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Background: Suboptimal medicines management due to inadequate knowledge can cause risks to patient safety and affect the quality of care and patient outcomes., Aim: To examine the effect of an educational programme on nurses' knowledge of medicines management., Method: A pre and post-design was used to evaluate the effectiveness of an educational medicines management programme. Data were collected from nurses before and after programme participation from September 2016 to June 2018. A total of 99 nurses received a multiple-choice questionnaire before and after the programme to assess for changes in their knowledge. Any changes in test performance following the medicines management programme were quantified and tested using McNemar's test and the generalised estimating equation for binary outcomes. The Chi-square test was used to analyse group differences., Results: The nurses' scores were significantly improved after the medicines management programme on questions regarding documentation, observation, aseptic technique and pharmacology half-life. There was a significant improvement on one of the five questions relating to medicine calculation when converting doses from milligrams to grams., Conclusion: A mandatory hospital medicines management programme had some effect on increasing nurses' knowledge. However, it also was also found that the programme content could have been improved, particularly regarding nurses' responsibilities for medicines management at patient discharge and documentation when undertaking generic substitution., Competing Interests: None declared, (© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: Chemotherapy-induced peripheral neuropathy results in multidimensional neurological and muscular symptoms, which interfere with the patients' daily life., Aim: Examine the psychometric properties of the Arabic version of the chemotherapy-induced peripheral neuropathy assessment tool (CIPNAT) among adult cancer patients., Method: A descriptive study design was used. A convenience sample of 210 patients was assigned to two groups: 135 who received chemotherapies of known neurotoxic potential and 75 who served as a comparison group. Translation and back-translation considering cross-cultural issues to produce the Arabic version of CIPNAT was used. Test-retest and internal consistency reliability were used to test the reliability of the tool, whereas for the validity, content and construct validity were assessed., Results: Test-retest scores for the overall scale (r = 0.98, p = < .001), for the symptom experience subscale (r = 0.97, p = <.001), and for the interference subscale (r = 0.96, p = < .001) all showed evidence of reliability. Cronbach α coefficients were 0.97, 0.96, and 0.95 for the total scores, symptoms experience, and interference scales, respectively. Items to total correlation ranged from moderate to strong (0.55-0.81). The Content Validity Index was 0.83. The data support the evidence of discriminant validity, as significant differences were found between the groups with regard to symptom experience (t = 8.51, p = < .001), interference (t = 5.60, p = <.001), and total score (t = 7.88, p = < .001)., Conclusions: The Arabic version of CIPNAT showed adequate reliability and validity to screen for chemotherapy-induced peripheral neuropathy symptoms and their interference in Arab countries. Further studies are needed to evaluate concurrent validity., (Copyright © 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Nausea and vomiting are complex symptoms related to many disease processes. With many pharmacologic interventions noted to have adverse effects, many patients are turning to alternative therapies, including acupuncture and acupressure. Their efficacy has been proven for nausea and vomiting related to pregnancy, in patients receiving chemotherapy, and in postoperative, pediatric, and female patients. There are minimal to no side effects with the use of acupuncture and acupressure for the treatment of nausea and vomiting. Providers should be encouraged to discuss the efficacy, benefits, and side-effect profile of acupuncture and acupressure with patients who suffer from nausea and vomiting., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2020 Elsevier Inc. All rights reserved.)

This study describes nursing students' perspectives on learning math for medication calculations in a Canadian baccalaureate nursing program in Qatar. There is a dearth of guidance within the nursing literature to support teachers to develop pedagogical methods to help improve students' math competence. Moreover, the challenge of teaching math skills to student nurses in Qatar is particularly difficult because there is little standardization of curricula in secondary education. Data collected from focus groups was analyzed using interpretive description. Focus groups included, Group 1 those students who were beginning to learn math for medication calculations and had not completed the required math module and Group 2, students who had not yet completed the math module. Themes emerging from the data included from first year students, 1. Fear of math resulting in resistance to learning math for medication administration. 2. Student success is dependent on good instructors. 3. Student resentment towards perceived 'complicated' math in the nursing program. Themes from second year students included 1. Lack of nursing student's confidence with medication calculation within the clinical settings 2. Lack of self-directedness to uptake math knowledge 3. Incongruence amongst clinical instructors with applied math practice whilst in the clinical setting., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Medication errors are potentially avoidable incidents that can lead to harm. Medications are often administered under challenging conditions, which creates opportunities for distractions and interruptions., Purpose: The aim of this study was to reduce the number of interruptions and distractions experienced by nurses during the medication administration process., Methods: A Lean approach was used to value stream map the process, devise solutions, and measure the impact of the change., Results: Sources of distraction and interruption were identified. Through collaboration the medication administration process was standardized, and a purpose-built medication administration room was developed. Frequency of interruptions and distractions from all sources was reduced., Conclusions: Value stream mapping the process enabled the identification of non-value-added activities that were threats to the integrity of the process. Standardizing the medication administration process and creating a safe space to facilitate the process successfully reduced interruptions and distractions from all sources.

Purpose: This study aimed to adapt the Registered Nurse Forecast (RN4CAST) nurse survey making it appropriate to assess the working environments of ambulatory chemotherapy nurses, specifically focusing on care left undone., Method: A two-phase approach was used. Firstly, cognitive interviews were conducted to adapt role specific sections of the RN4CAST nurses survey. The interviews were analysed to assess comprehension, retrieval, judgement and response processes to create the RN4CAST-chemotherapy assessment tool (CAT) survey. Secondly, a single centre feasibility study was undertaken to assess acceptability of the RN4CAST-CAT survey in an ambulatory chemotherapy setting. Results of the feasibility study were analysed using descriptive statistics and compared with routinely collected patient experience data., Results: The cognitive interviews (n=6) resulted in important amendments to the RN4CAST-CAT. Response rate to the feasibility study was acceptable at 57% (n=12) and item completion rate was good (on average only 1 response missing per item). On average nurses looked after nine patients per shift, administered seven chemotherapy treatments and worked an hour and 10 min over their contracted time. Main areas of care left undone were related to verbal communication with patients and assessing patient comorbidities and toxicities., Conclusions: We were able to adapt the RN4CAST to make it suitable for use in the ambulatory chemotherapy setting. Our study offers preliminary evidence that the RN4CAST-CAT and methodology are feasible and acceptable within the ambulatory chemotherapy setting. Larger scale testing is now required and if validated the RN4CAST-CAT has the potential to provide useful insights into the impact of nursing workload on staff experience, patient care and outcomes on ambulatory chemotherapy settings., Competing Interests: Declaration of competing interest None declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Nursing home patients often have multiple diagnoses and a high prevalence of polypharmacy and are at risk of experiencing adverse drug events. The study aims to explore the dynamic interactions of stakeholders and work system elements in the medication administration process in a nursing home ward. Data were collected using observations and interviews. A deductive content analysis led to a SEIPS-based process map and an accompanying work system analysis. The study increases knowledge of the complexity of the medication administration process by portraying the dynamic interactions between the major stakeholders in the work system, and the temporal flow of the activities involved. Secondly, it identifies facilitators and barriers in the work system linked to the medication administration process. Most barriers and facilitators are associated with the work system elements - tools & technology, organisation and tasks - and occur early in the medication administration process., Competing Interests: Declaration of competing interest This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: to report a clinical case of needle phobia which culminated in cardiac arrest and describe the outcome of a care plan based on fear and anxiety diagnoses, using the Roy adaptation model as the framework., Methods: case study conducted in a chemotherapy outpatient unit in Rio de Janeiro. Care was guided by the nursing process and the use of instruments to assess the venous network, anxiety and fear., Results: the Roy adaptation model enabled proposing nursing interventions that allowed the study subject to adapt to the external and internal stimuli triggered by vasovagal syndrome. The instruments indicated the choice of an adequate semi-implanted venous access device and led to improved levels of anxiety and fear., Final Considerations: after carrying out the nursing activities, anxiety was reduced, and the patient achieved greater control over fear.

Despite the benefits for patients as cancer treatment, antineoplastic drugs may cause adverse effects not only in patients but also in health care personnel. Apart from minor symptoms, antineoplastic agents can cause serious health problems. However, protection from occupational exposures to antineoplastic drugs varies between pharmacy staff and nurses. While protection used for pharmacy staff are more advanced, personal protective equipment seems to be the only protection for most nurses around the world. Exposure can never be totally prevented, but it should be minimized at all costs. Guidelines and recommendations have been published; however, these guidelines do not have legal enforcement power. This article aims to provide a literature review on the occupational exposure of health care personnel to antineoplastic drugs and to reflect the current status in Hong Kong.

Some nurses continue to routinely dilute I.V. push medications, a practice associated with a high risk of errors. This article reviews correct practices for administering I.V. push medications.

Aims: It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Methods: Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. Results: The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. Conclusions: The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages .

Summary: Background. Interruptions occurring during the drug preparation and administration have a documented effect on patients' safety. However, literature has paid little attention to show how the introduction of a set of standardized organizational interventions, based on the combination of the current evidence, could reduce the number of interruptions occurring during drug therapy management. For this reason, this study used the most recent evidence to combine a set of standardized organizational interventions, and it was aimed to assess the effect of those interventions on the number of interruptions occurring during drug therapy management (Hypothesis a) and the overall duration of the therapy administration (Hypothesis b). Methods. A quasi-experimental study was performed, using pre- and a post- organizational implementation data collections in a single Italian center. The data collections were related to the interruptions and 40 shifts were randomly selected for both pre- and post-phase, respectively on December 2016 and February 2017. The standardized organizational interventions were implemented using the current evidence on this topic. Results. The standardized organizational interventions decreased the interruptions in the post-implementation phase, but those had not an effect on the duration of the therapy administration. Conclusions. This study represented an updated evidence, which describes the effect of a standardized and evidence-based set of organisational interventions' implementation on drug therapy management. Our results suggest a number of hints for managers and future researches. Managers should keep into account the usefulness of those interventions, while future researches with experimental designs are needed to provide harder evidence on this topic., Competing Interests: The authors of this article have no conflict of interests to disclose., (Copyright© by GIMLE.)

Chemotherapy planning and patient-nurse assignment problems are complex multiobjective decision problems. Schedulers must make upstream decisions that affect daily operations. To improve productivity, we propose a two-stage procedure to schedule treatments for new patients, to plan nurse requirements, and to assign the daily patient mix to available nurses. We develop a mathematical formulation that uses a waiting list to take advantage of last-minute cancellations. In the first stage, we assign appointments to the new patients at the end of each day, we estimate the daily requirement for nurses, and we generate the waiting list. The second stage assigns patients to nurses while minimizing the number of nurses required. We test the procedure on realistically sized problems to demonstrate the impact on the cost effectiveness of the clinic.

Aims and Objectives: To explore the perceptions and experiences of surgical nurses before and after introducing the Medications and Oral Restrictions Policy (the Policy)., Background: The Policy was developed following extensive consultation, and evidence-based strategies were considered for its implementation. However, it is possible uptake did not meet expectations., Design: Focus group interviews., Methods: Three focus groups were conducted in November 2015 around 'what worked, what didn't and why, before and after hospital-wide implementation of the Policy.' Data were coded and analysed using an inductive-deductive thematic analysis approach. The COREQ checklist guided reporting., Results: The three groups consisted of 16, 14 and six surgical nurses. Before the Policy, there was confusion, lack of clarity and guidance, and lack of experience and confidence in managing medications when patients had oral restrictions. After the Policy rollout, there was a sense of 'knowing what to do' because of improved clarity and decision support; but there were also problems with: not everyone knowing about the policy, particularly due to staff movement and turnover; and, individual interpretation of the policy including use of its signs outside of context, and decision-making processes., Conclusion: Exploration of nurses' perceptions of a medication-related policy change found that while the Policy provided clarity and decision support for some, it made little difference for others. Limited reach of the policy was an issue despite an effort to address this at the outset, as well as variations in interpretation of the policy and subsequent decision-making., Relevance to Clinical Practice: How individuals interpret information and their understanding of the context behind the policy or guideline may affect implementation and should be considered alongside other barriers when implementing medication-related initiatives. Furthermore, implementation strategies that are independent of ongoing resources and/or key champions to sustain should be prioritised for all initiatives., (© 2019 John Wiley & Sons Ltd.)

Home care medicine is a platform for providing supportive care for end-stage cancers. However, for undefined reasons, patients with hematological tumors (HTs) often fail to receive opportunities for home care. We, therefore, sought to delineate the clinical differences between solid tumors (STs) and HTs and to determine whether home care is effective for patients with HTs, as well as those with STs. We retrospectively analyzed the treatments, prognosis, and places of death of patients with STs (n = 99) and HTs (n = 20) who received palliative home care in our clinic and subsequently died between May 2016 and May 2018. Patients with HTs commonly required intravenous antibiotics, platelet transfusion, and red blood cell transfusion, while patients with STs tended to more frequently require the use of opioids. Importantly, there were no significant differences between the cohorts with respect to survival time and frequency of emergent visits to patients after their referral to us. Furthermore, most patients in both groups died at home. More than 50% of patients were not admitted to hospitals during our follow-up. Collectively, while therapeutic approaches sometimes differ, this study provides clinical evidence that palliative home care can be feasible even for patients with HTs.

Background: Exercise may effectively reduce side effects caused by chemotherapy. However, no meta-analyses of exercise during or postchemotherapy for cancer patients have been definitely performed to guide clinical practice., Aims: To evaluate and summarize available scientific evidence to provide recommendations of an exercise intervention for cancer patients undergo chemotherapy., Methods: A systematic review and meta-analysis were performed with databases searching of MEDLINE, Cochrane Library, and Embase from their inception to October 15, 2017. Literature was selected to identify randomized controlled trials of exercise during or postchemotherapy for cancer patients. Risk-of-bias assessment was performed by two reviewers independently. Data were analyzed using the Cochrane Collaboration's RevMan 5.3 (Review Man, Copenhagen, Denmark)., Results: A total of 10 trials with 838 participants were included in our study. Exercise could have a beneficial effect in cancer patients undergo chemotherapy in the outcome of physical fitness (MD: 0.16, 95% CI: 0.08-0.25, p < .01 and MD: 2.46, 95% CI: 1.44-3.47, p < .01) and depression (MD: -1.36, 95% CI: -2.68 to -0.04, p = .04), but not in FACT-G, FACT-B, anxiety, weight, and BMI (all p > .05). Exercise sequence (during or postchemotherapy) did not influence the effect of exercise for cancer patients undergo chemotherapy. In total, six studies were assessed as an overall low risk of bias. Subgroup analyses and sensitivity analyses reached results similar to those of the meta-analyses, which reflected our results were reliable and robust., Linking Evidence to Action: Exercise seems to have a beneficial effect on physical fitness and depression, but not on quality of life, anxiety, weight, and BMI. More specific and detailed description of the implementation of exercise programs should be proposed in the future., (© 2019 Sigma Theta Tau International.)

Objective: To identify what risks and incidents related to the drug therapy process are presented in an Emergency Care Unit (UPA) and to present proposals for management actions and safe practices, in the perception of the nursing team., Method: Qualitative research, in the research-action modality, developed in the scenario of UPA, located in the interior of São Paulo. Data collection was done through interviews and focus groups with 33 professionals, between June 2015 and April 2016. For the data treatment, the Content Analysis Technique was used., Results and Discussion: From the participants' reports, thematic categories were organized, with the risks and incidents related to the drug therapy process being one of the listed categories, as well as proposals for actions., Conclusion: The study allowed the implementation of patient safety actions related to the administration of drugs in a PAU, offering a higher quality of care.

Objectives: To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing., Method: An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care., Results: Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents., Conclusion: General information available on patient safety should be incorporated in paediatric nursing care.

Objective: To compare computer-generated guidelines with and without the use of a Clinical Decision Support System - Oncology Care and Healthcare for Chemotherapy Patients, for the caregivers of children undergoing chemotherapy., Methods: This is a descriptive, evaluative, and quantitative study conducted at a paediatrics hospital in Curitiba, Paraná, Brazil, from December 2015 to January 2016. The sample consisted of 58 participants divided into two groups: Group 1, without the aid of software, and Group 2, with the aid of the software. The data were analysed using the Mann-Whitney U test., Results: The guidelines revealed a statistical significance (p<0.05), with a prevalence of a higher concordance average in Group 2 in comparison with Group 1., Conclusion: Computer-generated guidelines are a valuable qualitative support tool for nurses.

Objective: To assess the effectiveness of an improvement programme to reduce the number of interruptions during the medication administration process in a paediatric hospital., Design and Methods: A prestudy-post study design was used to monitor nursing interruptions during medication cycles in a paediatric hospital. Interruptions were reported on an observation sheet (MADOS-P) adapted to the paediatric context., Setting: A 600-bed tertiary paediatric research hospital in Italy., Intervention: The interventions included a yellow sash worn by nurses during medication cycles, a yellow-taped floor area indicating the 'No interruption area', visual notices in the medication areas, education sessions for healthcare providers and families, patient and parent information material., Results: 225 medication cycles were observed before the intervention (T0) and 261 after the intervention (T1). The median of interruptions occurring in each cycle decreased significantly from baseline to postintervention (8.0 vs 2.0, p=0.002), as the rate ratios (interruptions/patient post-pre ratio: 0.34; interruptions/medication post-pre ratio: 0.37; interruptions/hour of medication cycle post-pre ratio: 0.53, p<0.001). During preintervention, the main causes of interruptions were 'other patients' (19.9%), 'other nurses' (17.2%) and 'conversation' (15.7%); during postintervention, they were 'other nurses' (26.1%), 'conversation' (18.2%) and 'other patients' (17.4%)., Conclusions: This bundle of interventions proved to be an effective improvement programme to prevent interruptions during medication administration in a paediatric context., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Quality checks of the independent German Health Insurance Medical Service in in-patient nursing care facilities pursuant to Articles 114 et seqq. SGB XI [11th Book of the Social Code] also comprise the Pflegerische Medikamentenversorgung (PMV) [drug supply by nursing personnel]. Irregularities are described in quality reports in the reviewer’s own words. This investigation was intended to categorise the reasons for the above irregularities. Methods: The bases for the examination are the reports of quality checks of all of in-patient nursing care facilities conducted in 2014 (regular quality checks) in Hamburg and Schleswig-Holstein (N = 671), in which the PMV was examined for 5 742 randomly selected residents. Results: With regard to the documentation, inexplicable drug intakes (5.8 %) were found most frequently, followed by missing information on dosages and application provisions (0.8 % each), which were registered as irregularities at the residents. In the documentation of on-demand medication, insufficient indication data (3.2 %), missing daily maximum dosages (0.8 %) and missing single doses (0.6 %) were most commonly ascertained. The most frequent reasons for medication handling irregularities for the residents were false positioning (6.0 %), missing and respectively false data on consumption and on when the medical packaging was opened (3.5 %), as well as medication not directly administered using the blister (0.7 %). As for subordinate classifications of false positioning, incorrect dosages were revealed most often, followed by drugs with an exceeded expiry date and by out-of-stock drugs. Systematic patient-related factors with influence on PMV could not be determined. Conclusions: The extent of the irregularities and their type prompt a further increase in the efforts to improve the quality of nursing care facilities. The results can be used as a basis for designing specific initiatives to improve the PMV.

Aims and Objective: The aim was to describe registered nurses' experience in the context of delegating the administration of medication to unlicensed personnel in residential care homes., Background: The residents in residential care homes have a need for extensive care and nursing, and large amounts of medicines are common practice. Registered nurses' workload and difficulties in fulfilling their duties, such as administration of medicines, have led to frequent delegation of this task between the registered nurses and unlicensed assisting personnel. It is, of course, a great responsibility to ensure that the care of the older people remains safe while maintaining quality in the prevailing situation., Design: A qualitative inductive descriptive study., Methods: Data were collected using audio-recorded semistructured interviews with a purposive sample of 18 registered nurses and interpreted using manifest content analysis. The study was approved by the ethical research committee., Results: Registered nurses found the organisation unsupportive with regard to nursing interventions. The delegation context was experienced as a grey zone; the rules and regulations were not in line with the unspoken expectation to delegate the administration of medicine to unlicensed personnel, in order to be able to manage their daily work., Conclusions: The slimmed organisation of residential care homes relies upon registered nurses' use of delegation of medicine administration to unlicensed assistant personnel. It becomes an inevitable assignment entailing a challenging responsibility for patient safety and the quality of care., Relevance to Clinical Practice: The results of this study may contribute to a better understanding of the complexity of caring for older people in residential care homes and to improving the work environment of all healthcare personnel., (© 2016 John Wiley & Sons Ltd.)

The oncology clinics use different nursing care delivery models to provide chemotherapy treatment to cancer patients. Functional and primary care delivery models are the most commonly used methods in the clinics. In functional care delivery model, patients are scheduled for a chemotherapy appointment without considering availabilities of individual nurses, and nurses are assigned to patients according to patient acuities, nursing skill, and patient mix on a given day after the appointment schedule is determined. Patients might be treated by different nurses on different days of their treatment. In primary care delivery model, each patient is assigned to a primary nurse, and the patients are scheduled to be seen by the same nurse every time they come to the clinic for treatment. However, these clinics might experience high variability in daily nurse workload due to treatment protocols that should be followed strictly. In that case, part-time nurses can be utilized to share the excess workload of the primary nurses. The aim of this study is to develop optimization methods to reduce the time spent for nurse assignment and patient scheduling in oncology clinics that use different nursing care delivery models. For the functional delivery model, a multiobjective optimization model with the objectives of minimizing patient waiting times and nurse overtime is proposed to solve the nurse assignment problem. For the primary care delivery model, another multiobjective optimization model with the objectives of minimizing total overtime and total excess workload is proposed to solve the patient scheduling problem. Spreadsheet-based optimization tools are developed for easy implementation. Computational results show that the proposed models provide multiple nondominated solutions, which can be used to determine the optimal staffing levels.

In this article Richard Griffith considers whether it is ever in a patient's best interests to be given medicine by covert means, such as disguising it in food.

Interruptions decrease the efficiency of the medication administration process. In this study, interruptions were found in 63% of the medication passes on four medical-surgical units in a community hospital. However, interruptions do not always lead to negative outcomes.

It is often difficult to engage nursing students and keep their interest when teaching pharmacology. This article reports on an effective change from a lecture-only approach to teaching with the use of games and case studies in a baccalaureate nursing education program. Improvements have been noted in standardized test scores and student evaluations, and students are more engaged in the learning process. Learning has been shifted from the instructor, as in the traditional classroom, and is now student focused.

Chemotherapy-induced neutropenia may result in significant physical, social and emotional consequences for patients receiving anticancer therapy. Chemotherapy-induced neutropenia also leads to delays in treatment and reductions in dose intensity. In some cases neutropenia may be prevented by the use of granulocyte-colony stimulating factor, but it remains one of the most common side effects of chemotherapy. Patients who are neutropenic have a reduced ability to fight infection and are at increased risk of developing neutropenic sepsis. Nurses need to be able to recognise the signs and symptoms of neutropenic sepsis to ensure early diagnosis and treatment. There are evidence-based pathways for the treatment of patients with neutropenic sepsis and nurses have the potential to develop services and initiatives to support best practice for this group of patients.

Aims: To assess the medication knowledge of emergency department nurses and determine the factors affecting their nurse-initiated medication practices., Background: Nurse-initiated medications is a vital practice for all nurses in emergency departments which improves pain assessment, provides safe pain management and reduces time-to-analgesia and other meaningful treatments., Design: Mixed methods. Between September 2014-January 2015, data were collected by questionnaire assessing medication knowledge and face-to-face interviews determining factors affecting practice., Results: Nurse-initiated medications frequency of the Registered Nurses ranged from 0-36 times per week dependent on employed hours and emergency department area worked. Medication knowledge was consistent among nurses, but there was an overall deficit in nurses' knowledge of mechanism of action. Four major themes were identified from the 24 interviews: patient-centred care, caution and safety as principles of practice; continuing support and education; improvement of practice over time. All nurses regard the practice positively and to be extremely beneficial to patients. Although apprehensive at the start of their nurse-initiated medications practice, confidence improved with exposure and experience. Nurses sought additional information from colleagues and the available evidence-based resources., Conclusion: Medication knowledge is not the sole determinant of nurse-initiated medications practice. The practice is motivated by multiple factors such as patients' needs, safety and nurses' confidence., (© 2015 John Wiley & Sons Ltd.)

Background: Peripherally Inserted Central Catheter (PICC) is a central venous catheter suitable for patients who receive chemotherapy in Day Hospital regimen. The patient must be educated to a proper home management of the PICC through targeted education., Aim: To evaluate the effectiveness of a targeted educational intervention through the comparison of: indi- vidual interview, brochure paper, informative video., Method: Single-centre randomized controlled clinical trial with a simple three-arm comparative scheme. The study population is represented by all patients undergoing the insertion of PICC at the Oncological Day Hospital and Breast Unit in the observation period between October 2013 and February 2014. The Standard educational session is performed by the nurse positioning the PICC. PICC team consists of two nurses in possession of the first level master in venous access management. Following randomization eligible patients were divided in three groups: group A received Standard educational session; group B received the standard information and the brochure; group C received the stan- dard information and the informative video. The level of the achieved knowledge was investigated by administering targeted questionnaires., Results: A total of 40 patients joined the study: a convenience sample represented by people between the ages of 18 and 75 years, in outpatient care. Statistically significant difference in key areas necessary for the proper management of PICC: when to change the dressing (p=0.001), when to wash the catheter (p=0), how to recognize signs and symptoms of infection (p=0.001), identify at-risk behaviors (p=0.005), when carrying out the inspection of the catheter's insertion site (p=0)., Conclusions: The administration of a multimedial educational tool was found to be superior in efficacy compared to the only Standard educational session to increase patient's knowledges. The video appears to be more effective than the brochure. The obtained results are influenced by the small sample size and by the shortness of the follow up timing; this leads to a low generalizability of the conclusions.

Background: People living at home who lack ability to manage their medicine are entitled to assistance to improve adherence provided by a home care assistant employed by social care., Aim: The aim was to describe how older people with chronic diseases, living at home, experience the use and assistance of administration of medicines in the context of social care., Design: A qualitative descriptive study., Methods: Ten participants (age 65+) living at home were interviewed in the participants' own homes. Latent content analysis was used., Findings: The assistance eases daily life with regard to practical matters and increases adherence to a medicine regimen. There were mixed feelings about being dependent on assistance; it interferes with self-sufficiency at a time of health transition. Participants were balancing empowerment and a dubious perception of the home care assistants' knowledge of medicine and safety. Physicians' and district nurses' professional knowledge was a safety guarantee for the medicine process., Conclusions: Assistance eases daily life and medicine regimen adherence. Dependence on assistance may affect self-sufficiency. Perceived safety varied relating to home care assistants' knowledge of medicine., Relevance to Clinical Practice: A well-functioning medicine assistance is crucial to enable older people to remain at home. A person-centred approach to health- and social care delivery is efficient and improve outcome for the recipient of care., (© 2015 Nordic College of Caring Science.)