Emergency management of nursing human resources and supplies to respond to coronavirus disease 2019 epidemic

ObjectiveTo introduce the emergency management of nursing human resources and supplies of a large general hospital when facing the outbreak of coronavirus disease 2019(COVID-19).MethodThe Nursing Department of the hospital fully executed its functional authority to establish a three-level echelon of sustainable support, allocate human recourses dynamically, organize pre-service training, supervise the key working steps, formulate positive incentive methods, and deploy medical supplies scientifically.ResultBy taking these strategies, the hospital effectively improved the coping capacity of the nursing team and played a positive role in the prevention and treatment of COVID-19.ConclusionThe emergency management of nursing human resources and material resources for COVID-19 of the hospital is successful. But several deficiencies were identified as well, which indicated that the hospital needs to establish an efficient emergency management system, and pay attention to the practice of nursing emergency plans to enhance coping capacities in public health emergencies.     

A Meta-Ethnography of the Experiences of Adults with Lymphoma During Acute and Chronic Survivorship

ObjectivesThe acute and chronic phases of cancer survivorship are the periods of treatment, post-treatment, and early remission. During acute and chronic survivorship, adults with lymphoma have reported both positive and negative changes in health-related quality of life. This meta-ethnography aims to appraise the experiences of adults with lymphoma at the acute and chronic survivorship phases.Data SourcesThis qualitative review used the established meta-ethnography framework from Noblit and Hare and is outlined following the meta-ethnography reporting guidance (eMERGe). A systematic literature search using four unique databases was completed, including the Cumulative Index to Nursing and Allied Health Literature, PubMed, Ovid Emcare, and Clarivate Web of Science.ConclusionIn total, nine research studies were included in this review. Study characteristics and sample evidence were extracted from the included studies to produce the synthesis. The review and synthesis formed three main themes and six subthemes that reflect the challenges of cancer treatment and post-treatment, the communication and support from others, and how lymphoma patients reframe and reprioritize during and following treatment.Implications for Nursing PracticeThis meta-ethnography provides a comprehensive analysis of adults’ experiences with lymphoma at the acute and chronic survivorship phases. Several approaches for the management and care of lymphoma patients were found in this review, including integrating patient support groups from diagnosis through post-treatment, tailored psychological health care services, personalized care and delivery pathways at post-treatment, and the promotion of strategies to cope with cancer in remission. Additional research should examine younger and older adults to discover age-related issues in lymphoma populations in addition to disparities among minority patients with lymphoma and those from low socioeconomic backgrounds.     

Clinical Updates in Nausea and Vomiting

ObjectiveTo review recent updated antiemetic guidelines from national cancer organizations and its impact on chemotherapy-induced nausea and vomiting (CINV) in the prevention and delayed phase of therapy. This article will also describe assessment and nursing strategies for individualized care and timely side effect management.Data SourcesData sources include peer-reviewed articles sourced in electronic databases.ConclusionCINV is a persistent problem for a large percentage of patients undergoing chemotherapy treatment despite advances in antiemetic therapy and increased use of targeted therapies. CINV management should be based on patient-focused assessment and adherence to national antiemetic guidelines. Ongoing assessment and follow-up are critical to ensure optimum management of side effects to optimized quality of life.Implications for Nursing PracticeAwareness of national antiemetic guidelines is important in caring for patients undergoing chemotherapy. CINV can have a significant impact on patients, causing physical effects, treatment delays, and diminished quality of life. Oncology nurses play a key role in assessment of patient-related risk factors, education of patients and caregivers regarding pain medications, side effects, and oral adherence and continued follow-up for early recognition and intervention for uncontrolled CINV.     

护理风险管理在呼吸科危重症患者护理中的应用与效果

目的探讨护理风险管理在呼吸科危重症患者护理中的应用与效果。方法成立风险管理小组,建立适合呼吸科重症监护室特点的护理风险管理预案,对护士进行集中与分层相结合的培训,全面落实护理风险管理策略。结果实施护理风险管理后,降低了危重症患者的非计划性拔管、意外事件和护理纠纷的发生率（P〈0．01或P〈0．05）;危重症患者及家属对护理满意度由95．10％提高到99．29％。结论对危重症患者实施护理风险管理,能有效减少护理风险的发生,提高危重症患者护理质量,保证护理安全。     

Challenges of Caregivers of Cancer Patients who are on Oral Oncolytic Therapy

ObjectiveTo describe the major challenges faced by caregivers of patients receiving oral oncolytic therapy (OOT).Data SourcesPublished literature, national clinical practice guidelines, standards of care.ConclusionCaregivers of patients receiving OOT have unmet needs. Caregivers need standardized OOT education and coping support to improve patient outcomes through enhanced drug safety practices, better management of complex treatment regimens and adherence, patient symptoms, treatment side effects, care decision-making, and financial assistance for costly OOT.Implications for Nursing PracticeNurses are well-positioned to take leadership roles in facilitating optimal utilization of multidisciplinary health care resources necessary to support caregivers and improve outcomes in patients receiving OOT.     

How to Care and Minimize the Sequelae of Lower Extremity Lymphedema

ObjectiveThe objective of this review is to provide information regarding the care of patients with lower extremity lymphedema in the setting of urologic cancer.Data SourcesLiterature regarding lower extremity lymphedema was examined. Relevant information was integrated to create a review of the pathophysiology, management, and potential complications of lower extremity lymphedema.ConclusionLower lymphedema is a chronic, debilitating condition with no definitive cure. It may affect patients undergoing treatment for malignancies, especially those undergoing lymph node removal. Management of this condition is multimodal, and complex decongestive therapy is currently the gold standard. For patients who do not respond to this management, surgical options exist. More research should be done in understanding the prevalence and management of lower extremity lymphedema in patients suffering from urologic cancers because this is underdeveloped research.Implications for Nursing PracticeTo care for patients with lower extremity lymphedema postoperatively, a multimodal approach is warranted. Different techniques include complex decongestive therapy, intermittent pneumatic compression, physical therapy, skin care, patient education, social support, and, in some cases, surgery.     

Strategies used for the promotion of critical thinking in nursing undergraduate education: A systematic review

ObjectiveIdentifying the strategies used to promote critical thinking (CT) during undergraduate education in nursing courses.DesignSystematic review.Source of DataFive electronic databases were searched without language, publication time or geographic filters.MethodA systematic review of the literature. Including experimental studies that considered at least one teaching strategy to promote critical thinking of undergraduate students in Nursing courses. The search for studies occurred in three phases: title and summary review, complete text and implementation of a clinical form of selection according to predetermined criteria. All included studies were assessed for quality through a classification tool for experimental studies.ResultsSix studies were selected. The results were grouped into three key themes: an evaluation of the quality of the selected studies, characterization of the studies and the strategies used to promote critical thinking. All selected studies were in English, with significant conceptual similarity of Critical Thinking and dominance in choosing the approached theme during strategies in clinical nursing education with an emphasis on the nursing process.ConclusionsThe most widely used teaching intervention was Problem-Based Learning. Nursing education mediated by strategies that stimulate CT is considered a positive difference in undergraduate curriculums.     

Psychological and Financial Distress Management in Adults With Acute Leukemia

ObjectivesTo review and summarize psychological and financial distress in adults with acute leukemia and provide evidence-based methods that nurses can apply to alleviate distress experienced by patients.Data SourcesOncology and palliative care literature published over the past decade.ConclusionCurrent evidence supports the efficacy of psychosocial interventions to improve psychological well-being and reduce distress for adults undergoing treatment for leukemia.Implications for Nursing PracticeNurses play a critical role, not only in identifying patients who are experiencing impaired psychological well-being and high levels of distress, but also in providing prompt support to these patients.     

Multimodal Pain Management of Children Diagnosed with Osteogenesis Imperfecta: An Integrative Literature Review

ObjectivesThe objective of this literature review was to evaluate multimodal therapies and interventions that help prevent progression and manage pain in children with OI.DesignA systematic review of literature utilizing PRISMA guidelines.Data sourcesThe Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, PubMed, PsycINFO, UpToDate, and ProQuest Nursing & Allied Health Source.Review/Analysis methodsExisting literature on pain management in pediatric patients diagnosed with OI was reviewed and appraised. Fifteen studies met the criteria for review.ResultsResults indicated that therapies addressing pain management are most effective when they use a multimodal approach that promotes bone strength, psychological support, reduces the risk of fractures, increases bone stability, and maintains physiological function. Four multimodal treatments for pain management in children with OI were identified including bisphosphonate therapy, surgical intervention, physical therapy, and psychosocial support.ConclusionsDeveloping a finite understanding of the utilization of multimodal therapies to manage and treat pain can assist in engineering treatments that improve the quality of life for children diagnosed with OI.     

Nursing Leaders as Visionaries and Enablers of Action

ObjectivesThe engagement of nursing leaders is critical for the future of the cancer nursing profession, quality cancer care, and the overall health care system. The field of cancer care is facing enormous challenges, requiring strong nursing leadership. Cancer nursing leadership is needed to overcome the challenges caused by workforce shortages, restricted resources, historic and ongoing under-recognition of nursing, unsafe working conditions, and unequal access to education. The aim of this article is to contribute to the discussion about how cancer nursing leaders can act as visionaries and support transformation of cancer nursing for the future.Data SourcesAuthor experience, journal articles and organizational position papers were used.ConclusionTo improve the state of cancer nursing and the working conditions of the cancer nursing workforce, nursing leadership practices need to be embraced on all governance levels in clinical practice and academia. When effective and high-quality nursing leadership is enacted, positive outcomes for people affected by cancer, nursing, and health care systems can be achieved. Cancer nursing leadership needs to be supported through nursing scholarship, influencing national and global policies and strategies and by active involvement in national and international health care management.Implications for Nursing PracticeNursing leadership and governance is critical to strengthening the cancer nursing workforce. Strong nursing leadership is required to realize the vision for transforming the health care systems and cancer care. Therefore, collaboration among multidisciplinary leadership, health care organizations, academic institutions, professional organizations, and policy-making structures is warranted.     

新型冠状病毒肺炎集中救护中护理部的应急管理策略

总结新型冠状病毒肺炎集中救护中护理部预警启动、持续推进、科学防控等一系列应急管理策略。策略包括：发挥护理部纵向指挥、横向协调的运作职能,合理配置救治及护理人力资源,高效推进院内发热门诊、隔离病房、ICU等集中救治工作及省内危重症转诊收治工作;成立培训考核、管理督导、心理援助、后勤保障、报道宣传5个防控专项工作小组,统筹保障防控工作可持续性;优化工作流程,完善护理规范,解决临床问题,引领省内护理工作。通过实施应急管理策略,保证了集中救护的及时、有序、安全、高效,实现了重症病例零死亡,医护人员零感染的目标。     

Genetic Variants Associated with Cancer Pain and Response to Opioid Analgesics: Implications for Precision Pain Management

ObjectiveTo review the current knowledge on the association of genetic variants with cancer pain.Data SourcesData-based publications and review articles retrieved from PubMed, CINAHL, and Web of Science, as well as an additional search in Google Scholar.ConclusionGenetic variability can influence differential pain perception and response to opioids in cancer patients, which will have implications in the optimal personalized treatment of cancer pain. More studies are warranted to replicate findings.Implications for Nursing PracticeNurses are poised to educate patients on biomarker testing and interpretation and to use precision pain management strategies based on this information.     

Increased adoption of smoke-free policies on campuses with schools of nursing

BackgroundIn 2015, the majority of U.S. American Association of Colleges of Nursing (AACN)-accredited schools of nursing resided on campuses without smoke-free policies.PurposeTo determine the presence of smoke-free policies at AACN-accredited after resolutions from AACN and the American Academy of Nursing, and the creation of online resources.MethodsSmoke-free policies (2015-2017) were determined through listings on the ANRF College Campus Policy Database© and survey responses from nursing deans.ResultsSmoke-free policies for 689 schools of nursing increased from 36% in 2015 to 91% in 2017. There were no significant differences by nursing program types or geographic area. Twenty percent of deans reported using the resources, with over 1700-page views.ConclusionSmoke-free policies increased after support from two national nursing organizations. Learning in a smoke-free environment should be an expectation for nursing students to protect their own health, and to support their future critical role in tobacco control.     

A Quality Initiative Incorporating Tablet Technology to Facilitate Nonpharmacologic Pain Intervention Use in the Hospital

BackgroundThe opioid crisis has changed the culture and expectations of pain management, elevating the importance of nonpharmacologic pain interventions (NPIs) into multimodal pain management programs. Little is known about use of NPIs in hospitalized patients.AimsThis quality improvement project aimed to increase awareness and use of NPIs by engaging patients and nurses on one medical unit using tablet technology.MethodsPre- and post intervention data were collected using surveys of nurse and nursing assistant perceptions of NPIs and by assessing pain management experiences of acute care patients using the American Pain Society-Pain Outcomes Questionnaire-Revised. Interventions included staff education, integration of an NPI menu and tools onto bedside tablets, and a Comfort Card communication tool.SettingsThis Quality Improvement project was conducted on an 18-bed adult medical unit at a Midwestern academic medical center.Participants/SubjectsSubjects included RN and Certified Nursing Assistants from one medical unit. Patient perspectives were obtained from a baseline cohort of 30 hospitalized medical patients and compared to an intervention group of 15 medical patients. Patient inclusion criteria included adults ages 18 and older, hospitalized ≤72 hours, who verbalized a willingness to participate.DesignThe 8-week project included nurse and nursing assistant pre-/post-intervention perception surveys and an educational module about NPIs. Pain management experiences and NPI use were assessed post-tablet intervention using the American Pain Society-Pain Outcomes Questionnaire-Revised (APS-POQ-R). Additionally, staff education, integration of an NPI menu and tools onto bedside tablets, and a Comfort Card communication tool were planned interventions.ResultsNursing staff believe NPIs are beneficial, safe, and evidence-based; however, limited resources, time constraints, and lack of provider support are perceived as barriers. Staff and volunteers provided 80 comfort items to 38 patients during the project. Half of baseline patients (n = 30) and intervention (n = 15) groups reported not receiving information about pain treatment options. Many patients in both groups denied using “non medicine methods,” but further assessment revealed that 90% of the baseline group and 87% of the intervention group had used an NPI.ConclusionsResults suggest that patients and nurses may benefit from education about using NPIs in acute care. Nurses have a critical role influencing positive pain-related outcomes, and tablet technology can enhance patient use of NPIs during hospitalization.     

Cancer Pain Management Considerations in Older Adults

ObjectiveTo address the pharmacokinetics and pharmacodynamics of aging and its impact on the complexities of pain management in older adults with cancer. To describe assessment and nursing strategies for individualized care and side effect managementData SourcesPeer-reviewed articles.ConclusionCancer pain is a complex problem in older adults because of the variations in aging and alterations in pharmacokinetics and pharmacodynamics. Pain management must be based on thorough assessment, incorporating the unique factors of each patient. Ongoing follow-up is critical to ensure adequate pain control with optimization of functional status.Implications for Nursing PracticeAwareness of physiological changes of aging is important in caring for older adults. Oncology nurses can play a key role in the assessment of older adults with cancer and education of patients and caregivers regarding pain medications, side-effects, and oral adherence.     

A Scoping Review of Nursing's Contribution to the Management of Patients with Pain and Opioid Misuse

BackgroundNursing brings a unique lens to care of patients with pain and opioid misuse.AimsThis scoping review describes nursing's contribution to the literature on the management of patients with pain and opioid misuse, generating evidence to guide clinical care.DesignThe scoping review was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews guideline.Data SourcesUsing combined key terms (“opioid misuse,” “pain,” “nursing”) in systematic searches in PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL) electronic databases, snowball technique, and personal knowledge resulted in 108 relevant articles, reports, and websites.Analysis MethodSummative approach to content analysis was used to quantify and describe nursing's contribution to the literature.ResultsContributions of nurses emerged in the areas of research, clinical practice, policy, and education. The highest number of publications addressed research (50%, 54 of 108), whereas the fewest number of publications involved education (7%, 8 of 108).ConclusionResults provide a picture of the breadth of expertise and crucial leadership that nurses contribute to influence management of patients with pain and opioid misuse.Implications for NursingThis scoping review indicates the importance of continued support from key stakeholders, including training and interprofessional collaboration opportunities supported by the National Institutes of Health, to sustain nursing's contribution to quality care of patients with pain and opioid misuse. Ultimately, all health care professionals must collaborate to conduct rigorous research and construct evidence-based guidelines to inform policy initiatives and education strategies to solve the complex co-occurring epidemics of pain and opioid misuse.     

Efficacy of combination of localized closure,ethacridine lactate dressing,and phototherapy in treatment of severe extravasation injuries: A case series

BACKGROUNDThe management of severe extravasation injuries is still controversial. Extravasation injuries can be treated in many ways. AIMTo present a series of patients with severe extravasation injuries due to infusion who were managed with ethacridine lactate dressing combined with localized closure and phototherapy. METHODSIn this study, we evaluated the data of eight patients, including six from the Department of Burn, one (with colorectal carcinoma) from the Veteran Cadre Department, and one (with leukemia) from the Hematology Department. Of these, three patients were male and five were female. Age of the patients ranged from 10 mo to 72 years, including two children (10 and 19 mo of age). In this study, the infusion was stopped immediately when the extravasation was identified. The extravasation event was managed routinely using a blocking solution. A ring-shaped localized closure was performed using the blocking agents. Moreover, ethacridine lactate dressing and phototherapy were applied for 3-5 d. RESULTSIn this study, the drugs contained in the infusates were iodixanol, norepinephrine, alprostadil, amino acids, fat emulsion, cefoselis, cefoxitin, and potassium chloride + concentrated sodium chloride. All of the patients achieved complete healing after treatment and no obvious adverse reactions were observed. CONCLUSIONThe treatment of severe extravasation injuries using a combination of localized closure, ethacridine lactate dressing, and phototherapy resulted in satisfactory outcomes in patients.     

Nursing Considerations for Androgen Deprivation Therapy and Bone Health in Men Affected by Prostate Cancer

ObjectiveThis article reviews the effects of androgen deprivation therapy on bone health and loss of bone mineral density and its effects on risk of fractures for men with prostate cancer, as well as describes the assessment, management, and nursing strategies for patient and caregiver education, prevention strategies, and side effect management.Data SourcesPeer-reviewed articles formed the basis of this article.ConclusionAndrogen deprivation therapy has a deleterious effect on bone health, causing loss of bone mineral density and increasing the risk of fractures. The significant decrease in bone mineral density and fractures in elderly men can lead to morbidity, mortality, and poor quality of life. Bone mineral density assessment prior to initiating androgen deprivation therapy should be performed to identify bone issues prior to initiating therapy and to ensure that preventive bone health management strategies are executed.Implications for Nursing PracticeAwareness of bone loss factors for men treated with androgen deprivation therapy is important in caring for patients undergoing treatment for prostate cancer. Bone fractures can have a significant impact on activities of daily living and diminish quality of life. Oncology nurses can play a key role in patient and caregiver education regarding the importance of bone health management strategies and the assessment of patient-related risk factors that may limit adherence to treatment recommendations.     

Symptom Management in Oncology: Depression and Anxiety

ObjectiveTo describe nursing symptom management of depression and anxiety in patients with cancer.Data SourcesThese include journal articles, online resources, and personal experience in providing mental health care to cancer survivors with depression and/or anxiety.ConclusionNurses can provide emotional support for patients with cancer and depression or anxiety. Nurses can become aware of nonpharmacologic and pharmacologic treatment for depression and anxiety to help patients decrease their emotional distress. Nurses can also refer patients with cancer to psychiatric professionals and emotional support programs.Implications for Nursing PracticeNurses do not have to be experts in psychiatry to manage symptoms of depression and anxiety in patients with cancer. Nurses can listen empathically, guide patients in relaxation techniques, and advocate if they need psychotropic medications or psychiatric referrals.     

American Society for Pain Management Nursing Guidelines on Monitoring for Opioid-Induced Advancing Sedation and Respiratory Depression: Revisions

ObjectivesThis report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics.DesignSystematic review of the literature.MethodsA 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews.ResultsThe 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated.ConclusionsAll hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.Nursing Practice ImplicationsOpioid medications continue to be a major component in the management of acute pain. Clinicians have the primary responsibility for safe and effective pain management. Evidence based monitoring strategies can improve patient safety with opioids.