A sequential exploratory study to develop and validate neutropenic nursing care bundle for neutropenic patients...

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.

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.

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.

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.