Document Type : Original Article
Authors
1 Department of Oncology Nursing, College of Nursing, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
2 Department of Medical Oncology Haematology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Abstract
BACKGROUND: Patients diagnosed with cancer and who undergo cancer treatment are at potential
risk of bone marrow suppression leading to prolonged hospitalization, delay in treatment, and
chemotherapy dose reductions, which ultimately results in significant morbidity and mortality. This
sequential exploratory study using a mixed‑method approach was aimed to develop and validate a
neutropenic nursing care (NNC) bundle for neutropenic patients admitted in a tertiary care hospital,
Uttarakhand.
MATERIAL AND METHODS: This sequential exploratory study design with an instrument
developmental model was used to develop the NNC bundle. It consisted of two phases: Qualitative
phase and quantitative phase. In the qualitative phase, focused group discussion with eight oncology
nurses was performed to derive themes related to neutropenic nursing care using conventional
content analysis. An extensive literature review was also performed on these themes to explore the
current pieces of evidence for item pool generation. In the quantitative phase, a preliminary draft
bundle was developed, and two Delphi rounds (I and II) were carried out among the five experts for
the content validation of the NNC bundle and a final bundle was developed.
RESULTS: Major domains identified for the bundle were hand hygiene, care of central and peripheral
lines, routine oral care, antiseptic bath, peri‑anal care, diet, and environmental hygiene. The
content validity index (CVI) of the bundle was found to be >80% for all the items with I‑CVI >0.8 and
S‑CVI = 0.99 after conducting two rounds of Delphi.
CONCLUSION: The present study has provided a set of valid written neutropenic nursing interventions
to prevent complications in neutropenic patients. The NNC bundle should be subjected to other levels
of evaluation that measure the bundle’s practicability and suitability for the intended field.
Keywords
Santhappan S. Cancer statistics, 2020: Report from National Cancer
Registry Programme, India. JCO Glob Oncol 2020;6:1063‑75.
2. Ferlay J, Colombet M, Soerjomataram I, Parkin D. M, Pineros M,
Znaor A, et al. Cancer statistics for the year 2020: An overview.
International J Cancer 2021;1‑12.
3. What is Cancer?. Cleveland Clinic. Available from: https://
my.clevelandclinic.org/departments/cancer/patient‑education/
wellness‑prevention/what‑is‑cancer. [Last accessed on
2021 Apr 19].
4. Hospital BM. Children with cancer : WHO estimates 55. 2021;119.
Available from: https://www.downtoearth.org.in/health.
5. Badr M, Hassan T, Sakr H, Karam N, Rahman DA, Shahbah D,
et al. Chemotherapy‑induced neutropenia among pediatric cancer
patients in Egypt: Risks and consequences. Mol Clin Oncol
2016;5:300‑6.
6. Goldsmith C, Kalis J, Jeffers KD. Assessment of initial febrile
neutropenia management in hospitalized cancer patients at a community cancer center. J Adv Pract Oncol 2018;9:659‑64.
7. Hassan BAR, Yusoff ZB, Othman SB. A close look at neutropenia
among cancer patients — Risk factor and management. Updat
Cancer Treat 2015. Available from: https://DOI: 10.5772/60794.
8. Wilson BJ, Zitella LJ, Erb CH, Foster J, Peterson M, Wood SK.
Prevention of infection: A systematic review of evidence‑based
practice interventions for management in patients with cancer.
Clin J Oncol Nurs 2018;22:157‑68.
9. Gupta A, Abbasi B, Gupta S. Management of chemotherapy
induced neutropenia – An unmet clinical need. Am J Biomed Sci
Res 2019;4:313‑8.
10. Coping‑with‑cancer/physical‑emotional‑and‑social‑effects‑
cancer/managing‑physical‑side‑effects/neutropenia. 2020;10–2.
Available from: http://www.cancer.net/about‑us/cancernet‑
editorial‑board. [Last accessed on 2021 Apr 19].
11. WingardJR. Prophylaxis of infection during chemotherapy‑induced
neutropenia in high‑risk adults. UpToDate 2019;1–23. Available
from: https://www‑uptodate‑com.ezp2.imu.edu.my/contents/
prophylaxis‑of‑infection‑during‑chemotherapy‑induced
‑neutropenia‑in‑high‑risk adults?search=chemotherapyneu
tropenia&source=search_result&selectedTitle=2~150&usag
e_type=default&display_rank=2#H875810696%0A. [Last accessed
on 2021 Apr 20].
12. Doshi BD, Pandya NM, Shah CA, Gupta AK, Makwana MV.
Chemotherapy‑induced neutropenia in cancer patients with solid
tumours in India. Der Pharm Lett 2012;4:584‑90.
13. Perazzol C, Feitosa MR, Pontes L, Rocha J, Simões BP, Féres O.
Management of acute colorectal diseases in febrile neutropenic.
J Coloproctol 2014;34:189‑92.
14. Oberoi S, Das A, Trehan A, Ray P, Bansal D. Can complications
in febrile neutropenia be predicted? Report from a developing
country. Support Care Cancer 2017;25:3523‑8.
15. Divdar Z, Foroughameri G, Farokhzadian J, Sheikhbardsiri H.
Psychosocial needs of the families with hospitalized organ
transplant patients in an educational hospital in Iran. Ther Apher
Dial 2020;24:178‑83.
16. Sheikhbardsiri H, Esamaeili Z, Sheikhasadi H, Ayoubi MS,
Sarani A. Observance of patients rights in emergency department
of educational hospitals in South‑East Iran. Int J Hum
Rights Healthc 2020. Available from: https://doi: 10.1108/
ijhrh‑09‑2019‑0072
17. SheikhbardsiriH, MousaviSH, DoustmohammadiMM, KarimiM,
Salahi S. The effect of educational workshop on emergency
department nurses’ self‑efficacy in patient training. J Edu Health
Promot 2019;8:136.
18. Nirenberg A, Bush AP, Davis A, Friese CR, Gillespie TW, Rice RD.
Neutropenia: State of the knowledge Part I. Oncol Nurs Forum
2006;33:1193‑201.
19. Nirenberg A, Reame NK, Cato KD, Larson EL. Oncology nurses’
use of national comprehensive cancer network clinical practise
guidelines for chemotherapy‑induced and febrile neutropenia.
Oncol Nurs Forum 2010;37:765‑73.
20. Tarakcioglu Celik GH, Korkmaz F. Nurses’ knowledge and
care practices for infection prevention in neutropenic patients.
Contemp Nurse 2016;53:143‑55.
21. Download MAXQDA demo version for Windows. MAXQDA
2019. Available from: https://www.maxqda.com/
downloadmaxqdademoversionforwindows.
22. Yusoff MSB. ABC of content validation and content validity
index calculation. Education in Medicine Journal. 2019;11:49–54.
https://doi.org/10.21315/eimj2019.11.2.6.
23. Kumar P, Kaur R, Kaur S, Trehan A, Kapoor R. Development
of a protocol for nurses and caregivers related to prevention,
early detection and management of chemotherapy‑induced
neutropenic complications. Nurs Midwifery Res J 2020:1‑25.
Available from: http://doi.org/10.33698/NRF0266
24. Kumar A, Mahal R. Modified delphi technique: Content validity
of the pressure ulcer risk assessment tool. J Nurs Sci Pract
2017;7:17‑19.
)