Bailie Kiera, Jacques Lisa, Phillips Angele, Mahon Paula
Division of Hematology, Oncology and Bone Marrow Transplant, 37210British Columbia Children's Hospital, Vancouver, BC, Canada.
School of Nursing, 8166The University of British Columbia, Vancouver, BC, Canada.
J Pediatr Oncol Nurs. 2021 May-Jun;38(3):157-165. doi: 10.1177/1043454221992293. Epub 2021 Feb 22.
Pediatric oncology patients with an external central venous catheter (CVC) in situ can be discharged from the hospital. Caregivers are expected to learn how to care for the CVC prior to discharge while also dealing with their child's new cancer diagnosis. This study aimed to evaluate the perceptions of a CVC education program received by caregivers to identify opportunities for improvement. A qualitative study was conducted in 3 stages, using an evidence-based co-design approach, involving caregivers and one adolescent patient discharged from the British Columbia Children's Hospital Oncology/Hematology/BMT inpatient unit. Stage I involved semi-structured interviews to gain feedback on the existing CVC education program. In Stage II, educational resources were updated or developed and implemented. For Stage III, the revised CVC education program was evaluated through a focus group and semi-structured interviews. Interview transcripts were analyzed using QSR NVivo. The original CVC education program was overall well received. Repeated instruction and support provided by nurses was reported to have increased confidence with performing CVC skills. Participants appreciated the multimodal approach to meet learning needs and expressed interest in additional visual aids. Inconsistencies in nurses' practice and offers of "tips and tricks" were identified to be challenging for caregivers while learning a new skill. Videos depicting CVC care were developed to provide an additional visual tool, decreased inconsistencies in care, and support to caregivers at home. Caring for a CVC at home is challenging and overwhelming for caregivers. A standardized multimodal education program is required to support caregivers at home.
患有外置中心静脉导管（CVC）的儿科肿瘤患者在导管在位的情况下可以出院。预计护理人员在出院前要学会如何护理CVC，同时还要应对孩子新确诊的癌症。本研究旨在评估护理人员对所接受的CVC教育项目的看法，以确定改进的机会。采用基于证据的协同设计方法分三个阶段进行了一项定性研究，研究对象包括护理人员和一名从英属哥伦比亚儿童医院肿瘤/血液/骨髓移植住院部出院的青少年患者。第一阶段包括半结构化访谈，以获取对现有CVC教育项目的反馈。在第二阶段，更新或开发并实施了教育资源。在第三阶段，通过焦点小组和半结构化访谈对修订后的CVC教育项目进行了评估。使用QSR NVivo软件对访谈记录进行了分析。最初的CVC教育项目总体上受到好评。据报告，护士提供的反复指导和支持增强了护理人员进行CVC护理操作的信心。参与者赞赏满足学习需求的多模式方法，并对额外的视觉辅助工具表示感兴趣。在学习一项新技能时，护理人员发现护士操作的不一致以及提供的“小贴士和技巧”具有挑战性。制作了描述CVC护理的视频，以提供额外的视觉工具，减少护理中的不一致情况，并为在家中的护理人员提供支持。在家中护理CVC对护理人员来说具有挑战性且压力巨大。需要一个标准化的多模式教育项目来支持在家中的护理人员。
