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Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi
Yufeng Zhou1, Yan Cui2, Hong Wang3
1Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, JIangsu 211166, China.
Insights
Pediatric oncology nurses in China now have a new tool to assess infection risk. This helps stratify patients into low- and high-risk groups, improving infection prevention for children with cancer.
Area of Science:
- Oncology Nursing
- Pediatric Healthcare
- Infectious Disease Prevention
Background:
- Infections are the leading preventable cause of death in pediatric oncology patients.
- Effective infection risk assessment and stratification are crucial for prevention.
- China lacks a specific, nursing-focused tool for this purpose.
Purpose of the Study:
- To develop a nursing work-based, Chinese-specific tool for assessing infection risk in pediatric oncology patients.
- To create a practical instrument for nurses to identify and manage infection risks.
Main Methods:
- A modified Delphi study involving 24 experts from 8 hospitals across 6 Chinese provinces.
- Development of a 37-item questionnaire, refined through three rounds of expert consultation.
- Establishment of consensus criteria, including rating means, coefficient of variation (CV), and Kendall's W.
Main Results:
- A two-part tool was developed: the Immune Status Scale (ISS) with 5 items and the Checklist of Risk Factors of Infection (CRFI) with 14 items.
- The ISS allows stratification of children into low-risk and high-risk groups.
- Recommendations for daily CRFI screening for high-risk and twice-weekly for low-risk children were established.
Conclusions:
- The developed tool provides a structured approach for nurses to assess and manage infection risk in pediatric oncology patients in China.
- The ISS and CRFI offer a practical framework for risk stratification and monitoring.
- Further research is required to validate the tool's clinical efficacy.
Abstract:
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.