Nutritional Assessment of Children With Cancer a Challenge for Oncology Nurses

Evidenced-based guidelines for nutritional assessment of children with cancer are needed to help better guide oncology nurses and to ensure the highest quality of care, according to study results published in the Journal of Pediatric Oncology Nursing.¹ Researchers examined staff nurses’ clinical decision making regarding nutritional assessment of children with cancer and found that nurses likely are not well prepared or resourced to address nutritional status of patients.

“This has implications for continuing education. My sample was highly educated (around 80% had a BS or higher), highly certified (certification rate was about 70%), highly experienced (average of more than 10 years of experience as a pediatric oncology nurse), all members of at least one professional organization, and most working at magnet institutions (about 70% of the sample) and yet they still have difficulty with performing accurate nutritional assessments,” said study corresponding author Amanda J. Lulloff, PhD, RN, a nurse educator  at the Cancer and Blood Disorders Center  at Seattle Children’s Hospital, Seattle, Washington (email, March 2, 2020).

THE STUDY

Children with cancer have risk factors that lead to unique nutritional challenges, and malnutrition has been associated with worse outcomes. Dr Lulloff and her colleagues conducted a web-based survey composed of a demographic form, vignettes of patients with diverse nutritional status, and the New General Self-Efficacy Scale. The survey was sent to members of the Association of Pediatric Hematology Oncology Nurses (APHON) and each nurse was asked to rate their confidence in addressing nutritional issues.

Only registered nurses who provided direct clinical care to pediatric oncology patients for an average of 8 or more hours per week were included in the study. The researchers used demographic information as proxies for nursing clinical knowledge, education level, training, and nursing experience. A total of 15 patient vignettes were used to explore registered nurses’ decision making regarding nutritional assessment of children with cancer. The vignettes consisted of a nutritional rating, confidence in the rating, and selection of cues that support the nutritional rating.

A total of 318 participants consented to participate; the researchers were able to analyze data for nutritional ratings and confidence scores from 136 participants. The investigators had complete data for cue selection (the factors in the vignette the nurses considered to support their rating) from 94 participants. “Oncology nurses are better at recognizing when someone is undernourished, but less well at recognizing when someone is overnourished. More studies are reporting obesity is a problem for subsets of our patients and survivors. Studies are also demonstrating obesity at diagnosis or during treatment can lead to higher morbidity and mortality,” Dr Lulloff explained.