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Family-Centered Pediatric Radiation The rapy: A Nurse-Led Quality Improvement Collaboration Model
| Content Provider | Semantic Scholar |
|---|---|
| Author | Austin, Elizabeth A. |
| Copyright Year | 2015 |
| Abstract | Problem: Parents of children diagnosed with cancer face a number of physical, emotional, and social hurdles in the race for a cure. Family schedules shift dramatically to accommodate daily radiation therapy treatment appointments. Ambulatory procedure unit nursing staff attempt to teach and interpret the process without the benefit of a family-centered intradepartmental structured communication process to promote safe care with these families. Methods: Implementation of a structured family-centered interprofessional standard work model to promote interdepartmental collaboration. The project implemented a structured familycentered interview and standard work algorithms to improve the radiation therapy family experience. Results: A structured, streamlined, interdepartmental interview, teaching format, and educational resources for nurses to use with families. Standardized work roles were formulated to improve the communication algorithm and collaboration between departments. Conclusion: The implementation of a nurse-led, standardized work process increased interprofessional collaboration, resulting in increased communication and a family-centered perioperative care model. FAMILY-CENTERED THERAPY 7 TABLE OF CONTENTS Page ABSTRACT....................................................................................6 CHAPTER 1: INTRODUCTION Theoretical Framework.......................................................................11 CHAPTER 2: LITERATURE REVIEW Evidence for the Study......................................................................16 CHAPTER 3: METHODS Structured Interview...........................................................................20 Coordination of Key Personnel.............................................................22 Sampling Method..............................................................................25 Review of the Interdepartmental Process...................................................25 Data Collection.................................................................................26 Evaluation of Data.............................................................................26 Validity and Reliability.......................................................................27 Potential Challenges...........................................................................27 CHAPTER 4: RESULTS AND DISCUSSION Data Collection................................................................................29 Population......................................................................................30 Data Analysis..................................................................................30 Role and Workflow............................................................................32 Project Challenges.............................................................................34 CHAPTER 5: CONCLUSION..................................................................37 References ...................................................................................39 Appendices.....................................................................................46 Appendix A: LITERATURE REVIEW...................................................46 Appendix B: PARENT INTERVIEW FORM............................................47 Appendix C: ANXIETY INVENTORY...................................................53 Appendix D: PARENT INFORMATION SHEET.......................................54 Appendix E: STANDARD ROLES.........................................................56 FAMILY-CENTERED THERAPY 8 Appendix F: STANDARD WORK FOR PEDIATRIC RADIATION THERAPY TEAM................................61 Appendix G: PROPOSED POLICY........................................................66 Appendix H: RADIATION THERAPY CHECK-OFF SHEET FOR PACKARD FLOOR/UNIT NURSES.....................67 Appendix I: PATIENT BROCHURE WITH ANESTHESIA...........................68 Appendix J: PATIENT BROCHURE WITHOUT ANESTHESIA.....................70 Appendix K: FAMILY FEEDBACK QUESTIONNAIRE..............................72 Appendix L: FAMILY FEEDBACK QUESTIONNAIRE RESULTS...................73 Appendix M: FAMILY INTERVIEW DATA...............................................74 Appendix N: RADIATION THERAPY BINDER CHECK-OFF SHEET............76 FAMILY-CENTERED THERAPY 9 Family-Centered Pediatric Radiation Therapy: A Nurse-Led Quality Improvement Collaboration Model Parents and children state that they need more support, information, and engagement with the healthcare team to maintain overall health during complicated cancer treatment schedules (CLIC Sargent, 2013). Multiple studies conclude that parents and children identify respectful and relational communication with providers as increasing satisfaction with their experience (Hsiao, Evan, & Zeltzer, 2007; Milton, 2007; Siddiqui, Sheikh, & Kamel, 2011). The communication process between parents of radiation oncology therapy children and the hospital staff nurses is an interpersonal relationship that can include a great deal of uncertainty. This project examines the nurse’s role in communicating with these parents in a family centered manner, increasing parental knowledge, and reducing their anxiety about the radiation therapy schedule. The ultimate goal of this project is to formulate a collaboration model for an interdepartmental family-centered communication policy/structure. Cancer is the second leading cause of death in children, second only to accidents (American Cancer Society, 2014; Hoyert & Xu. 2012). Family life disruptions include long treatment plans, multiple surgical procedures, isolation from the general public due to immune suppression, and disconnected communication processes between many hospital departments (Costelloa, Patakb, & Pritchard, 2010). These families experience additional stress with daily hospital visits, native language differences, and fear of their child’s possible reactions to the treatments (Tomlinson, Peden-McAlpine, & Sherman, 2012). The emotional impact of the process and treatment options for the parents can be overwhelming (Franck, Winter, & Oulton, 2007). The parents receive an enormous amount of information in a short amount of time (surgery, scans, chemotherapy, and the radiation therapy plan) and are expected to make the best FAMILY-CENTERED THERAPY 10 decisions for their child (Coulson & Greenwood, 2012; Elder, Ymaokoski, Wittman, & Kodish, 2007; Franck, Winter, & Oulton, 2007). The team communication process can impact parental anxiety with the healthcare experience. Sixty-six per cent of medical errors are due to ineffective interprofessional communication (Institutes of Medicine, 2003). The current decision-making process for the radiation therapy treatment team is an uncoordinated effort (Figure 1). Hospital nursing staff attempt to deliver family centered information and teaching without a standardized interdepartmental policy. The parents and staff verbalize a lack of a comprehensive family centered orientation about radiation therapy to optimize the coordination of care throughout the month-long treatment cycle. The Joint Commission (2010) explains that family centered communication is an essential component of safe, quality patient care. Standard work is a process-improvement technique for analyzing work place activities for areas that could be streamlined by reducing waste and increasing value for the customer (Hintzen, Knoer, Van Dyke, & Milavitz, 2009; Lean Enterprises Institute, 2014). This method was adopted from the airline industry and the Toyota Motor Company that both emphasize improving workflow productivity through process improvement, problem solving, and teamwork (Liker, 2004). The goal of implementing this quality improvement initiative is to eliminate low value activities and adopt work patterns that improve accountability and efficiency (Hintzen, Knoer, Van Dyke, & Milavitz, 2009). The pediatric hospital adopted this approach to workflow analysis and is recognized as a national leader for implementing this approach (Hullinger, 2014). The application of the principles of standard work should increase teamwork through the analysis of the collaborative processes involved with the radiation therapy treatment schedule. This quality improvement project focus is a nurse-led standardized collaboration model for a family-centered pediatric radiation therapy process. FAMILY-CENTERED THERAPY 11 Theoretical Framework Austin Babrow and colleagues developed the Problematic Integration Theory (PI) in 1992 after frustration over finding a theoretical framework that encompassed situations that are uncertain, how people handle these situations, and the role of communication within this dynamic (Baxter, & Braithwaite, 2008). Babrow identifies the social, psychological, emotional, and knowledge factors involved with an experience of uncertainty as a human state during certain situations (Babrow, 2007) and the role of communication (Baxter, 2009). Peplau’s practice-based theory analyzes the beneficial and detrimental components of interaction during the nurse-client interaction (Peden, 2006). She proposed that the interaction between the patient and the nurse followed a four-step sequence (Nelson, 2010). Peplau formulated her interpersonal theory influenced by humanistic psychologists, developmental psychology, and interpersonal psychiatrists (Nelson, 2010). Type Peplau’s interpersonal relationship theory identifies four phases of the therapeutic nursepatient relationship that includes orientation, identification, working, and resolution (Nelson, 2010). Babrow’s problem integration theory is a communication theory used with numerous health care situations. This theory addresses the interactions between participants in situations that include uncertain components, such as participant roles, outcome, and expectations (Babrow, 2007). The themes of Problematic Integration are reducing uncertainty, and thus |
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| Alternate Webpage(s) | http://scholarworks.sjsu.edu/cgi/viewcontent.cgi?article=1000&context=etd_doctoral |
| Alternate Webpage(s) | https://scholarworks.sjsu.edu/cgi/viewcontent.cgi?article=1000&context=etd_doctoral&httpsredir=1&referer= |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
