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Implementation of a Nurse Mentorship ProgramProblem & Purpose: The Institute of Medicine’s (IOM) report, “The Future of Nursing: Leading Change, Advancing Health”, supports the need for nurses to engage in lifelong learning opportunities. A 72-bed community hospital identified a gap in mentoring support for nurses after their first year of employment in order to support their professional development. Value for mentoring was evident in the existence of a mentoring committee at the project site, however, the committee has been inactive. The purpose of the quality improvement (QI) project was to develop, implement and evaluate the effects of a nurse mentorship program (NMP). Methods: Seven mentees were recruited, all who expressed an interest in being mentored and were part of the most recent cohort of the organization’s Maryland Nurse Residency Collaborative (MNRC). Five of the seven mentors were experienced nurses recruited at a hospital sponsored event, while the other two mentors were experienced nurses recommended by their mentee. The NMP was developed with best mentoring practices provided by the Academy of Medical-Surgical Nurses. At the beginning of implementation, educational sessions were provided to participants to establish requirements of the program to include initiating goal contracts and professional development plans and documenting engagements. Engagement and professional development activities were monitored through data collection. Results: As a result of the program, 100% of dyads who engaged, completed a goal contract and professional development plan along with meeting at least one professional development goal. The program received 100% overall satisfaction for mentors, and 66% for mentees. Conclusion: Although small, all dyads achieved levels of satisfaction with the NMP and achieved a portion of professional development goals set. The NMP promoted a culture in the organization of support for professional development and career advancement among nurses.
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Implementation of Carbohydrate-Based Liquid Nutrition in LaborProblem and Purpose: At a large community hospital in the mid-Atlantic region, with over 2,400 deliveries yearly, all women were kept fasting during labor. This outdated practice can lead to increased stress, pain and dissatisfaction with the labor experience. The primary purpose of this quality improvement project was to implement an evidence-based policy for oral carbohydrate-based liquid nutrition in laboring women at low risk of operative delivery. Methods: An evidence-based tool was developed to assess risk of operative delivery. Women at low risk were cleared to receive a carbohydrate-based clear liquid diet. The unit personnel were educated on the new policy, assessment tool, and orders prior to implementation. Implementation tactics included staff specific policy verbal and email reminders. Inpatient charts were reviewed to track and evaluate the number of high and low risk patients, diet orders and frequency of high-risk characteristics. Data analysis included the use of descriptive statistics and a run chart with daily staff compliance rates. Results: A total of 235 women had vaginal deliveries (58% high-risk, 42% low risk) during the nine-week project implementation. Following staff education, diet order compliance rates in both high and low risk groups was 61%, increasing to 75% by the end of implementation. The initial compliance for low risk patients was only 38% following education but increased to 55% by the end of the implementation. In contrast, the compliance rate for high-risk women was 98% after education and 100% at the end of implementation. There were no recorded incidences of pulmonary aspiration or complications during implementation. Conclusion: This project was successful in implementing a policy and assessment tool for carbohydrate-based liquid nutrition for women in labor. Barriers to compliance included the additional step of adding the clear liquid diet order in the electronic medical record and disagreement with the high-risk characteristics in the assessment tool. Recommendations for continued success include adding the clear liquid diet order to the admission order set and adjusting the risk factors in the assessment tool to allow more women to be categorized as low risk of operative delivery and receive carbohydrate-based liquid nutrition.
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Preoperative and Intraoperative Interventions for Enhanced Recovery after Gynecological SurgeryProblem and Purpose: Surgery causes a neuroendocrine and inflammatory stress response on the body that impairs hemostasis (Carli, 2015). Often, many of the interventions implemented during the perioperative care of patients are not evidence-based but rather due to dogmatic traditions. Enhanced recovery after surgery (ERAS) programs consist of evidence-based interventions implemented during the preoperative, intraoperative, and postoperative phases of surgery. Researchers have found that ERAS programs lead to a reduction in hospital length of stay, cost, and complications (Nelson et. al., 2016). At a community hospital in the mid-Atlantic region, anesthesia providers sought ways in which hospital length of stay and complications can be reduced in patients undergoing GYN surgery. In addition, GYN surgery is one of the most frequent types of surgical procedures performed at this institution. The purpose of this quality improvement project was to develop a clinical practice guideline (CPG) regarding ERAS for GYN surgery in order to optimize the perioperative care of patients. Methods: An expert panel was formed consisting of the chief nurse anesthetist and anesthesiologist of the institution. A need for an ERAS CPG was established based on several meetings with key stakeholders. A literature review was conducted to develop the CPG and a draft was presented to the expert panel. Next, a Non-Human Subjects Research (NHSR) review was sought from the Institutional Review Board at the University of Maryland. The Agree II Tool was utilized by the expert panel to evaluate the quality of the CPG. Feedback from the expert panel was then incorporated into the final draft. The CPG was presented to the anesthesia providers of the institution. Practitioner Feedback Questionnaires (PFQs) were distributed and anonymously collected at the end of the presentation. A descriptive statistical analysis was performed utilizing Microsoft Excel with the data obtained from the AGREE II Tool and PFQ surveys. Results: The results of the AGREE II tool were favorable with an overall calculated total domain score of 92%. The individual total domain scores are as follows: scope and purpose 97.2%, stakeholder involvement 100%, rigour of development 87.5%, clarity of presentation 94%, applicability 92.9%, and editorial independence 89.6%. The return rate for the PFQ surveys was 100% (n=15). The PFQ survey results revealed that 100% of providers believed that there is a need for an ERAS CPG for GYN surgery, that its utilization will benefit patients, and that the draft guideline recommendations will be supported by other anesthesia providers of the institution. This is indicative of the usability and wide acceptance of the CPG by the facility. Conclusion: Due to the favorable results of the AGREE II Tool and PFQ survey evaluations, it is evident that the developed ERAS CPG is of high quality and its use will be accepted at this institution.
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Implementing Patient Triage Communication, Improving Nurse-Provider Communication and Promoting SafetyProblem & Purpose: Ineffective handoff communication is a critical patient safety problem resulting in delays in treatment and adverse events. At a large, hospital-based outpatient clinic of a large East Coast academic medical center, the lack of a standardized communication tool resulted in messages that were misunderstood or lacked valuable information. The purpose of this evidence-based quality improvement project was to facilitate nurse-provider communication through the implementation and evaluation of a patient triage communication tool based upon situation, background, assessment, recommendation (SBAR) methodology. Methods: This DNP project was guided by Lewin's Change Theory. A retrospective electronic health record (EHR) review demonstrated a lack of a structured communication method resulting in communication breakdowns. A literature review demonstrated that SBAR methodology creates a common language for nurse-provider communication. An adapted SBAR methodology communication tool was uploaded into the EMR. Over nine weeks, triage nurses and providers from trauma general surgery teams A, B, C, D, and ACES utilized the communication tool for every patient call. Weekly chart audits evaluated the median time at each point in communication and length of time to close the call encounter. Safety Attitude Questionnaire (SAQ) evaluated teamwork and safety climate pre-implementation and post-implementation. Results: Compliance with the standard communication tool ranged from 83% to 100% (average 95%). The reason for the lack of use in week one of implementation was electronic health record coding issues within the communication tool. Comparing data 1-month pre-implementation through 9 weeks of implementation: SAQ demonstrated the lack of teamwork remained steady at 60%, and communication breakdowns decreased from 70% to 40%; time cycling demonstrated: nurse to provider communication response mean decreased from 1.91 to 1, provider to nurse communication response mean decreased from 0.97 to 0.84 and nurse to patient communication response mean decreased from 1.05 to 0.86. The median length of time from the initial call to the encounter closure decreased from 245.5 (4.09 hours) to 155 (2.58 hours). Process cycling revealed that the triage process could not be standardized under the defined steps as it did not account for variability in nursing practice or quality of the voice messaging system. Conclusions: The standardization of triage documentation impacted the time from the initial call to encounter closure as well as the number of responses between nurses and providers. While the time benchmark of 120 minutes (2 hours) was not met, the improved response times have led to leadership support for sustainability and spread to the remaining four trauma specialty surgery teams.
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Utilization of Written Asthma Action Plan In a Pediatric Primary Care SettingProblem: Asthma is a common and potentially serious chronic disease that affects over 20 million adults and 6 million children in the United States. Pediatric standard of care supports providing an asthma action plan to asthma patients/families. The use of asthma action plans (AAP) has been associated with improved asthma patient outcomes. Studies have shown poor utilization of AAP by healthcare providers for promoting self-management and self-efficacy. Purpose: The purpose of this DNP quality improvement project was to implement and evaluate the use of personalized written asthma action plans by healthcare providers in a pediatric primary care setting. Methods: The project was implemented over a 13-week period beginning in September of 2019. Participants were existing and newly diagnosed asthma patients less than or equal to 21years old who were receiving care for sick visits or annual physical examination. The conceptual framework of the project was based on Kurt Lewin’s change theory. In addition, a 4-hour education and training on asthma and the importance of the AAP was given to the healthcare providers (a physician and nurse practitioner), the office manager, and supporting members of staff. Healthcare providers and medical assistants were equally trained on how to complete an asthma action plan. The change process included the use of a colored paper asthma action plan and medical assistants provided the AAP sheet with a completed demographic section of the tool before the medical provider completed the other sections. Results: During the implementation period, data were collected on the number of AAP’s completed by the healthcare providers. This information was aggregated through a chart audit of de-identified copies of completed AAP’s. Run charts were used for data analysis. The clinic achieved 90% of AAP utilization rate, which surpassed the 60% goal of the project. Conclusion: The implementation and utilization of a written asthma action plan and in-service training in a pediatric outpatient setting improves patient accessibility to a treatment plan by primary care healthcare providers. The use of an evidence-based AAP can enhance patient management of asthma by giving patients and caregivers a roadmap to asthma care.
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Prophylactic Sacral Dressings and Skin Assessments in Acute Care Emergency Surgery PatientsProblem & Purpose Statement: Hospital acquired pressure injuries (HAPIs) are a growing issue within the healthcare system. On average, 2.5 million people in the United States develop a HAPI. Annually, approximately $26.8 billion dollars is spent on treating HAPIs in the United States alone. Consequences of HAPIs include increased length of stay, decreased quality of life, increased morbidity and mortality, and decreased hospital reimbursement. The purpose of this quality improvement (QI) project is to decreased the incidence of HAPIs, in Acute Care Emergency Surgery (ACES) patients with Braden scores less than or equal to fourteen in the Surgical Intensive Care Unit (SICU) through the implementation of a prophylactic sacral dressing and nurse practitioner (NP) and registered nurse (RN) skin assessments. Methods: The QI project took place over a ten-week period, from September 2, 2019 to November 10, 2019 and was implemented in three phases. Phase I included identification of unit skin champions and education pertaining to the Braden Scale and preventing HAPIs. Phase II included the implementation of a prophylactic sacral dressing and NP & RN skin assessments. Phase III included data collection and analysis. In order to help with implementation, Lewin’s theory of planned change was utilized. Results: Prior to implementation, there was a total of six HAPIs, with Braden scores ranging from eight to fourteen, with an average of twelve. Post implementation, there were a total of zero HAPIs, with Braden scores ranging from ten to fourteen, with an average of thirteen. 96% (n=61) of ACES patients who met criteria had a prophylactic sacral dressing applied. 100% of ACES patients who met criteria had a skin assessment completed and documented by RNs, while 35% (n=22) of ACES patients who met criteria had a skin assessment completed and documented by ACES NPs. Data collection form compliance was 44% (n=35). Conclusion: Compliance rates among RNs and NPs varied in respect to the documentation, and completion of the data collection form. RNs had a higher compliance rate associated with skin assessment documentation in the electronic health record compared to NPs. There was a decrease in the incidence of HAPIs after implementation of a prophylactic sacral dressing and RN/NP skin assessments.
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Implementation of Mindfulness with Emergency Nurse Practitioners to Decrease BurnoutProblem & Purpose: The emergency department is challenging due to its fast-paced and highly stressful environment. Nurse Practitioners (NPs) are at risk for increased stress and decreased well-being leading to burnout. This quality improvement project aim was to teach nurse practitioners the skill of mindfulness, specifically guided sitting meditation. With effective intervention, it is expected that the skill of mindfulness can directly impact stress and well-being with the goal of decreasing burnout amongst the group. The Maslach Burnout Inventory (MBI) tool was used to identify burnout. Methods: This quality improvement project involves nurse practitioners that work in an urban emergency department in the Mid-Atlantic region. NPs were invited to four mindfulness sessions over a 12 week period focused on guided sitting meditation. The MBI pretest was administered to the NPs at the start of the mindfulness session and then they had access to a self-guided sitting meditation via electronic file after each session. The NPs were encouraged to practice the guided sitting meditation for 10 minutes a day for at least 5 days a week independently and report weekly the frequency of use. Results: Brief mindfulness, specifically guided sitting meditation can impact burnout, Twenty-one NPs participated in four mindfulness sessions completing the MBI both pre and post sessions. Means scores for Emotional Exhaustion (EE) showed a positive trend going from 25.1 to 22.9 (p=0.27) Depersonalization (DP) also showing a positive trend declining from 9.9 to 9.3 (p= 0.70) However, neither was statistically significant.
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Implementation of a Behavioral Pain Scale for Traumatic Brain Injured PatientsProblem & Purpose: Each year, 1.7 million Americans suffer traumatic brain injuries (TBI) with many patients requiring intensive care, resulting in increased pain due to aggressive treatments, frequent neurological exams, and invasive procedures. Patients with TBIs present with atypical pain behaviors (PB) and decreased levels of consciousness that impede effective pain assessments, leading to inadequate pain management and poor outcomes. Pre- and postadministration pain score documentation compliance of a neurotrauma critical care unit (CCU) were below organizational benchmarks, averaging 75% and 56% respectively. Additionally, anecdotal reports from nurses found dissatisfaction with the organization’s current pain scales. Methods: A nurse-driven team, entitled the “Brain Pain Squad,” led a quality improvement (QI) project to implement the Behavioral Pain Scale (BPS) for noncommunicative, critically ill adult patients with TBIs who were mechanically ventilated (MV). Staff education was provided in small groups with hands-on application of the scale. Handouts as well as promotional signage were readily available on the unit. Presentations during staff meetings and weekly email reminders called, “Brain Pain Project Pearls” enhanced education and provided updates. Periodic rewards and recognition events increased staff support throughout operationalization. Data collection included weekly compliance rates of pre- and post-administration pain score documentation as well BPS usage. Usability testing via electronic staff survey occurred following a nine-week implementation period. Results: Staff readily adopted the BPS with an average compliance of 92.04%. Preadministration compliance improved by 4.57% whereas post-administration compliance declined by 6.46%. The overall usability score of the BPS was 86, equating to excellent usability. Conclusion: A nurse-driven team and formal education plan led to the successful implementation of the BPS with minor improvements in pre-administration pain score compliance and a decline in post-administration pain score compliance. Variations in compliance may be due to discrepancies between organizational policy, clinical practice, and data collection methods. Policy changes, additional education, and better functionality of the electronic health record (EHR) may increase compliance further. Critical care units who care for the neurologically impaired should consider instituting the BPS and future QI efforts should focus on the implementation of the BPS for noncommunicative TBI patients who are not intubated.
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Standardized Telephone Follow-Up Calls for New Ventricular Assist Device PatientsProblem & Purpose: The transition from hospital to home is a vulnerable period that poses significant challenges for complex patient populations such as those with ventricular assist devices (VADs). At the organization of interest, approximately 40% of VAD patients were readmitted within 30 days following their implant hospitalization which exceeded the national readmission rate. Many readmissions are preventable if effective discharge planning and timely follow-up occurs. The purpose of this project was to develop and implement a standardized telephone follow-up (TFU) script based on recommendations from the American Heart Association (AHA) and the Agency for Healthcare Research and Quality (AHRQ) to ensure new VAD patients were receiving discharge follow-up calls that addressed their unique post-discharge needs. Methods: The TFU script included questions about symptoms of heart failure, device alarms, follow-up appointments, medications, home health care, and dressing supplies and contained instructions for the caller based on patient responses. Unit nursing staff were educated on the use of the script and asked to make calls between 48-72 hours after discharge. Weekly discussions were held to facilitate the change in practice. The project tracked compliance with the TFU script and descriptive data were analyzed to measure the impact of the standardized call. Results: Over the 12-week implementation period, 7 of 7 eligible patients received a follow-up call for a 100% compliance rate. The overall script completion rate was 96%. The average time of call after discharge was 91 hours. Two patients (33%) did not have follow-up appointments and were transferred to the scheduling line. One patient (17%) did not receive medications on discharge, and five patients (83%) required additional transitional care coordination communicated to the VAD coordinator or heart failure nurse practitioner. An 8th patient was readmitted within 24 hours of discharge and could not receive a call. Conclusion: The use of a standardized TFU script can be successfully implemented by RN staff to help identify critical post-discharge needs and ensure compliance with recommended timely follow-up. Follow-up calls should address the specific needs of complex patient populations to facilitate successful transitions of care and reduce preventable readmissions.
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The Evidence Integration Triangle for Management of Behavioral Psychological Symptoms of DementiaProblem and Purpose Behavioral Psychological Symptoms of Dementia (BPSD) are described as symptoms of apathy, agitation, inappropriate vocalization, aggression, wandering, and resistance to care. Incorrectly managing BPSD can lead to the improper administration of psychotropic medications, which can negatively impact the health and quality of life for residents with dementia. The purpose of this quality improvement project was to implement the Evidence Integration Triangle for Management of Behavioral Psychological Symptoms of Dementia (EIT-4-BPSD) in a nursing home. The Evidence Integration Triangle is a four-step implementation framework that includes participatory implementation processes, provision of practical, evidence-based interventions, and pragmatic measures of progress towards goals. Methods The EIT-4-BPSD was implemented over a ten-week period. The four steps included: Step 1: Assessment of the environment and policies; Step 2: Education of staff; Step 3: Establishing person-centered care plans; and Step 4: Mentoring and motivating staff. Outcomes were evaluated pre and post-implementation. Resident outcomes were obtained from the Minimum Data Set National Database and included: use of psychotropic medications and falls. Staff outcomes included knowledge of person-centered behavioral approaches for BPSD based on a 10-item multiple-choice test. Facility outcomes included evaluation of a random sample of five de-identified care plans to evaluate for evidence of incorporation of person-centered approaches to managing BPSD. Results Patient outcomes revealed a 12.5% decrease in the administration of psychotropic medications and a 5.6% decrease in falls. Nurse’s post-test knowledge of person-centered management of BPSD increased from 63.5% to 70% post-implementation. Evidence of established personcentered care plans increased from 40% at baseline to 90% post-implementation. Conclusion The EIT-4-BPSD intervention was practical to implement and provided the staff with information and resources to help integrate person-centered behavioral approaches into care plans and routine clinical care. Ongoing work by the nurse champion is needed to continue to maintain the focus on the use of person-centered behavioral approaches.
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Post-Operative Urinary Tract Infection Reduction: Discharge Bundle Implementation in Outpatient Urogynecology PatientsIntroduction/Background: Post-operative urinary tract infections (UTIs) are a common, costly and potentially serious postsurgical complication amongst urogynecology patients undergoing surgical pelvic procedures. A Maryland hospital’s urogynecology program had post-operative UTI incidence rates above the American College of Surgeons quality improvement program’s nationally desired metric (NSQIP), and previous interventions proved ineffective. Aims: The purpose of this project was to incorporate a standardized, evidence-based discharge care bundle, aimed at reducing UTI rates by at least 50% in post-surgical urogynecology patients. The intervention was a discharge care bundle which included non-prescription, pharmacologic supplements (cranberry & probiotic supplements) taken by patients for 30 days post-operatively. Methods: Patients who had surgical procedures during the months of October 2019 through December 2019, received education and after surgical care instructions encouraging intake of a standard 30 day supply of cranberry tablets and lactobacillus acidophilus chewable wafers, along with instructions for 32 ounces of daily water intake for 30 days post-operatively. Patient follow up at 2, 4 and 6 weeks, assessed for compliance and UTI symptom development. Baseline UTI data was then compared to post intervention data. Results: NSQIP UTI rates for the 3-months, post-bundle implementation, were favorable at 0%. Following bundle implementation, the NSQIP UTI rate for the urogynecology cohort remained below the expected rate of <4%, and dropped 6% from the clinic’s 3-month pre-implementation rate. There was only one documented UTI for all patients who opted to take the recommended supplements, compared to eight documented UTIs for patients who did not opt to take the recommended supplements. High compliance rates among those who followed the discharge bundle recommendations were also noted. Conclusions: A decrease in UTI rates was seen after implementation of an evidence based UTI discharge bundle within a selected urogynecology cohort. This intervention demonstrates the potential for effective use of supplements to avoid post-operative UTIs for patients undergoing urogynecology procedures.
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Prescription Medication Adherence among Socioeconomically Diverse Black MenAbstract Background: Non-adherence to prescription medications may at least partially explain high rates of morbidity and mortality from chronic illness among Black men. Black men from lower socioeconomic backgrounds have previously been identified as low adherers but little is known about Black men with adequate incomes and access to healthcare resources. The Ecological Model is used as a framework to examine barriers and facilitators of medication adherence among Black men. Purpose: The purpose of this study is to estimate the prevalence and identify barriers and facilitators to medication adherence among a socioeconomically diverse group of Black men with a range of chronic illnesses. Methods: A cross-sectional study using a 105 item anonymous survey questionnaire was conducted. A convenience sample of 276 Black men (age 35-75 years) was recruited from 15 churches in Baltimore City, and Baltimore, Montgomery and Prince George’s counties. Mann-Whitney U, Kruskall-Wallis and Chi-square analysis were used to examine group differences and multinomial logistic regression provided odds ratio estimates of the association between various factors and low (reference), medium and high medication adherence. Results: Half the sample (49%) were low adherers. Socioeconomic differences in medication adherence were identified by homeownership (X2 = 6.327, p = .042). No statistically significant differences were found for education, employment, income and health insurance coverage. Personal and interpersonal factors found to be associated with medium adherence were coping (AOR=.91, 95% CI=.84-.99), self-efficacy (AOR=6.74, 95% CI=2.79-16.27), income – (low - AOR=10.94, 95% CI=2.42-49.51, middle –AOR=3.34, 95% CI=1.38-8.10), marriage or having a significant other (AOR=5.40, 95% CI=1.83-15.92) and homeownership (AOR=3.37, 95% CI=1.04-10.92). Personal and interpersonal factors found to be associated with high adherence were self-efficacy (AOR=6.63, 95% CI=1.89-23.27), homeownership (AOR=9.32, 95% CI=1.41-61.60), income (low - AOR=8.55, 95% CI=1.31-55.68) and not sharing information with others (AOR=2.89, 95% CI=1.17-7.13). No associations were identified for community, organizational or government/policy level factors. Conclusions: Higher self-efficacy, homeownership and marital status were facilitators and higher coping, higher income and some forms of social support were barriers to medication adherence. This study illuminates opportunities for improving prescription medication education and implementing practice innovations to increase rates of adherence among Black men across the socioeconomic spectrum.
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Participation and Effectiveness of Worksite Health Promotion ProgramBackground: Worksite Health Promotion Programs (WHPPs) are limited by low participation and engagement. However, little is known about what factors influence participation and the relationship between participation and changes in body weight and composition. Mobile health technology (mHealth) may facilitate participation and engagement in WHPPs as mhealth is not limited by time or location, which are known barriers to participation and engagement. Yet, few studies have examined the use and effectiveness of WHPPs using mHealth interventions that aimed to change body weight and composition. Purpose: To explore the features and effectiveness of WHPPs in previous studies that used mHealth interventions. To identify factors influencing participation and engagement in a WHPP and the relationship between participation and changes in body weight and composition. Methods: A systematic literature review was conducted to explore features of WHPPs using mHealth that aimed to change body weight and composition. A secondary data analysis was conducted using data obtained from participants in the intervention group of a WHPP to identify: 1) factors that influence participation and engagement and 2) the relationship between participation and body weight and composition changes. Results: From the systematic review, 10 out of 12 WHPP studies using mHealth significantly improved body weight and composition. The most commonly used mHealth interventions were providing information, goal setting, and data entry. Based on the secondary data analysis, low levels of stress, anxiety, or high job satisfaction were significantly related to high participation in a WHPP. Significant relationships between participation and body weight and composition changes were not found due to a small sample size. However, this study found that those who reduced five pounds of body weight at six months among overweight or obese participants showed high participation in physical activity and/or diet components of a WHPP. Conclusions: WHPPs using mHealth can significantly improve body weight and composition. Employees’ psychological factors should be considered to increase participation in WHPPs. Further studies with larger sample size are needed to identify the relationship between participation and changes in body weight or body composition.
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Psychosocial Care Needs of Children with Cancer and Their Families: Perceptions and Experiences of Omani Oncologists and NursesBackground: Much evidence demonstrates the psychosocial impact of childhood cancer on children and their families. While many health care systems are evolving to integrate psychosocial services into clinical care, barriers exist that must be understood before changes can be implemented in systems new to this care. Oncologists and nurses are on the front lines of care and have unique perspectives about the needs of their patients and families. Objectives: The purposes of this study were: 1) describe the experiences and perceptions of pediatric oncology physicians and nurses in Oman regarding the psychosocial care needs of children with cancer and their families; and 2) describe the barriers and facilitators to providing psychosocial care. Methods: A qualitative, phenomenological study was conducted. Purposive sampling strategy was used to recruit 26 oncologists and nurses with experience caring for children with cancer and their families. Individual, semi-structured interviews were conducted and recorded. Colaizzi's method of data analysis was utilized to inductively determine themes, clusters, and categories. Data saturation was achieved, and methodical rigor was established. Result: Four themes emerged from the data. The first was “perceived need for care beyond medicine.” The oncologists and nurses recognized that more psychosocial assessment, care, and services were needed. The second theme was “recognition of pediatric oncology as a challenging clinical practice area,” which had two subthemes: emotional burden and challenging situations. Participants described the challenges they faced trying to meet the needs of children and extended families. The third theme was “barriers to providing effective psychosocial care,” which had three subthemes: barriers related to the health care system, barriers related to health care providers, and barriers related to infrastructure and environment. The fourth theme was “providing optimal supportive care within the available facilities,” which had two subthemes: supportive care and facilitating factors. Cultural and community factors were highlighted. Conclusion: As the pediatric oncology services in Oman mature, clinicians are eager to develop the psychosocial assessments and needed services. Future research is needed to elicit the perspectives of Omani children with cancer and their families. Resources will be needed from higher authorities to design, implement, and evaluate the recommended changes.
