Using Tap Water for Enteral Tube Flushes.

Background: Enteral feeding tubes, used in patients who require enteral nutrition or medication, require flushing between medications and feedings to maintain patency. Various types of water can be used to flush enteral feeding tubes, which raises the question of which type of water is best supported by evidence.

Purpose: The aims of this quality improvement project were to examine the evidence on the use of tap water instead of sterile water for enteral tube flushes and to implement the use of tap water as a safe, cost-effective alternative to sterile water at a multisite oncology institution.

Decreasing Premedication for Blood Transfusions: A Quality Improvement Project.

Background: Premedication administration to patients who are to receive blood transfusions continues despite evidence of a lack of benefit when given to prevent febrile nonhemolytic or mild allergic transfusion reactions. Reviews of ordering practices and staff surveys on an adult inpatient hematology-oncology unit in our multisite oncology medical center indicated a lack of standardization and overuse of premedication in blood transfusions and a lack of knowledge of when it was appropriate to use premedication.

Methods: A literature search was performed, and the evidence led to a proposal for a quality improvement (QI) project focused on development of an evidence-based algorithm to guide clinicians in when to administer which premedication, development of clear documentation for premedication plans, integration of the documented premedication plans into electronic orders for blood products, and staff education.

Reducing Tubing and Device Misconnections.

Purpose: The aim of this quality improvement (QI) project was to explore prevention strategies to reduce tubing and device misconnections that cause patient harm and death. Practicing evidence-based techniques can improve rates of nursing-sensitive indicators, such as central line-associated bloodstream infections, and increase patient safety.

Methods: Our nursing quality management team reviewed internal quality data and found 11 reported misconnections.

Best Practices in Pediatric Oncology Pain Management.

Pediatric oncology patients are vulnerable to pain that may be caused by the disease or its treatment, and this symptom can be challenging to manage. This article focuses on the importance of pain control, pain assessment and treatment, and special considerations in pediatric oncology pain management, including preparing children for painful procedures and the family's role in managing pain.

Affirmative Palliative Care for Transgender and Gender Nonconforming Individuals.

Nurses have a professional and ethical responsibility to provide inclusive, affirmative palliative care to transgender and gender nonconforming (TGNC) individuals experiencing life-limiting illness or injury. In accordance with standards for professional nursing and health organizations, nurses must continue to take tangible steps to achieve a level of care that is affirming, holistic, nonprejudicial, and collaborative. Providing quality care for TGNC individuals requires informed, competent integration of palliative nursing care, gender-affirmative care, and trans-person-centered health care within nursing practice.

Addressing CAUTIs with an External Female Catheter.

Background: Catheter-associated urinary tract infections (CAUTIs) can lead to complications that prolong hospital stays and result in patient discomfort as well as increased health care costs and mortality. At our academic medical center in New York City, in 2016-17, 21 of 87 CAUTI cases (24%) were in bedbound female patients in whom indwelling catheters were used for incontinence. Although condom catheters were available as an alternative to indwelling urinary catheters for male patients, there was a lack of effective products for female patients.

Integrating Palliative Care into Nursing Care.

The need for palliative care in our health care system has exponentially increased in the past few years as a result of the COVID-19 pandemic, the aging population, and the increasing number of people living with serious illnesses. While nurses play a critical role in delivering palliative care, many lack confidence and knowledge, causing practice gaps in the clinical and psychological management of seriously ill patients. The collective burden of the pandemic has demonstrated the importance of palliative care education and training, specifically in communication, symptom management, and continuing education.

The ICN Global Nursing Leadership Institute: Integrating the SDGs into Leadership and Policy Development.

This article is one in a series in which contributing authors discuss how the United Nations (UN) Sustainable Development Goals (SDGs) are linked to everyday clinical issues; national public health emergencies; and other nursing issues, such as leadership, shared governance, and advocacy. The 2030 Agenda for Sustainable Development, a 15-year plan of action to achieve the goals, was unanimously adopted by all UN member states in September 2015 and took effect on January 1, 2016. The Agenda consists of 17 SDGs addressing social, economic, and environmental determinants of health and 169 associated targets focused on five themes: people, planet, peace, prosperity, and partnership.

What Should Clinicians Do When a Patient's Autonomy Undermines Her Being Treated Equitably?

Language and cultural barriers can impede communication between patients and clinicians, exacerbating health inequity. Additional complications can arise when family members, intending to protect their loved ones, ask clinicians to lie or not disclose to patients their diagnoses, prognoses, or intervention options. Clinicians must express respect for patients' and families' cultural, religious, and social norms regarding health care decision making, but they might also be ethically troubled by some decisions' effects on patients' health outcomes.

Reducing Waste and Increasing Sustainability in Health Care Settings.

Since the 1960s, plastic has been used in the production of medical equipment and products that improve patient comfort, safety, and treatment. Yet an unwelcome challenge has emerged in the years since: how to safely dispose of this material without negatively affecting human health and the environment. Working with medical devices and supplies that are constructed using plastics, nurses are at the forefront of this issue and must identify solutions, collaborate with other health care workers, and lead efforts to establish more sustainable options.

Evolving Medicaid Coverage Policy and Rebates.

Medicaid covers approximately 1 in 5 Americans and accounts for one-sixth of US health care spending. Despite having to navigate increasing and variable spending on prescription drugs, Medicaid programs must balance their annual budgets, and they rely heavily on the Medicaid Drug Rebate Program (MDRP). The MDRP requires programs to maintain an open formulary covering all of a manufacturer's drugs in exchange for being given the lowest price in the market.

CE: Breast Cancer Screening: A Review of Current Guidelines.

: Breast cancer accounts for more than a quarter million diagnoses each year in the United States. Routine screening is the primary method used to detect cancer in its earliest stages, before symptoms develop. Recent changes to national screening guidelines have resulted in a lack of consensus and confusion among health care providers and the public.

Herbal Medications and Anesthesia Case Management.

Herbal medicine use in the United States has increased substantially. Despite this upward trend, patients often fail to disclose use of these medicines to their healthcare provider. Currently, the US Food and Drug Administration (FDA) does not require preclinical animal studies, controlled clinical trials, or postmarket surveillance of herbal supplements.

Decreasing Smoking but Increasing Stigma? Anti-tobacco Campaigns, Public Health, and Cancer Care.

Public health researchers, mental health clinicians, philosophers, and medical ethicists have questioned whether the public health benefits of large-scale anti-tobacco campaigns are justified in light of the potential for exacerbating stigma toward patients diagnosed with lung cancer. Although there is strong evidence for the public health benefits of anti-tobacco campaigns, there is a growing appreciation for the need to better attend to the unintended consequence of lung cancer stigma. We argue that there is an ethical burden for creators of public health campaigns to consider lung cancer stigma in the development and dissemination of hard-hitting anti-tobacco campaigns.

CE: Human Papillomavirus-Related Oropharyngeal Cancer: A Review of Nursing Considerations.

: The overall incidence of head and neck cancer-which includes laryngeal, hypopharyngeal, nasal cavity, paranasal sinus, nasopharyngeal, oral, oropharyngeal, and salivary gland cancers-has declined in the United States over the past 30 years with the concomitant reduction in tobacco use. Over that same period, however, the worldwide incidence of oropharyngeal cancer has escalated significantly, most notably among men and women under age 60 who live in developed countries. This epidemic rise in oropharyngeal cancer is largely attributed to certain genotypes of the human papillomavirus (HPV).

Adverse Late and Long-Term Treatment Effects in Adult Allogeneic Hematopoietic Stem Cell Transplant Survivors.

Hematopoietic stem cell transplantation (HSCT) has become the standard of care for many malignant and nonmalignant hematologic diseases that don't respond to traditional therapy. There are two types: autologous transplantation (auto-HSCT), in which an individual's stem cells are collected, stored, and infused back into that person; and allogeneic transplantation (allo-HSCT), in which healthy donor stem cells are infused into a recipient whose bone marrow has been damaged or destroyed. There have been numerous advancements in this field, leading to marked increases in the number of transplants performed annually.