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Background:Central venous catheters (CVCs) support the administration of chemotherapy and other medications, blood products, fluids, and nutrient infusions, and reduce the need for peripheral blood sampling in children with cancer. CVC use is also associated with the risk of central-line-associated bloodstream infection (CLABSI). Despite the implementation of CLABSI care bundles, CLABSI prevention remains challenging. Method:This project implemented supportive preventive care interventions to decrease CLABSI in pediatric hematology/oncology patients in a tertiary hospital in the Middle East region. Interventions included bathing or skin care once daily, oral care twice daily, and ambulating patients three times daily. Parent and staff education materials were developed. The project moniker was Step 1-2-3, inspired by successful implementations of such measures in a U.S. cohort showing reduced CLABSI rates. The project used a mixed methods approach. We report outcomes through August 2022. Results:Pre-project (12/2019–05/2020) five CLABSIs occurred in the inpatient unit. Following the implementation of Step 1-2-3, Pediatric Oncology achieved 492 CLABSI-free days. Six CLABSIs then occurred over a short period of time between October 2021 and January 2022, which was associated with high levels of patient acuity and staff sick leave. The inpatient ward remained CLABSI-free from January 9, 2022, through August 2022. Discussion:Extended periods of CLABSI-free care in a pediatric hematology/oncology unit are achievable. A variety of factors contribute to the sustainability of being CLABSI-free. Data collection and analysis are important factors which aided in our understanding of our own CLABSI events.

Background:Education for parents and caregivers of children with cancer is one of the fundamental roles of nurses to avoid complications, provide quality care, promote adherence to treatment and maintain basic standards of care. This study aimed to design educational material for parents and caregivers of children with cancer in Peru on general information about childhood cancer and its care. Method:Within the framework of the WHO Global Initiative for Childhood Cancer in Peru, a multicenter working group was convened by the Peruvian Ministry of Health. A comprehensive needs assessment of parents and caregivers of children with cancer was performed through a survey in June and July 2020. The survey was conducted online (via Google Forms) and in person at nine hospitals to examine the preferred method of delivery and content of information. Results:Based on the findings from the parent needs assessment, a national nursing working group developed Spanish-language audiovisual materials (i.e., diagnosis and treatment videos for nurses to educate parents and caregivers). A total of 365 parents and caregivers were included. Most respondents (56.9%) were parents of children receiving treatment. Main topics were childhood cancer overview and side effects (85%), food and nutrition (75%), and palliative care (67%); most (70.9%) preferred information through talks and videos (64.7%). Twenty-three videos were developed with support by the Pan American Health Organization and the Ministry of Health. Discussion:Assessing the educational needs of parents and caregivers of children with cancer provides a starting point in the design of targeted strategies.

Background:The aim of this study was to explore the efficacy, safety, and pain level of granulocyte colony-stimulating factor (G-CSF) administration via a subcutaneous catheter compared with direct injection in children with cancer. Method:This was a pilot randomized controlled trial of standard G-CSF administration versus subcutaneous catheter administration. Children 2–15 years of age who were beginning G-CSF after their first chemotherapy cycle and anticipated to receive G-CSF following the next three cycles of chemotherapy were eligible. Efficacy, safety, and pain were as outcomes of the study. Results:Twenty-nine children with cancer (median age 12 years) were enrolled in the study (16 children in the subcutaneous catheter group and 13 children in the direct injection group). During Cycle 2, the median number of days to reach absolute neutrophil count (ANC) ≥ 500/mm3was greater among those in the subcutaneous catheter group (12 vs. 10; p=  .02). In Cycle 3, however, the subcutaneous catheter group received fewer doses of G-CSF (8 vs. 12; p=  .004). No complications related to subcutaneous catheter use were observed. No differences in the visual analog scale pain score were observed between groups in Cycles 1 to 3; however, in Cycle 4, children in the subcutaneous catheter group had lower median pain scores than those in the direct subcutaneous injection group (Mdn=  0, [IQR]  =  0–2 vs. Mdn=  1, IQR  =  0–6; p< 0.01). Conclusion:Results demonstrated administering G-CSF via a subcutaneous catheter enables ANC to recover with no pain or complications associated with its use. Thus, oncology teams may consider this administration method to be used in children with cancer.

The pediatric oncology unit at the Rajiv Gandhi Cancer Institute and Research Center (RGCI & RC), a nonprofit medical facility and research institute based in Delhi, India, sought to improve clinical nursing practice through nurse leadership training supported by international nursing mentorship. A nursing team leadership program with a goal to strengthen practice was designed in collaboration with the RGCI & RC nurse education department and pediatric oncology physicians on the unit. Two expert oncology nurses from the United States made multiple visits from 2017 to 2019 to support the development of the leadership program and the resulting practice changes. Specific areas of nursing addressed through these efforts included attention to education, practice, and leadership. Selected processes were improved by the following: (a) development of a pediatric oncology nursing orientation program to follow general onboarding by the nursing education department, (b) strengthening and updating standard operating procedures for nursing, and (c) development of a nursing Team Leads program. Four team leads completed training, and staff nurses are now active members in the care of patients and opining themselves when decision-making occurs during rounds. RGCI & RC nurses have written abstracts and posters accepted at national and international conferences, which further strengthens their profile in the larger pediatric oncology professional community.

Background:Online healthcare information is often used by pediatric oncology nurse educators in low- and middle-income countries (LMICs) for teaching clinical nurses as part of their initial orientation or continuing education. Access to peer-reviewed nursing journals via paid subscriptions or sub-specialty nursing textbooks in these settings is rare. This project identified and evaluated websites appropriate for pediatric oncology nurse educators in LMICs for teaching staff nurses, and for clinical staff nurses engaging in self-directed learning. Method:A strategic Google search for childhood cancer websites and an appropriate scoring tool was conducted. The Currency, Relevance, Authority, Accuracy, and Purpose Test, along with a previously published scoring rubric that was further adapted by the authors for pediatric oncology were used. Pediatric content, language options, and reading levels were appraised. Results:Of 86 identified websites, 51 met the inclusion criteria for evaluation. Websites were classified as highly recommended (n= 36), recommended (n= 12), or not recommended (n= 3) based on scores (range 14–30; maximum possible score = 30). Half offered content in multiple languages. Most websites were 9–10th-grade reading level. Discussion:Childhood cancer information appropriate for clinical nurse orientation and self-directed learning by LMIC nurses is available on free websites. Some information (diagnosis, chemotherapy, psychosocial support) is repeated across websites, while some is lacking (pediatric cancer genetics and health equity disparities). Reading levels are higher than recommended for health literacy. The reviewed websites were rarely peer-reviewed, inconsistently updated, and generally self-regulated. However, 48 websites on childhood cancer were deemed appropriate pediatric oncology clinical nursing education resources.

Background:Mapping out actual supportive care needs assists nurses in providing holistic individualized care. This study aimed to explore the care needs of parents of children with cancer in the Philippines. Method:Guided by the Supportive Care Needs Framework (SCNF), this study used an embedded mixed-method design with the quantitative revised Cancer Patient Needs Questionnaire and qualitative semistructured interviews to describe parents’ care needs and priorities. Results:Filipino parents (N= 156) of children with cancer have various care needs which could be classified along the SCNF categories—practical, informational, spiritual, physical, emotional, and physical needs as ranked from highest to lowest. A number of variables were significantly associated with care needs. Solid tumor diagnosis was associated with greater practical, emotional, and psychosocial care needs; having a child who had undergone surgery was associated with more practical and spiritual care needs; and being within one year of the child's diagnosis was associated with practical, psychosocial, and spiritual care needs. Parent priority needs included (a) addressing financial needs; (b) access to temporary housing to minimize treatment-related costs; (c) support groups among parents of children with cancer as a source of information; (d) financial and social support between members of family and partners of parents of children with cancer; and (e) using prayer to facilitate acceptance. Conclusions:Supportive care needs of parents of children with cancer are important components of care that should be given recognition to enhance holistic individualized care throughout the childhood cancer experience.

Background:The severity of the psychological impact on parents of children with cancer, often depressive symptoms due to mild-to-severe stress, is well documented. The causes are primarily related to their child's cancer diagnosis and treatment, side effects, lack of social support, missing information about their child's disease, and understanding of how to care for their child during treatment. This study assessed predictors of depressive symptoms among parents of children with cancer in one hospital in Ethiopia. Method:The institution-based, cross-sectional design was employed. Parents (n= 126) whose child was admitted at Jimma University Medical Center between February 25 and April 25, 2020, and met inclusion criteria were invited to participate. Results:Questionnaires from 122 parents of children with cancer were included (four had missing data). The prevalence of depressive symptoms was 60.7%. Multivariate regression analysis revealed gender (B= 1.207, p= .033) and higher levels of education (B= 1.019, p< .001) were associated with depressive symptoms in mothers. Receiving information about the child's treatment, however, was negatively associated with depressive symptoms (B= −1.490, p= .031). Monthly income and contact with religious leaders were not significant predictors. Discussion:Mothers of children hospitalized for initial cancer treatment in Jimma, Ethiopia, are at risk for depressive symptoms. It is possible that mothers with higher education are in occupations demanding their time, not allowing them to fulfill responsibilities felt to be essential in the child's treatment journey. Information on the child's treatment nurses have an important role in identifying depressive symptoms in parents but require training to do so.

Background:Cancer is a significant health problem in Turkey with pediatric cancer being the fourth leading cause of death among children. Pediatric oncology has been acknowledged as a pediatric subspecialty since 1983, and 3,000 new cases of childhood cancer are expected every year. Method:We describe our country's geography, the number and distribution of pediatric oncology centers, the profile of clinical and academic nurses, and our clinical practice. We present two nurse-led research projects. Results:Although nursing practice differs according to centers, treatment and care are usually evidence-based, especially in university and public hospitals in big cities. Nurses with an undergraduate education work in pediatric oncology units; however, few nurses with graduate degrees work in clinical settings. The Turkish Oncology Nurses Association supports the development and implementation of guidelines for evidence-based nursing care. Nurses’ clinical responsibilities include patient admission to the clinic, patient and family education, care coordination, patient care, symptom management, palliative, and intensive care services. Results of two recent nurse-led studies highlight challenges to meet the needs of patients and families from surrounding countries, including refugees, and opportunities for nurses to provide holistic support to parents of hospitalized children. Discussion:Increasing the number of nurses is a priority to improve pediatric oncology nursing care. Actions to advance pediatric oncology nursing include developing advanced clinical roles for nurses with graduate degrees; supporting nurses caring for children and families from outside Turkey, including language support services; and resources to conduct national and international studies related to professional and holistic care delivery.