An evaluation of the quality of a chemotherapy administration service established by nurses in an oncology day care centre

Traditionally, chemotherapy administration has been a medical role in Hong Kong. In 1998, two chemotherapy nurses took over part of this role within a major oncology day care centre after completing a course in chemotherapy administration and patient care. The aim of this study was to measure and evaluate the quality of care by using a self-developed audit form and the Worthing Chemotherapy Satisfaction Questionnaire (WSCQ). All records of patients who had had i.v. cannulas inserted by nurses over a period of one year were audited for the accuracy of the i.v. cannulation (n=2217). Also, patient satisfaction was assessed in 50 patients. The results showed that the accuracy of i.v. cannulation was kept constantly above 80% from the eighth month of auditing onwards. It was also found that patients preferred the use of a butterfly needle for the administration of chemotherapy. The study revealed that the level of information received regarding treatment (r=0.36, P=0.011) and satisfaction of practical advice on caring for side effects (r=0.35, P=0.012) were determinants of patients' overall satisfaction. Furthermore, anxiety when patients received chemotherapy could also be associated with overall satisfaction (r=-0.27), although the P value was of borderline significance only (P=0.58). In conclusion, the study reflected a high level of quality of care in relation to this element of nurse-led practice.     

Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?

INTRODUCTION: The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. AIM: This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. METHOD: The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. RESULTS: Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. CONCLUSION: Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.     

Ovarian cancer: An update for nursing practice

A diagnosis of ovarian cancer is a crisis for any woman. Ovarian cancer has the highest mortality of all the gynaecological cancers. In addition to the very real threat of death, such a diagnosis raises critical issues concerning femininity, motherhood and sexuality. The high mortality associated with this disease is due (in part) to problems associated with early diagnosis. Women frequently experience non-specific symptoms, which may be attributed to other, less alarming causes. The lack of specific symptoms experienced by women, as well as the lack of effective mass screening strategies, make early detection difficult. This makes it crucial that nurses involved in the care of women be alert to the insidious and non-specific onset of this serious condition.     

Quality of life,fatigue, and activity in Australians with chronic kidney disease: A longitudinal study

In this study we investigated the relationship between health‐related quality of life, fatigue, and activity levels of people with anemia secondary to chronic kidney disease over a 12 month period following the introduction of an erythropoietin‐stimulating agent. Using a longitudinal repeated‐measure design, 28 people with chronic kidney disease completed the Short Form‐36 Health Survey, Human Activity Profile and Fatigue Severity Scale at the commencement of an erythropoietin‐stimulating agent, and then at 3, 6, and 12 months. Over a 12 month period, a significant change was found for health‐related quality of life in relation to role–physical, vitality, mental health/emotional well‐being, and overall mental health. However, activity levels did not significantly improve during that time. Renal nurses in dialysis units and chronic kidney disease outpatient clinics have repeated and frequent contact with people with chronic kidney disease over long periods of time, and are in an ideal position to routinely assess fatigue and activity levels and to institute timely interventions to optimize health‐related quality of life and independent activity.     

Creating an environment to implement and sustain evidence based practice: A developmental process

Background

Elements of evidence based practice (EBP) are well described in the literature and achievement of EBP is frequently being cited as an organisational goal. Despite this, the practical processes and resources for achieving EBP are often not readily apparent, available or successful.

Purpose

To describe a multi-dimensional EBP program designed to incorporate evidence into practice to lead to sustainable improvement in patient care and ultimately patient outcome.

Implementation strategies

A multi-dimensional EBP program incorporating EBP champions and mentors, provision of resources, creation of a culture to foster EBP and use of practical EBP strategies was implemented in a 22-bed intensive care unit (ICU) in a public, tertiary hospital in Brisbane, Australia. The practical EBP strategies included workgroups, journal club and nursing rounds.

Achievements

The multi-dimensional EBP program has been successfully implemented over the past three years. EBP champions and mentors are now active and two EBP workgroups have investigated specific aspects of practice, with one of these resulting in development of an associated research project. Journal club is a routine component of the education days that all ICU nurses attend. Nursing rounds is now conducted twice a week, with between one and seven short-term issues identified for each patient reviewed in the first 12 months.

Conclusions

A multi-dimensional program of practice change has been implemented in one setting and is providing a forum for discussion of practice-related issues and improvements. Adaptation of these strategies to multiple different health care settings is possible, with the potential for sustained practice change and improvement.