
Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi study
Yufeng Zhou, Yan Cui, Hong Wang, Fang Wang, Chao Lu, Yan Shen
Journal of Biomedical Research ›› 2016, Vol. 30 ›› Issue (5) : 386-392.
Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi study
Infections are identified as the most common preventable cause of death in pediatric oncology patients. Assessing and stratifying risk of infections are essential to prevent infection in these patients. To date, no tool can fulfill this demand in China. This study aimed to develop a nursing work-based and Chinese-specific tool for pediatric nurses to assess risk of infection in oncology patients. This research was a modified Delphi study. Based on a literature review, a 37-item questionnaire rating on a 0–5 scale was developed. Twenty-four experts from 8 hospitals in 6 provinces of China were consulted for three rounds. Consensus for each item in the first round was defined as: the rating mean was>3 and the coefficient of variation (CV) was<0.5. Consensus for each item in the second round was defined as CV<0.3. Consensus among experts was defined as: P value of Kendall's coefficient of concordance (W)<0.05. After three rounds of consultation, a two-part tool was developed: the Immune Status Scale (ISS) and the Checklist of Risk Factors of Infection (CRFI). There were 5 items in the ISS and 14 in the CRFI. Based on the ISS score, nurses could stratify children into the low-risk and high-risk groups. For high-risk children, nurses should screen risk factors of infection every day by the CRFI, and twice weekly for low-risk children. Further study is needed to verify this tool's efficacy.
pediatrics / oncology nursing / infection control / risk assessment / Delphi technique
Tab.1 Participant demographics |
Demographics | First-round (n=24) | Second and third-rounds (n=23) |
---|---|---|
Gender | ||
Male | 9 | 8 |
Female | 15 | 15 |
Age(years) | ||
Mean | 42.92 | 40.91 |
Range | 33-56 | 33-56 |
Working experience(years) | ||
Mean | 19.86 | 20.04 |
Range | 10-35 | 10-35 |
Educational Level | ||
Doctor | 5 | 4 |
Master | 4 | 4 |
Bachelor | 15 | 15 |
Professional title | ||
Senior | 17 | 16 |
Middle | 7 | 7 |
Tab.2 Rating means and CVs of item in the first-round consultation |
Risk factors of infection | Rating mean ( X̄ ) | Standard Deviation(SD) | Coefficient of variation(CV) |
---|---|---|---|
1. Diagnosis of disease | 3.96 | 1.22 | 0.31 |
2. Chemotherapy regimen | 4.67 | 0.76 | 0.16 |
3. Days after beginning chemotherapy | 3.85 | 1.08 | 0.28 |
4. Days of hospitalization | 2.96* | 1.81 | 0.61** |
5. Routine blood test | 4.96 | 0.2 | 0.04 |
6. Body mass index | 3.88 | 1.54 | 0.4 |
7. History of infection after diagnosis of malignant tumors | 3.83 | 1.53 | 0.4 |
8. Level of education of children and guardians | 3.11 | 1.76 | 0.57** |
9. Compliance with treatment | 4.4 | 1.22 | 0.28 |
10. Family economy state | 3.29 | 1.71 | 0.52** |
11. Health conditions of guardians | 3.67 | 1.46 | 0.4 |
12. Number of persons with access to the ward | 3.33 | 1.55 | 0.47 |
13. Protective isolation | 4.58 | 0.83 | 0.18 |
14. Children and their guardians' compliance with wearing masks | 4.21 | 1.02 | 0.24 |
15. Children and their guardians' compliance with hand hygiene | 4.29 | 1.43 | 0.33 |
16. Ventilation of the ward | 4.5 | 0.83 | 0.19 |
17. Frequency of going out of the ward | 3.35 | 1.55 | 0.46 |
18. Children and their guardians' compliance with oral care | 4.17 | 1.17 | 0.28 |
19. Frequency of special oral care | 4.08 | 1.32 | 0.32 |
20. Eating habits | 3.58 | 1.47 | 0.41 |
21. Disinfection of tableware | 3.98 | 1.28 | 0.32 |
22. Condition of oral mucosa and gingiva | 4.46 | 0.88 | 0.2 |
23. Eruption of teeth | 2.63* | 1.76 | 0.67** |
24. Constipation | 3.44 | 1.69 | 0.49 |
25. Diarrhea | 3.38 | 1.74 | 0.52** |
26. Children and their guardians' compliance with perianal care | 4.33 | 0.92 | 0.21 |
27. Frequency of urination | 2.25* | 1.75 | 0.78** |
28. Compliance with perineal care | 4.39 | 0.94 | 0.21 |
29. Condition of prepuce | 3.18 | 1.5 | 0.47 |
30. Menstrual period | 2.39* | 1.62 | 0.68** |
31. Frequency of bathing | 2.43* | 1.8 | 0.74** |
32. Frequency of changing clothes | 2.52* | 1.75 | 0.70** |
33. Condition of skin (such as itchiness, redness, wetness and edema) | 4.08 | 1.41 | 0.35 |
34.Condition of wounds | 4.5 | 0.83 | 0.19 |
35.Wound dressing | 4.17 | 0.96 | 0.23 |
36. Insertion and management of peripheral venous access devices | 4.43 | 0.95 | 0.21 |
37. Insertion and management of PICC, CVC or port | 4.52 | 0.9 | 0.2 |
Note. *Rating mean,<3.0, **CV>0.50. |
Tab.3 Rating means and CVs of item in the second-round consultation |
Risk factors of infection | Rating means (X̄) | Standard Deviation(SD) | Coefficient of variation(CV) | |
---|---|---|---|---|
1. Diagnosis of disease | 4.24 | 0.97 | 0.23 | |
2. Chemotherapy regimen | 4.14 | 0.91 | 0.22 | |
3. History of infection after diagnosis of oncology | 4.11 | 1.10 | 0.27 | |
4. Days of hospitalization | 4.77 | 0.58 | 0.12 | |
5. Routine blood test | 3.93 | 1.05 | 0.27 | |
6. Body mass index | 3.71 | 1.32 | 0.36* | |
7. Compliance with treatment | 4.58 | 0.93 | 0.20 | |
8. Health conditions of guardians | 4.00 | 1.28 | 0.32* | |
9. Family living conditions | 3.66 | 1.17 | 0.32* | |
10. Protective isolation | 4.67 | 0.82 | 0.17 | |
11. Children and their guardians' compliance with wearing masks | 4.26 | 1.06 | 0.25 | |
12. Children and their guardians' compliance with hand hygiene | 4.53 | 0.85 | 0.19 | |
13. Disinfection of the wards | 4.39 | 0.80 | 0.18 | |
14. Number of persons with access to the ward | 3.97 | 1.07 | 0.27 | |
15. Frequency of going out of the ward | 3.65 | 1.15 | 0.32* | |
16. Children and their guardians' compliance with oral care | 4.52 | 0.84 | 0.19 | |
17. Frequency of special oral care | 4.09 | 1.02 | 0.25 | |
18. Eating habits | 3.74 | 0.96 | 0.26 | |
19. Disinfection of tableware | 3.75 | 1.34 | 0.36* | |
20. Condition of mouth mucosa and gingiva | 4.26 | 1.07 | 0.25 | |
21. Dental caries | 3.39 | 1.40 | 0.41* | |
22. Children and their guardians' compliance with perianal care | 4.22 | 1.12 | 0.26 | |
23. Conditions of defecation | 3.58 | 1.22 | 0.34* | |
24. Insertion and management of peripheral venous access devices | 4.12 | 1.07 | 0.26 | |
25. Insertion and management of PICC, CVC or port | 4.30 | 1.02 | 0.24 | |
26. Children and their guardians' compliance with sustaining care of PICC, CVC, port during discharge period | 4.26 | 1.16 | 0.27 | |
27. Conditions of skin (such as itchiness, redness, wetness and edema) | 3.71 | 1.18 | 0.32 | |
28. Condition of wounds | 4.44 | 0.86 | 0.19 | |
29. Wound dressing | 4.43 | 0.85 | 0.19 | |
30. Routine urine test | 3.81 | 0.99 | 0.26 | |
31. Compliance of perineal care | 4.21 | 1.26 | 0.30 | |
32. Condition of prepuce ( only for boys) | 3.51 | 1.23 | 0.35* |
Note. * CV>0.30. |
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Supplementary files
JBR-16014-OF-YFZ_suppl_1 (72 KB)
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