Wong Chris I, Henrich Natalie, Barysauskas Constance M, Conway Margaret, Desrochers Marie D, Mahan Riley M, Billett Amy L
Pediatric Hematology-Oncology, Boston Children's Hospital, Boston, Mass.
Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Mass.
Pediatr Qual Saf. 2023 Mar 13;8(2):e638. doi: 10.1097/pq9.0000000000000638. eCollection 2023 Mar-Apr.
Caregivers of pediatric oncology and stem cell transplant patients often care for central lines (CLs) at home. Methods to achieve caregiver CL care proficiency, and interventions designed with caregiver input are lacking.
Caregivers of pediatric oncology and stem cell transplant patients patients with an external CL or removed within 2 weeks were eligible for a survey assessing knowledge, the value of training strategies, and comfort. We mapped responses (n = 79) and acceptability/challenges of introducing a pilot caregiver CL teach-back clinic program onto the capability, opportunity, motivation behavioral (COM-B) model of change to identify drivers of caregiver CL care proficiency. A working group, including caregivers, refined and approved a final driver diagram.
: Ninety-four percent of caregivers answered knowledge questions correctly (capability); 95% considered hands-on training helpful (opportunity); 53% were not very comfortable with CL care (motivation). : Seventy-nine percent of caregivers were interested in a teach-back as additional training; 38% participated (opportunity); 20% refused participation due to being overwhelmed/not having time (motivation). Thirty-three percent of participants had a CL proficiency assessment (capability). Drivers of home caregiver CL care proficiency included: support for the caregiver's physical capability to perform CL care; enabling the CL care nurse trainer role; facilitating and increasing training opportunities, and engaging caregivers early and continuously to motivate proficiency development appropriately.
An approach centered on caregivers as main stakeholders can identify drivers to co-design an intervention for improved home CL care delivery. A standardized process to train and evaluate caregivers with multiple hands-on opportunities might be beneficial.
儿科肿瘤和干细胞移植患者的护理人员通常在家中护理中心静脉导管（CL）。目前缺乏提高护理人员CL护理熟练度的方法，以及基于护理人员意见设计的干预措施。
儿科肿瘤和干细胞移植患者中，带有外置CL或在2周内拔除CL的患者的护理人员有资格参与一项调查，该调查评估知识、培训策略的价值以及舒适度。我们将79份回复映射到引入试点护理人员CL回授诊所项目的可接受性/挑战上，以能力、机会、动机行为（COM-B）变革模型来确定护理人员CL护理熟练度的驱动因素。一个包括护理人员在内的工作组完善并批准了最终的驱动因素图。
94%的护理人员正确回答了知识问题（能力）；95%的人认为实践培训有帮助（机会）；53%的人对CL护理不太放心（动机）。79%的护理人员有兴趣将回授作为额外培训；38%的人参与了（机会）；20%的人因不堪重负/没有时间而拒绝参与（动机）。33%的参与者进行了CL熟练度评估（能力）。家庭护理人员CL护理熟练度的驱动因素包括：支持护理人员进行CL护理的身体能力；使CL护理护士培训师发挥作用；促进并增加培训机会，以及尽早并持续吸引护理人员以适当激发熟练度发展。
以护理人员为主要利益相关者的方法可以确定驱动因素，以便共同设计一项干预措施，改善家庭CL护理服务。一个具有多种实践机会来培训和评估护理人员的标准化流程可能会有帮助。
