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Predictors of Hospitals' Nonachievement of Baseline Nursing Standards for Pediatric Oncology

Sullivan, Courtney E., MSN, APRN; Morrissey, Lisa, MSN, MPH, RN; Day, Sara W., PhD, RN, FAAN; Chen, Yanjun, MS; Shirey, Maria, PhD, MBA, RN, FAAN; Landier, Wendy, PhD, CRNP, FAAN

doi: 10.1097/NCC.0000000000000688
Article: PDF Only

Background The International Society of Pediatric Oncology established baseline standards for pediatric oncology nursing; limited evidence is available to predict hospitals' capacity to meet these standards internationally.

Objectives The aims of this study were to (1) determine the proportion of hospitals that met, partially met or did not meet baseline standards for pediatric oncology nursing and (2) identify predictors of hospitals' nonachievement of baseline standards for pediatric oncology nursing.

Methods/Analysis A secondary analysis of International Society of Pediatric Oncology web-based survey data of baseline nursing standards was conducted. Predictor variables were derived from surveyed hospital characteristics and external data sources. Multivariable parsimonious logistic regression models identified predictors of hospitals' nonachievement of each standard.

Results Nurses from 101 hospitals across 54 countries completed the survey; 12% to 66% of hospitals reported meeting each of 6 baseline standards. Predictors of nonachievement of standards included low current health expenditure as percentage of gross domestic product, World Health Organization Region of Africa, United Nations “developing or transition” country classification, countries with fewer than 3 nurses/midwives per 1000 population, and hospitals without bone marrow transplant and/or intensive care units.

Conclusions Hospitals with characteristics predictive of inability to meet baseline standards will likely require greater capacity-building support and advocacy to improve the quality of nursing care.

Implications for Practice Findings from this study highlight internal and external factors that challenge the delivery of high-quality pediatric oncology nursing care internationally.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Author Affiliations: School of Nursing, University of Alabama at Birmingham, Birmingham (Ms Sullivan and Drs Shirey and Landier); Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee (Ms Sullivan and Dr Day); SIOP Baseline Nursing Standards Taskforce, Geneva, Switzerland (Ms Sullivan, Ms Morrissey, and Dr Day); Inpatient Hematology/Oncology, Boston Children's Hospital, Massachusetts (Ms Morrissey); College of Nursing, University of Tennessee Health Science Center, Memphis (Dr Day); and Institute for Cancer Outcomes and Survivorship, School of Medicine, University of Alabama at Birmingham (Ms Chen and Dr Landier).

The authors have no conflicts of interest to disclose.

This study was supported by the University of Alabama at Birmingham School of Nursing Colvin Fellowship and the American Cancer Society's Doctoral Degree Scholarship in Cancer Nursing, awarded to Courtney E. Sullivan.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Correspondence: Courtney E. Sullivan, MSN, APRN, School of Nursing, University of Alabama at Birmingham, 1701 University Blvd, Birmingham, AL 35294 (

Accepted for publication October 1, 2018.

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