of the year there were many ...new nurses hired, leaving many without opportunities to take care of oncology patients. This created a knowledge gap in oncology care. The purpose of this project was to support and provide guidance and opportunities for oncology nurses to learn more about oncology nursing and taking care of oncology patients. Interventions: Plan: To survey nurses to find a gap in knowledge and assess to see if there is an interest in learning about oncology nursing educational opportunities. A six item multiple choice and open ended questionnaire was used. Do: An inservice was conducted and an oncology resource handout was given to staff. An online oncology resource handout was distributed to staff via email. Check: Monthly surveys were taken to assess progress with nurses using oncology resources. Act: Continued information on oncology nursing resources should be provided to staff regularly to continue to develop nurses' knowledge of the oncology patient population. Evaluation: In August 2020 oncology nurses (n=20) were educated on oncology nursing resources. In Sept, 6% read an oncology article and 39% took an oncology CEU. There was an increase in taking Oncology CEUs in October (50%) and November (50%). There was also an increase in reading oncology nursing articles in October (60%), but it decreased in November (25%). These results show that educating the nurses on oncology nursing resources initially helped in increasing nurses taking oncology CEUs and reading oncology articles. Our recommendation is to continue to encourage staff to utilize oncology nursing resources and share opportunities for learning with staff. Our hope is to continue to be a resource for staff in directing them to learn more about oncology nursing through CEUs and journal articles as well as through direct learning opportunities during the work shift. Oncology nursing is a complex specialty requiring expertise in managing oncology emergencies, administration of various cancer therapies, symptom management, palliative care, and psychosocial needs of patients & families. Nurses require oncology specific education that is not always provided at work. Encouragement for staff to educate themselves is helpful in developing oncology nurses.
Oncology Nursing Practice Oncology nurses are exposed to many stressors while caring for the complex needs of cancer patients, which leads to burnout. The nurses on an inpatient medical oncology unit ...at an NYC academic medical center expressed many feelings of burnout in the work environment post the height of the COVID-19 pandemic. Two years later, nurses are still expressing and experiencing burnout. The purpose was to decrease oncology nurses' perceptions of nursing burnout through evidenced-based interventions. A survey was used to assess the current level of nurse burnout and ask the nurses to rank different activities in order of importance to help with decreasing the perception of burnout among staff. From May to August 2022, interventions to decrease nurse burnout were implemented such as, uninterrupted breaks, staff recognition using e-cards, organized outdoor group activities, and information on wellbeing-coaches and counseling available to staff. Burnout was measured with a 1 item question on a 5-point Likert scale validated previously in nurses to measure burnout. Items 1-2 indicate no burnout and items 3-5 indicate some level of burnout from "burning out" to "burnout won't go away" to "completely burned out." The burnout level of nurses equals 2.93 in May 2022 (n=46). This is at the higher end of 2, closer to 3, where 3 means some level of burnout. Participants were asked to rank 13 activities related to resilience and decreasing burnout in order of importance. The staff rated 1st: uninterrupted break, 2nd: time to unplug, 3rd: taking a break outside, 4th: group outings/activities, 5th: meditation/mindfulness was tied with view of outside during break, and 6th: recognition. Post implementation, in July (n=37) the burnout level was 2.89 and in August (n=31) burnout level was 2.98. Helping nurses deal with nurse burnout is multifactorial. Although the interventions implemented did not decrease perceptions of nurse burnout, staff were empowered to help each other and increase unity among staff. The staff felt like it was in their control to act towards improving their work environment and an improvement in staff morale was palpable. Over the past 6 months of the burnout project, a new shared governance unit council emerged to help further the professional practice of staff, increase staff engagement, and increase oncology nursing educational opportunities.
Oncology nurses are exposed to many stressors while caring for the complex needs of cancer patients, which leads to burnout. The nurses on an inpatient medical oncology unit at an NYC academic ...medical center expressed many feelings of burnout in the work environment post the height of the COVID 19 pandemic. Nurses often expressed the inability to take a break. The purpose of the project was to decrease oncology nurses' perception of burnout through providing a system for encouraging nurses to take a break. Charge nurses utilized the electronic medical record (EMR) messaging system each shift to assign breaks with a buddy system. Nurses emailed staff, mentioned at unit meetings, and were encouraged and supported by the nurse manager to take a break. Pre (n=5i) and post (n=qg) test survey evaluating nurses taking breaks and level of burnout. Nurses were assigned a number for confidentiality and to track the level of burnout (n=g8). Burnout was measured with a 1 item question on a 5-point Likert scale validated previously in nurses to measure burnout. Nurses were also asked how often they skip breaks on a 5 point Likert scale with 5 being "strongly agree." The baseline level of perceived burnout was 3.2368 and post it increased to 3.6053 (Sig. = <.001). Nurses' agreement with having to skip breaks prior was 4.6053 and post intervention it decreased to 4.2895 (Sig. = <.001). Post intervention, nurses significantly decreased skipping breaks, but the level of perceived nursing burnout increased. This suggests that there are other factors involved in perceived burnout. The post test asked "what is the main reason contributing to your perceived burnout?" Nurses mentioned lack of adequate staffing (n=2o), increase in patient acuity (n=9), and increase in workload (n=6). Continued socialization and acceptance of taking a break is important to maintain the nurses' well being on the oncology unit. Nursing burnout in the current environment post the COVID 19 pandemic is an uphill battle, due to staffing and the general consensus of nurses feeling exhausted and worn-out. Some further interventions being conducted are providing mentoring, shared governance council participation, and methods to increase staff morale. Further study on the reasons nurses do not take a break and feel burnt out is in development.
In an urban NYC academic medical center on a 38 bed medical oncology step-down unit CLABSI numbers increased in the months after the height of the COVID 19 pandemic. During the first wave of COVID 19 ...in NYC, new nurses were hired and were trained in a stressful environment without many opportunities to care for oncology patients. As a step-down unit in a state of emergency, the main population of patients included COVID 19 patients, hospice patients, and patients who were ICU level of care. The purpose of this project to decrease CLABSI infections on a medical oncology unit after the first wave of the COVID 19 pandemic. An inservice was created in which a mock patient room was set up. Nurses entered and had to identify and correct the breaches in central line maintenance that were observed. Following the nurses then demonstrated the correct practices of line care, blood culture draws, and dressing changes. CLABSI numbers were significantly increased from July 2020 to Sept 2020 with a total of 6 CLABSI infections during that time. Inservices were conducted with 100% of the nursing staff at the end of September and October 2020. Post implementation in Nov 2020 - Jan 2021 there were о CLABSI infections. CLABSI infection incidences: July=2, Aug=2, Scpt=2, Oct=i, Nov=o, Dcc=o, Jan=o. The incidence of GLABSIs significantly decreased after the inservice. It is acknowledged that there are multiple contributing factors to the incidence of CLABSIs. Patients at that time showed hesitancy in seeking care related to their fear of COVID-19. Oncology nurses were able to take ownership of their practice. Oncology nurses have a key role in maintaining patient safety and decreasing the incidence of CLABSIs in oncology patients. Most education inservices involve direct teaching. The approach used in this inservice was to show the nurses some of the observed wrong practices and have the nurses correct the staff members conducting the inservice. This provided them an opportunity for dialogue and for the nurses to assess their own gaps in knowledge. Nurses expressed that they felt like they were in a non-judgemental learning environment and that the goal was to maintain patient safety.
Inpatient oncology charge nurses expressed a need for a streamlined approach to handoff that focuses on the needs of the unit. Charge nurses stay late to give handoff resulting in feelings of ...burnout, job dissatisfaction, and accumulation of incidental overtime. The purpose of the study was to use an oncology charge nurse tool to create an efficient handoff, decrease incidental overtime, and increase job satisfaction An oncology specific streamlined handoff tool and new approach to utilizing the electronic medical record (EMR) was implemented. Handoff was based on acuity and quality (step-down, chemotherapy, research, hospice, fall risk, central lines, psycho/social needs, isolation), staffing, patient flow (census, admissions, discharges, barriers), and equipment/supply needs. Charge nurses communicated with staff through huddle messages and receiving report from staff. At baseline the incidental OT was 4.29 hrs and during implementation 3.54 hours. A spike was seen in incidental ОТ for the 6 main charge nurses in the first (y.ióhrs) and second (8.i6hrs) schedule periods post implementation of the project. This could be related to adjusting and becoming more familiar with the process. There was a steady decrease in the third (575hrs), fourth (5.38hrs), and fifth (3hrs) schedule periods post implementation. This might be related to the new charge handoff method becoming the standard practice to conduct charge handoff. The standardized oncology charge nurse handoff allowed for: (a) focused handoff concentrating on the most pertinent needs of the unit, (b) ability of charge RN to retain most important information, (c) charge RN to be readily available to meet the needs of the unit, (d) charge RN to start environment of care and patient rounds early in shift, (e) better ability of charge nurse to understand how to best help RNs on shift, and (f) potential decrease in charge RN incidental overtime and increase in charge RN satisfaction. Oncology patients have a high acuity and complex needs. The oncology charge nurse needs a tool specific to the needs of an oncology unit to create an efficient method of giving and receiving charge report. The oncology charge RN has many roles including leader, mentor, expert, communicator, and mediator. An oncology charge nurse handoff tool enables the oncology charge RN to achieve nursing excellence and create a more favorable work environment.
When social movement organizations receive extensive newspaper coverage, why is it sometimes substantive and sometimes not? By "substantive," we mean coverage that reflects serious treatment of the ...movement's issues, demands, or policy claims. Scholars agree that the news media are key to movement organizations' influence, helping them alter public discourse and effect political change, but often find that protests are covered nonsubstantively. Employing insights from literatures on historical institutionalism, the social organization of the news, and the consequences of movements, we elaborate an "institutional mediation" model that identifies the interactive effects on coverage of news institutions' operating procedures, movement organizations' characteristics and action, and political contexts. Although movement actors suffer compound legitimacy deficits with journalists, the institutional mediation model identifies the openings news institutions provide, the movement organizational characteristics, the forms of collective action likely to induce substantive news treatment, and the political contexts that will amplify or dampen these effects. We derive four interactive hypotheses from this model, addressing the effects of organizational identities, collective action, and political contexts on news outcomes. We appraise the hypotheses with comparative and qualitative comparative analyses of more than 1000 individually coded articles discussing the five most-covered organizations of the 1960s U.S. civil rights movement across four national newspapers. We find support for each hypothesis and discuss the implications for other movement organizations and the current media context.
Why do newspapers cover social movement actors, and why is this coverage sometimes favorable? Early scholarship saw the news media mainly as a source of data on collective action, and sought to ...ascertain its biases, but scholarship has increasingly focused directly on why movements gain coverage, especially coverage that can advance their goals. To understand why and how newspapers cover movement actors, we start with the insight that movements rely on the news media for many reasons, but their coverage is largely in the control of news institutions. In this review, we focus on perspectives that specify 3‐way interactions between the characteristics of newspapers, social movement actors, and the social and political contexts, but we begin with how news media institutions are organized. We conclude with suggestions for future research that take advantage of the digital revolution of the last generation.
BACKGROUNDThis scoping review focuses on the intersections of racism, health, and health care, as well as interventions for the African American population in Milwaukee, Wisconsin-one of the most ...hypersegregated regions in the country. We investigate what existing research provides about the impact of segregation and racism on health and consider how community setting informs health interventions, practice, and policy. METHODSWe analyzed studies that address racism and health in Milwaukee to assess the state of the science in this area. We searched databases using the terms "African American," "racism," "segregation," and "health." A total of 296 studies resulted, and 54 met the inclusion criteria. RESULTSRacism is a known determinant of health. However, a lack of research investigating the impact of racism on health in Milwaukee County leaves a knowledge gap necessary for improving health among African American residents. The adverse effects of racism on health are compounded by the social, economic, and policy context of geographic and social segregation that limit access to care and resilience. Themes identified in the review include measures of physical and mental health, community factors related to health (eg, housing, environmental contamination, economic and social exclusion), intervention strategies, and theoretical gaps. DISCUSSIONProfessionals must work across disciplines and social sectors to address the effects of racism on the physical and mental health of African American individuals in urban metropolitan environments. Health research and medical interventions in hypersegregated communities must center structural racism in their analysis.
