Oncology Nursing Society 32nd Annual Congress Podium and Poster Abstracts
The abstracts appear exactly as they were submitted and have not undergone editing or the
Oncology Nursing Forum
Editorial Board’s review process. If any errors or omissions have been made, please accept our apologies.
Abstracts that are not being presented do not appear.
1825
PLEURX CATHETERS VERSUS TRADITIONAL CHEST TUBES FOR
MALIGNANT PLEURAL EFFUSION: AN OUTCOMES MEASUREMENT.
Marie Swisher, MSN, RN, OCN
®
, Sidney Kimmel Cancer Center at
Johns Hopkins Comprehensive Cancer Center, Baltimore, MD; and
Emily Marshall, BSN, RN, Sidney Kimmel Comprehensive Cancer
Center at Johns Hopkins Hospital, Baltimore, MD.
The use of PleurX™ Pleural catheter, a long term indwelling cath-
eter for management of recurrent malignant pleural effusions (MPE)
was recently introduced in this NCI designated Comprehensive Can-
cer Center. Treatment of MPE was managed in the past by chest tube
(CHT) insertion and drainage often using video assisted thorascopy
(VAT) and mechanical and/or chemical pleurodesis, with varying
success rates. At our institution, CHT placement involved an admis-
sion to the hospital, average length of stay (LOS) of 6.5 days, at an
average hospital cost (HC) of $41,000. In addition, patients experi-
enced pain often requiring patient controlled analgesics (PCA). The
introduction of the PleurX™, which in previous studies allowed for
outpatient management, has offered another option in the manage-
ment of MPE for cancer patients. Previous studies have shown that
these catheters are effective at relieving dyspnea, decreasing HCs,
and reducing significant discomfort experienced by patients primar-
ily related to a smaller, more flexible PleurX™.
The purpose of this presentation is to describe this Cancer Center’s
experience using the PleurX™ during the first 12 months of imple-
mentation. This will include outcome measurements of LOS, HCs,
pain and use of analgesics, complications, and home management is-
sues in this group of patients’ compared to patients who had received
traditional CHT management.
An outcomes database was developed with approval of the Insti-
tution’s Internal Review Board (IRB). Outcome measures from an
equal group of patients managed with CHT and PleurX™ were com-
pared. A case scenario approach will be utilized to provide a review
of a typical patient’s PleurX™ treatment course.
An analysis of the outcomes measurements will be completed. Based
on these results, nursing recommendations will be developed and in-
cluded in patient & family and staff education about this new therapy.
As members of the multidisciplinary team, oncology nurses are in
a unique position to study the impact of new treatment modalities on
patients and associated nursing care. This review can help to quickly
adapt new teaching materials, not only for patients and their families,
but also for staff. Development of an ongoing database will allow for
continued monitoring of the effectiveness of this new technology.
cology nurses interface with basic scientists, physicians and comput-
er programmers to identify datapoints to be collected, their impor-
tance to disease initiation and clinical outcome, to work in building
the program and then test it.
As community hospitals become hybrids of private practice and hos-
pital-based physicians, data collection for research is difficult. Nurs-
ing is the commonality of all settings and centralizes data collection
between practices and the hospital itself. Whether finding an existing
program that will answer needs or building one, a multi-disciplinary
team is needed to get the right one and nursing is a key member.
The nursing representative was identified by the multi-disciplin-
ary team as the immediate contact and “go-to” person for questions
and testing of models. All information to be collected was discussed
between clinicians, basic scientists and the nurse and then formatted
into spreadsheets for use by the computer programmers. As the sys-
tem became functional, the nurse populated the system with practice
patients to test the system for: ease of data input, availability of data
in routine MD charting and querying the data for missing datapoints
and expected research questions.
Oncology clinical research requires specialized knowledge to un-
derstand the unique patient populations and the many endpoints that
can be used to evaluate cancer treatments. The Clinical Cancer Ana-
lytic Research Database (CCARD) was developed to collect data on
6 disease sites, with a focus on the data being information needed to
answer potential questions for combined investigator-initiated basic
science and clinical research. Additional sites will be added as time
and needs arise.
As community hospitals grow, many begin to adopt an academic
model, which includes investigator-initiated research. Building re-
search programming that responds to the needs of basic scientists
and clinical physicians needs a point person who has knowledge that
bridges the knowledge realms of computer programmers and cancer
specialists. The oncology nurse fits that role best, as someone who
can speak to clinical issues in lay-person terms.
1847
1841
DEVELOPMENT OF A HOSPITAL-BASED CLINICAL RESEARCH DATA-
BASE. Rosemarie Tucci, RN, MSN, AOCN
®
, Lankenau Hospital, Wyn-
newood, PA.
Investigator-initiated oncology research in a community hospital
requires data collection best completed with nursing oversight. On-
LDI: THAT’S ONE SMALL STEP FOR A NURSE, ONE GIANT LEAP FOR
A CANCER CENTER. Camille Servodidio, RN, MPH, CRNO, OCN
®
,
CCRP, Hartford Hospital, Hartford, CT.
Leadership Development Institute (LDI) provided the opportunity,
motivation, and the skill set for one nurse fellow to work with cancer
nursing colleagues on a yearlong project.
The purpose of the LDI project was to develop and implement a
rewards and recognition program for certified oncology nurses in a
community hospital’s cancer center. No formal certification recogni-
tion program was in place. Implementing a change in hospital setting
can parallel the landing on the moon.
A needs assessment survey was developed and distributed to 50
nurses in the cancer program. 19 (38%) of the surveys were returned.
Cancer program nurses identified plaques and pins as two of the pre-
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ferred recognition items. During Nurses’ Week, nursing leaders threw
a mocktail party (cocktails without the ETOH) and the Vice President
of Nursing and Cancer Center Director distributed OCN
®
pins to certi-
fied nurses. Certified nurses were also recognized for their accomplish-
ments during tumor board. Names of certified nurses were published
in Nursing Spectrum. Perpetual plaques were ordered for each unit to
recognize certified nurses. ONCC employer recognition plaques were
ordered for the three units that had greater than 50% of nurses certi-
fied. A “100% party” was held to recognize the three units that had
achieved 100% OCN
®
certification. Certified nurses were highlighted
in cancer program newsletter, hospital newsletter, and health care team
newsletter. The 2007 ONCC Employer Recognition Award applica-
tion for recognizing certified nurses was submitted.
Small steps as outlined above, when taken together, play an important
role in moving an entire cancer center forward through improved pro-
fessionalism, morale, and celebration. Senior nursing administration
has supported this project and has agreed to financially support OCN
®
review course as well as the OCN
®
test for those who pass. This con-
cept has also been adopted by other departments within the hospital.
Similar to the first landing on the moon, this project is the begin-
ning of a much larger vision. To value certification is to value profes-
sional oncology nurses who take the challenge, make the leap, and
positively impact oncology patient care.
The challenge to shift our nursing culture from “traditional” to EBP
was exciting. We look forward to evaluating the impact on oncology
nursing practice and patient outcomes in the coming year.
1858
1856
ALL A-BOARD: THE EVIDENCE BASED PRACTICE JOURNEY. Cynthia
Briola, BS, RN, OCN
®
, Andrea M. Barsevick, DNSc, RN, AOCN
®
, Karon
Martyn, RN, BSN, OCN
®
, Nancy Fell, RN, OCN
®
, Kathleen MacDonald,
RN, BSN, OCN
®
, and Therese Innamarato, RN, OCN
®
, Fox Chase Can-
cer Center, Philadelphia, PA.
Among all health care disciplines, the value of basing health care
practice on high quality evidence is unchallenged. However, due to
wide variation in educational programs of recent RNs and high numbers
of experienced nurses without education about evidence-based practice
(EBP), many nurses do not know how to engage in this practice.
The EBP Council at a comprehensive cancer center accepted the
challenge and planned mandatory EBP education for all RNs. The
goals of the program were to: 1) support a culture shift from “tradi-
tion” toward EBP, 2) educate nurses about EBP principles, 3) in-
crease nurses’ comfort accessing EBP resources, and 4) incorporate
evidence into clinical practice.
A four-phase educational program began in January 2006. In Phase
I, a nurse educator presented an overview of EBP including basic prin-
ciples. Embracing EBP includes the development of a new skill set.
In Phase II, EBP Council members conducted an interactive guided
poster presentation of five EBP nursing projects. Small groups of
nurses gathered around each poster; council members used a question-
answer approach to conduct discussion of each project. In Phase III,
librarians introduced nurses to EBP resources such as online search
engines and taught principles of conducting a search using nursing
examples. In Phase IV, groups of nurses will conduct unit-based EBP
projects, with all nursing staff encouraged to participate. To assist the
units, guidelines are available; EBP Council members will assist with
projects. Topics will be identified by January, 2007 and completed by
April 2007. Posters will be displayed in April and May 2007.
Attendance at mandatory sessions is being computed. Education
on demand or by taped-video sessions will ensure that future nursing
staff will be brought up to date. Criteria for evaluation include the
number of clinical areas and the number of nurses on each shift who
participate. Evaluation criteria for posters will include formulation
of a search question, evaluation of level of evidence, and integration
into clinical practice.
REDUCING NOISE LEVELS ON A BUSY ONCOLOGY UNIT. Kira Rash-
ba, BSN, RN, and Reedy Anita, RN, MSN, OCN
®
, Johns Hopkins Hos-
pital, Baltimore, MD; and Ilene Busch-Vishniac, PhD, James West,
PhD, and Mark McLeod, Johns Hopkins University, Baltimore, MD.
Hospital noise levels have increased in recent years. This is par-
tially attributed to technology such as monitors, infusion pumps and
bed alarms. Alarms, combined with call systems and staff conver-
sations, make for a noisy environment. The World Health Organi-
zation (WHO) and Environmental Protection Agency recommend
noise levels less than 40-45 decibels (dB) during the day and 35dB
at night. Elevated noise levels make it difficult to hear conversations
between health care providers, increasing the risk for medical errors.
Higher noise levels also cause stress among health care workers and
patients have difficulty resting. Oncology units are at a particular
disadvantage as a result of infection control practices requiring hard
surface materials.
Noise level on this busy NCI-designated comprehensive cancer
center’s hematology oncology unit was irritating and caused difficul-
ty on morning rounds and throughout the day. Patients complained
of seemingly constant alarms, intercom calls and voice noise. Noise
levels on the unit were measured at 70dB, about that of a street car
passing, well above the WHO recommendations. The purpose was to
decrease sound levels on the unit.
Noise reduction panels were designed by acoustical engineers and
were approved by nursing, infection control and housekeeping. Two
inch fiberglass pieces were covered with sound absorbing materials
and were installed on walls and ceilings of work areas. Panels were
designed to be easily removed and cleaned.
Acoustical engineers measured noise levels before and after the in-
stallation of noise panels. Quantitative and qualitative measures were
taken: noise levels and reverberation times were measured and patient
and staff surveys were completed. Quantitative measures showed that
after sound panel installation noise levels dropped by more than 15
dB and reverberation times decreased by nearly a factor of three. Both
staff and patient surveys demonstrated a lessened perception of noise.
After installation of noise reduction panels, both patients and staff
realized a new, quieter environment. Hospitals can intervene to de-
crease the amount of environmental noise, thus decreasing the risk
of medical errors, stress of staff and interruption of rest in the hos-
pitalized patient.
1859
INCREASING PATIENT WOC NURSE RESOURCES IN AN ERA OF
COST CONTAINMENT. Constance Ellis, MS, RN, CWOCN, OCN
®
, Uni-
versity of Texas M.D. Anderson Cancer Center, Houston, TX.
This poster/podium presentation will discuss how two Wound, Os-
tomy Continence nurses as a major oncology institution extended
the services of the certified WOC nurses at their institution and in
their community. This information should serve as a guide for other
nurses facing the same problem. The problem, an increase in the
demand for the expertise of the WOC nurses services and the lack
of educated nurses or time or funds to send them to the WOC Nurse
Education Programs, led to the development and presentation of a
“Basic Ostomy and Wound Care Workshop” (Bows).
These 8 hour workshops were designed and marketed (via inhouse
brochures, free journal advertising, and the internet)to nurses in hos-
pital, outpatient, long term care, and home care settings of the Hous-
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ton metroplex. The course fee of $75 covered a continental break-
fast, lunch, course materials and CNE credit.
The content of the workshop was divided into 2 four hour seg-
ments. The AM portion focuses on ostomy care covering general
principles of assessment and management of patients undergoing
GI and GU ostomy surgery. Suggestions are given for dealing with
simple stoma and peristomal complications. Each participant pre-
pared and wore a pouch until the end of the day. The second segment
reviewed basic wound assessment, management and documenta-
tion focusing on pressure ulcers and lower extremity ulcers. Using
a gaming technique/case study, wound care products were reviewed
and the participants were rewarded prizes for their participation.
BOW’s has now been presented 10 times with 200 nurses attend-
ing. Informal surveys of certified WOC nurses in hospital and non-
hospital settings report an increased number of patient needs being
met in a more timely manner, decreased stress of the CWOCNs and
increased job satisfaction in the newly educated nurses.
Our oncology patients being treated with surgical interventions
such as ostomies have psychosocial and physical needs require
knowledgeable and skilled nurses. These workshops open the door
to resources for those nurses and encourage them to develop new
skills for their patients.
grams need to be ongoing in nature and nurses must be supported as
they reframe their concept of sexuality and engage in a new skill.
Research that identifies strategies to enhance perceived facilitators
and decrease perceived barriers related to nurses’ assessment of pa-
tients’ sexuality concerns should continue to be an essential goal for
nursing.
Funding Source: Oncology Nursing Society
1877
1865
SEXUALITY AND CANCER: HOW ONCOLOGY REGISTERED NURS-
ES ASSESS PATIENTS’ SEXUALITY IN CLINICAL PRACTICE. Joann
Mick, RN, MSN, MBA, AOCN
®
, UT M.D. Anderson Cancer Center,
Houston, TX.
Sexuality can be negatively affected by cancer when illness or
treatments cause disturbances in self-concept and/or body image or
result in difficulties with sexual function.
A diagnosis of cancer raises critical issues regarding sexuality that
must be assessed, including: motherhood, fatherhood, femininity,
masculinity, and fertility.
A hermeneutic phenomenological approach was used to explore
oncology nurses’ experiences of performing sexuality assessments
when caring for oncology patients.
The research was conducted at a large, comprehensive cancer cen-
ter in the southwest United States. Data were gathered through a se-
quence of audio taped interviews of 20 practicing oncology nurses,
which were transcribed and analyzed.
Study results revealed that sexuality assessment is a dilemma that
nurses face in their practices. Most nurses verbalized understand-
ing of the importance of sexuality assessment. While nurses were
able to ask patients for information about many other sensitive is-
sues, personal constraints often prevented them from addressing the
topic of sexuality. A list of identified, often self-imposed, barriers
was revealed that prohibited nurses from assessing patients’ sexual-
ity. Nurses’ practices regarding sexuality assessment occurred in a
milieu that consisted of their conceptualization of sexuality, personal
world-views, and individual efforts to search for a comfort level that
would make discussing sexuality more feasible. Most nurses openly
admitted they did not do a good job with sexuality assessment. Some
nurses were able to offer ideas or suggestions to improve nursing
practice with the sensitive topic of sexuality.
Evidence derived from this study indicated that simple, short term
educational programs will be ineffective in overcoming the major
barriers that nurses identified regarding the opportunity and ability
to initiate sexual assessment. Programs to increase sexuality assess-
ment must address factors, such as nurses’ personal comfort with
sexuality, individual knowledge levels, and language skills to enable
routine initiation of dialogues with patients about sexuality. Pro-
PELVIC AND VAGINAL RECONSTRUCTION: THE ROLE OF THE AM-
BULATORY CARE ONCOLOGY NURSE. Nasrin Vaziri-Kermani, RN,
CPSN, Memorial Sloan-Kettering Cancer Center, New York, NY.
Certain advanced cancers of the vagina, ovaries, rectum, and vulva
require extensive surgical resection which often leaves the patient
with a large surgical defect in the pelvic, perineal, and vaginal region
along with emotional scarring. Specialized reconstructive proce-
dures are now available to correct the surgical defect. Patients under-
going these complicated procedures require extensive preoperative
and postoperative education and psychosocial support. Oncology
nurses play an essential role in helping patients and their families
meet these needs and in insuring they have a smooth transition from
their hospital stay to their home care setting.
Oncology nurses must be well informed about the complex issues
related to pelvic resection followed by pelvic and vaginal recon-
struction to provide optimal patient care. Experienced nurses play an
important role in sharing their knowledge and educating those nurses
who have less experience with regard to the numerous physical, psy-
chosocial, and educational needs of these patients. This presentation
will describe how nurses can best meet the needs of these patients.
Nursing interventions focus on continuous physical and psycho-
social assessment and patient and family education. Nurses need
to prepare patients for what to expect postoperatively and how to
care for themselves at home. Issues surrounding potential changes
in body image, physical and sexual activity, and altered sensation
at the surgical sites need to be reviewed. Depending on the specific
surgical procedure, education in ostomy and urostomy care may be
indicated as well as care of the flap. Patients should be aware of
potential complications including ileus, flap loss, and infection. Pa-
tients are also at high risk for developing emotional problems includ-
ing depression, anger, or disappointment and may require a referral
for counseling.
Upon patient discharge, the nurse makes frequent follow-up phone
calls and schedules postoperative visits as needed to allow ongoing
evaluation of the patients’ physical and emotional progress and to
make appropriate referrals as indicated.
This information will provide oncology nurses with a more thorough
understanding of the specific needs of this patient population and the
appropriate nursing intervention to adequately meet these needs.
1880
IMPROVING THE QUALITY AND SAFETY OF CARE FOR PATIENTS RE-
CEIVING HACE. Jean Imler, RN, Queen’s Medical Center, Honolulu, HI;
Carrie Guyette, BSN, Oregon Health and Science University, Portland,
OR; and Joanne Itano, PhD, University of Hawaii, Honolulu, HI.
Hepatic artery chemoembolization (HACE) is commonly used to
treat unresectable hepatocellular carcinoma (HCC). To many oncol-
ogy nurses, HACE is an infrequent treatment procedure with a com-
plex pre-procedure protocol requiring a high degree of coordination
with the MD office, radiology, IV team, pharmacy and nursing staff.
This categorizes HACE as a low volume, high risk procedure.
Increase the quality and safety of care for patients receiving HACE
by improving nursing staff knowledge of the care of patients receiv-
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ing HACE. The PDCA (Plan, Do, Check, Act) model was used to
guide this project.
Based on extensive review of literature, a 30 minute in-service was
prepared on liver cancer, its treatments, and nursing care of the pa-
tient receiving HACE pre- and post-procedure and important dis-
charge instructions. The in-service was presented 3 times covering
all shifts and 50% of the nursing staff attended. Food was provided
to encourage attendance.
Evaluation consisted of a pre and post test and a demographic sec-
tion to gather data on years of experience and previous experience with
HACE patients. The pre and post test measured knowledge related to
the care of patients receiving HACE. There was a 34% increase from
pre to post test scores. The data was also analyzed by years of nursing
experience and prior experience with patients receiving HACE. An
increase in knowledge in all groups was observed.
Based on the success of this project, the care of the patient receiv-
ing HACE has been added to the annual competency assessment of
all RN staff and to the orientation check list for all new RN hires.
A copy of the in-service materials was provided to all staff and the
author is identified as the unit resource. The next step is to meet
with the radiology scheduler, MD offices and bed control to ensure
timely admission of patients receiving HACE. The final phase will
be to monitor the impact of this intervention on patients admitted for
HAC, i.e. delay in procedure, increased length of stay and increased
time spent by nursing staff to coordinate care.
1881
DEVELOPMENT OF A TEACHING TOOL FOR PATIENTS RECEIVING
BRACHYTHERAPY RADIATION AND NON-RADIATION NURSES.
Donna Stamatis, RN, BSN, OCN
®
, and Sheila Brown, RN, BSN, OCN
®
,
Mass General Hospital, Boston, MA.
Brachytherapy or high dose radiation has been around for 15-20
years. With new technology it is now done in an outpatient setting.
Due to these changes, nurses in general have very little experience
with the new technology. There was a need for communication be-
tween radiation nurses and others in the cancer center.
To provide communication through a teaching model on radiation
brachytherapy for nurses who care for these patients as they travel
through the cancer center. Developed booklet for teaching. These
were implemented for teaching patients with cervical, endometrial,
and prostate cancers. The ability to provide information to nurses
outside of radiation oncology in order to work collaboratively.
Teaching tool proved invaluable to patients and non-radiation nurs-
es. Patients had better understanding of their treatment and potential
side effects. Nurses felt more comfortable with this population and
were better able to understand side effects and symptom manage-
ment.
Patients receiving brachytherapy require teaching and symptom
management which will provide continuity of care throughout the
cancer center. This requires knowledge and understanding of all in-
volved in their care.
col containing specific drug information, standing orders, and a kit
containing emergency medications and supplies.
The purpose of this project was to evaluate nursing staff knowledge
about, use of, and satisfaction with a protocol to manage hypersensi-
tivity/anaphylactic reactions to antineoplastic agents. The protocol,
which includes a requirement to enter an event report for tracking
purposes, was developed by pharmacy and approved by the medical
and nursing leadership of a large outpatient cancer treatment center
in Western New York/Finger Lakes Region.
Data was obtained from nursing staff via an anonymous self report
survey. Response rate was 100% (N=18). Questions included knowl-
edge of protocol, use of protocol in the last 6 months, and perceptions
of change in practice since implementation of the protocol. Addition-
ally, event reports for all hypersensitivity/anaphylactic reactions were
reviewed in the six months since protocol implementation (N=26);
agents were 38% rituximab, 35% taxanes, and 27% others.
The majority of nurses (67%) reported having read the protocol
and knew the location of the protocol and kit. The majority of nurses
(89%) reported that the protocol allows for faster administration of
emergency treatments, has increased their awareness of potential for
reaction (72%), and has increased their comfort level with admin-
istering chemotherapy/biotherapy (77%). Twelve nurses (67%) re-
ported caring for a patient with a reaction in the past six months, 11
acknowledged using the protocol and 10 entered an event report.
Survey findings indicate the nursing staff are satisfied with the pro-
tocol and report a positive impact on their practice. Staff use of the
protocol and the generation of an event report needs to be increased
to 100% of the time when a patient experiences a reaction. Overall,
implementation of the protocol has been successful, and further edu-
cation will be provided based on project results.
1890
1883
IMPLEMENTING AN ANTINEOPLASTIC HYPERSENSITIVITY PROTO-
COL: A NURSING PERSPECTIVE. Carol Williams, RN, BSN, OCN
®
, and
Shannon Phillips, MS, RN, AOCNS, James P. Wilmot Cancer Center,
Rochester, NY.
Many cancer patients receive medications that have the potential to
cause hypersensitivity or anaphylactic reactions, specifically certain
chemotherapy and biotherapy agents. Efficiently managing these re-
actions is critical to the prevention of patient injury or death. This
management can be accomplished by providing nurses with a proto-
ASSESSING NURSES’ ATTITUDES TOWARD DEATH AND CARING
FOR DYING PATIENTS. Michelle Lange, BSN, RN, OCN
®
, Bridgette
Thom, MS, and Nancy Kline, PhD, RN, CPNP, FAAN, Memorial Sloan-
Kettering Cancer Center, New York, NY.
Oncology nurses care for patients in all stages of disease, from
diagnosis to death. Patients at end of life present unique challenges,
from both emotional and physical perspectives. As previous research
suggests, implementing an educational program tailored to oncology
nurses’ needs may be useful in helping to provide quality end of life
care. However, prior to designing, testing, and implementing such a
program in a hospital setting, it is necessary to first determine how
the nurses employed there feel about caring for dying patients.
The purpose of this study was to gain insight into the issues that af-
fect, challenge, and concern oncology nurses when caring for dying
patients, and to make recommendations for an appropriate educa-
tional intervention to be developed and tested.
The Nursing Role Effectiveness Model is based on the structure-pro-
cess-outcome model of quality care. The model analyzes the nurse and
patient variables that may impact nurses’ role performance and subse-
quently influence patient outcomes. Nurse structural variables, such as
education and work experience, are shown to have positive effects on
communication, contributing to improved patient outcomes.
Registered nurses employed throughout the hospital were invited
to complete anonymous, voluntary surveys that consisted of two
valid and reliable instruments, the Frommelt Attitude toward Care
of the Dying scale (FATCOD form B) and the Death Attitude Pro-
file Revised (DAP-R), and a brief demographic questionnaire. The
Kruskal-Wallis and the Mann Whitney U tests were used to compare
differences among demographic groups, with post-hoc testing using
the Tamhane and Dunnett T3 tests.
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Preliminary findings indicate that age and years working at the in-
stitution appear to be strong influences on attitudes towards death
and caring for dying patients. RNs with previous work experience in
caring for dying patients have a more positive attitude toward caring
for these patients, while less positive attitudes toward caring for dy-
ing patients correlated with more fear and avoidance toward death. If
the results remain consistent at the time of final analysis, recommen-
dations for an end-of-life educational program will be developed.
1894
MANAGEMENT OF TRIAPINE-INDUCED METHEMOGLOBINEMIA: A
CASE STUDY. Aiko Kodaira, RN, MS, OCN
®
, and Maura Kadan, RN,
BSN, Johns Hopkins Hospital, Baltimore, MD.
Triapine is a novel ribonucleotide reductase inhibitor that has been
tested in various phase I and II clinical trials to treat both solid tumor
and hematological malignancies. Triapine administration can cause
methemoglobinemia, and can be detrimental in people with G6PD
deficiency. On the leukemia unit at this NCI designated Compre-
hensive Cancer Center, nurses became aware of several significant
cases of hypoxemia accompanied by transient methemoglobinemia
in patients without G6PD deficiency. In these patients, the monitor-
ing parameters and optimal management for this altered state of he-
moglobin have not been determined. Clear guidelines for managing
these patients are necessary.
The purpose of this case study is to identify and explore key fac-
tors of nursing management for triapine induced methemoglobin-
emia in patients with myeloproliferative disorders (MPD), chronic
myelogenious leukemia in accelerating phase (CML-AP) or blast
crisis (CML-BC), and aggressive chronic myelomonocytic leukemia
(CMML) in order to prevent, monitor, and manage the symptoms.
One patient’s episode of triapine-induced methemoglobinemia is
used as an example to highlight the major challenges in managing this
issue in the above patient populations. A literature review was con-
ducted to obtain existing information regarding this complication.
Throughout the case study, the patient’s symptoms, oxygen re-
quirements, lab values, and medical and nursing interventions are
analyzed. It is clear that management of methemoglobinemia is par-
ticularly challenging in these patients due to the high number of blast
cells and associated anemia.
In this patient population, some unique issues, such as leukostasis,
hyperleukocytosis-associated anemia, limitation of red blood cell
transfusion, and the increased tendency of capillary leak emerged. Ad-
ditional questions, such as whether or when a serum methemoglobin
level should be checked, or when the antidote - methlyene blue - should
be administered, are also discussed. This case study provides nurses
an opportunity to learn about this lesser known, but serious, side effect
of triapine. It also provides nurses with the chance to critically ana-
lyze these phenomena in this highly unique and complicated patient
population, and to standardize the interventions for a more consistent
approach in managing triapine- induced methemoglobinemia.
nursing care includes providing patients with a realistic expectation
of recovery based on evidence.
Study objectives included: determining the duration and intensity
of pain and interference with activities at 4 and 8 weeks after TRAM
breast reconstruction; identifying interventions which aid in recov-
ery; and determining the effect of nursing education/information on
the nurse sensitive patient outcome of patient satisfaction.
Roy’s Model of Adaptation provided the conceptual framework.
Providing patients with evidence-based information and effective
pain management should promote adaptation while lack of knowl-
edge and prolonged pain could lead to maladaptive responses and
delay recovery.
A convenience sample of 25 women who had TRAM reconstruction
breast surgery agreed to participate in the study; this report includes 16
participants who provided complete data. The self-administered “Base-
line Assessment of Pain” and physical therapist-completed “Physical/
Occupational Therapy Assessment” (POTA) instruments were used to
collect data pre-operatively. An “Assessment of Recovery Post-TRAM
Flap Breast Surgery” questionnaire was completed at 4 and 8 weeks.
The POTA was completed again at 8 weeks. Information such as pain
sites, pain intensity, and pain interference with seven areas of function-
ing were measured. Variables including previous back pain and type of
surgery (free versus pedicled; immediate versus delayed) were mea-
sured. Descriptive statistics and t-tests were used for analysis.
Most women had higher than baseline pain and interference scores
4 weeks after surgery; scores at 8 weeks were almost back to base-
line. Significant findings revealed that abdominal pain was higher for
women with free TRAMs (p=0.027) and women with previous back
pain reported more lower back pain (p=0.02). Opiods, followed by
NSAIDs, were the most common intervention used to relieve pain.
Patients were overwhelming satisfied with the information provided
by the nurse. Nurses can positively influence patient outcomes by
educating patients about typical recovery and useful interventions.
1902
1896
ASSESSMENT OF RECOVERY POST TRAM (TRANSVERSE RECTUS
ABDOMINIS MYOCUTANEOUS) FLAP BREAST SURGERY. Deena Dell,
MSN, RN, AOCN
®
, BC, Carolyn Weaver, MSN, RN, AOCN
®
, Jeannie
Kozempel, PT, MS, and Andrea Barsevik, RN, DNSc, AOCN
®
, Fox
Chase Cancer Center, Philadelphia, PA.
Preparing patients about what to expect after TRAM flap breast
reconstruction is critical to recovery. A literature review revealed a
lack of studies examining recovery. Patients are usually told that they
will be able to return to previous activities in 6 to 8 weeks although
the evidence base for this prediction is lacking. Quality, effective
DEVELOPMENT OF AN ONCOLOGY-SPECIFIC DISCHARGE FORM:
SMOOTHING THE TRANSITION BETWEEN HOSPITAL AND HOME.
Anita Grenier, RN, OCN
®
, Duke University Health System, Durham, NC.
Discharge needs of hospitalized medical oncology patients are of-
ten very complex. The nursing staff of our unit believed the generic
discharge form provided to patients was inadequate in documenting
patient needs and education provided. We felt that a form specific to
the needs of oncology patients would improve the patient and care-
giver’s ability to manage at home after hospitalization. Identifying
key information for review aids nurses in providing consistent and
continuing education upon discharge.
According to Press Ganey survey results, patient satisfaction scores
on the discharge process and readiness for discharge had declined July
2005 – January 2006 from 95% to 78%. Believing prepared patients
are more satisfied, it was decided to pursue a project to increase patient
and caregiver knowledge of and compliance with post hospitalization
care. This poster describes a specialized oncology discharge form cre-
ated to ensure consistency in oncology nursing practice and evaluate
the patient’s comprehension level at the time of discharge.
After reviewing a similar form used by a cardiology unit, the form
was modified to address the needs of the oncology population. The
content is comprised of unit educational resources including literature
from the National Cancer Institute and clinical pharmacology materials,
and includes standardized sections (“Education”, “Post-Chemotherapy
Instructions” and “When to Call”) unique to individual patient needs. A
draft of the discharge form received favorable reviews from unit staff as
well as the hospital oncology clinical practice council (CPC).
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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The completed document was reviewed and endorsed by the hos-
pital oncology CPC and unit medical director. Fellow staff members
verbalized their concerns/suggestions and appropriate changes were
made. Press Ganey scores showed a 5-8% increase after the form was
implemented. Additionally, a telephone survey showed overwhelm-
ingly positive responses, with 85% stating they felt very prepared to
care for self at home after discharge.
By focusing on the individualized needs of oncology patients, we
have created a consistent and satisfying approach to preparing pa-
tients and families for their return home after treatment. Other on-
cology nurses may use similar approaches to increase patient satis-
faction by providing consistent and continuing education to patients
upon hospital discharge.
1910
OUTCOMES OF ONCOLOGY NURSING CRITICAL CHECKS. Patricia
Geddie, RN, MS, AOCNS, M.D. Anderson Cancer Center Orlando, Or-
lando, FL.
Nurses responsible for administering antineoplastic agents, man-
aging treatment related side effects and emergencies are required to
have specialized expertise and clinical competency to deliver care
in a safe and appropriate manner. Over the years, the number and
categories of agents and side effect profiles have increased. Nurses
entering into the specialty of oncology nursing can be overwhelmed
by the amount of clinical knowledge, competency and responsibility
that they are expected to possess.
To reduce the number of oncology care related errors and im-
prove nursing satisfaction by providing a concise checklist, “Critical
Check” for the delivery of treatment and care management of oncol-
ogy patients.
Critical checks were written and developed by Oncology Clinical
Nurse Specialist to provide a check list for common procedures and
care issues for oncology patients: Chemotherapy administration,
spills and extravasations; Radiation therapy; Neutropenia, Ane-
mia, Thrombocytopenia; and Oncologic Emergencies. The Critical
Checks are provided and discussed in the oncology nursing courses
and are also available for printing on the hospital’s intranet oncology
nursing site. At the bottom of each critical check, a statement is in-
cluded that the critical check is not all inclusive and refers the nurse
to seek out more information is needed.
Verbal feedback from nurses have indicated that the critical
checks are a useful tool to guide them in the care of the oncol-
ogy/hematology patient. The hospital’s computer department was
not able to track the number of nurses who accessed the critical
checks on the intranet site. The oncology critical checks have been
in existence since 2002. The critical checks have been re-evaluated
and updated by a committee of oncology nursing staff, educators
and advance practice nurses for content and relevance. In 2006, the
hospital’s intranet dedicated a site for all nursing critical checks
and other nursing disciplines have posted their critical checks there
as well.
Critical checks for oncology nursing care are a way to provide
standard and organized information about essential steps to provide
and deliver care. A committee of advanced oncology practice nurses,
staff nurses, educators and leadership must be committed to the on-
going evaluation and updating of the information.
RN, PhD, St. Joseph Hospital of Orange, Orange, CA; and Siu-Fun
Wong, Western University, Pomona, CA.
Approximately 85% of lung cancer is attributed to cigarette smok-
ing. Smokers offered advice from a nurse were 50% more likely to
quit compared with smokers not offered such advice. Very few pro-
grams are available to empower nurses to provide tobacco cessation
education to patients, and few nurses have been exposed to such con-
tent in their nursing education.
To describe a training program designed to educate bedside nurses in
a community hospital with tools, knowledge and confidence necessary
to provide patients with initial tobacco cessation interventions.
Rx for Change: Clinician-Assisted Tobacco Cessation Program,
designed for pharmacy schools as a 7-8 hour curriculum, was modi-
fied into a 3 hour program, incorporating both lecture (behavioral
counseling and pharmacotherapy) and role-playing. The training
program, taught by an oncology nurse and a pharmacist, is tailored
for inpatient nurses and emphasizes the first four of 5A’s (Ask, Ad-
vise, Assess, Assist, Arrange).
A pilot study from one training session with 20 nurses showed
that nurse attendees had good to very good ratings of overall ability
to help patients quit tobacco and that 49% found the information
to be completely new. At 6 months follow-up, all respondents had
counseled or referred at least one patient to a quit smoking program.
The pilot indicated that knowledge gains were not maintained over
6 months.
Knowledge may be improved by adding some method of refresher
information to help with knowledge retention. This course will be
a mandatory inservice for all nurses at the community hospital; ap-
proximately three years will be required to educate all nurses. Nurs-
es taking the course during 2007 will be invited to participate in a
1 year clinical trial evaluating the effect of a pretest on knowledge
and attitudes. This presentation will describe the modified Rx for
Change course.
1913
1911
IMPLEMENTING A TOBACCO CESSATION TRAINING PROGRAM FOR
STAFF NURSES IN A COMMUNITY HOSPITAL SETTING. Pamela Mat-
ten, RN, OCN
®
, St. Joseph Hospital of Orange, Orange, CA; Eunice
Chung, PharmD, Western University, Pomona, CA; Dana Rutledge,
NURSING RECOGNITION & RETENTION: HOW ONE UNIT RECOG-
NIZES AND PROMOTES ONCOLOGY NURSING CERTIFICATION.
Anna Giallo-Uvino, RN, BSN, OCN
®
, Suzanne Sweeney Gornell, and
Mary G. Boyle, RN, Memorial Sloan-Kettering Cancer Center, New
York, NY.
Oncology nurses at a comprehensive cancer center identified a
need to promote certification among its nursing staff. Although a
number of nurses had obtained the certification, an equal number of
nurses were not certified. With the increasing complexity of cancer
treatments, certification provides a measure of excellence.
Developing a formal process of recognizing and encouraging nurs-
es to become certified helps with job satisfaction and retention. This
presentation will describe the steps taken to acknowledge oncology
nursing certification and in effect enhance the oncology nurses’ pro-
fessional development in one outpatient department.
As part of the shared governance committee structure, the Recruit-
ment, Recognition and Retention Committee was formed in 2006.
One of the goals of this task force was evaluating the number of
certified nurses in the facility. We surveyed the nurses in our geni-
tourinary medical oncology and urology department via an email
questionnaire. Results indicated that 21 of 42 staff nurses are certi-
fied in oncology nursing. To recognize this achievement, three of the
outpatient nurses organized a number of activities such as obtaining
a certification plaque from the Oncology Nursing Certification Cor-
poration (ONCC), a plaque dedication party, and public recognition
of the nurses’ accomplishments in the Nursing Spectrum. Our plaque
is displayed in our lobby for all patients to see.
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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Certification in oncology nursing is a specific way to ensure that
nurses have the education, skill and knowledge to practice in a com-
petent manner. Certification promotes professional development,
opens doors to new career opportunities, and is valued by employers
and patients. By highlighting the accomplishments of the depart-
ment’s certified nurses, we can promote and mentor more nurses to
pursue their certification.
OCN
®
certification is a professional achievement that nursing ad-
ministration believes in and supports. Encouraging dialogue of the
process between staff, posting deadlines for the test and the appli-
cation process, time off for test taking, a hospital approved review
course are ways to support staff in this endeavor. This project, though
small in scale resulted in positively affecting the pursuit of oncol-
ogy nursing certification. Since the project’s initiation, 3 additional
nurses in our unit have successfully taken the test.
cancer education and improves access to appropriate cancer care and
support services. A successful cancer telenursing program enhances
communication between health professionals and the community and
serves as an integral element of the cancer care delivery system.
1917
1914
EYE ON THE COMMUNITY: THE ROLE OF A CANCER TELEHEALTH
NURSING SERVICE IN IMPROVING PATIENT AND FAMILY EDUCA-
TION, ACCESS TO RESOURCES AND CLINICAL TRIAL ENROLLMENT.
Rebecca Eggleston, RN, OCN
®
, University of Michigan Health System,
Ann Arbor, MI; and Kimberly Zapor, RN, BSN, OCN
®
, Annette Schork,
RN, BSN, OCN
®
, and Jean Campbell, RN, University of Michigan Can-
cer AnswerLine, Ann Arbor, MI.
Individuals who have been diagnosed with cancer as well as their
family members and friends often seek a comprehensive resource
for cancer information, and may need assistance in navigating the
cancer care delivery system. Cancer AnswerLine, a cancer telenurs-
ing service, invites those affected by a cancer diagnosis to call toll
free or submit an online request to communicate with an experienced
oncology nurse.
The purpose of this poster presentation is to describe the impact
of a singular cancer telenursing service on the patient, and health
professional cancer community.
Established in 1995, Cancer AnswerLine has been marketed through
print, radio, web and outdoor venues with the vision of increasing
public awareness of a trusted and unique community service avail-
able for information seekers with questions about cancer prevention,
diagnosis, treatment and access to clinical research. Those seeking
information need not be patients at the University of Michigan. Pro-
gram requirements include an established risk management, policy
and procedures program, HIPPA compliant software for interaction
documentation, and a secure online email database protecting sensi-
tive patient health information. Nurses staffing Cancer Answerline
have extensive oncology background, and are expected to be familiar
with and comprehend current cancer related issues, pursue oncology
continuing education credits, and oncology nursing certification. As-
sessment of service and value to the cancer community has been
measured through direct mail customer satisfaction survey, spoken
and written comment, established partnerships, benchmarking, and
data captured through both telephone and software functionality.
Collection and interpretation of data evaluating the overall impact
of Cancer AnswerLine on the community is in progress. Data rep-
resenting caller demographics, reason for call, cancer site, number
of cancer related service and clinical research referrals, total call/
email volume, and patient/family direct mail survey results will be
presented. Also provided will be substantiation of our collaboratory
relationships and benchmarking experiences within the health pro-
fessional community.
A cancer telenursing service offers the cancer community a unique
opportunity to receive information tailored to specific need from an
experienced oncology nurse. It fulfills the public need for reliable
GENDER AND ETHNICITY: ARE THEY INFLUENCING CANCER PAIN?
Eun-Ok Im, PhD, MPH, RN, FAAN, Wonshik Chee, PhD, Enrique Gue-
vara, MSN, Yi Liu, MSN, and Hyun-Ju Lim, MSN, University of Texas
at Austin, Austin, TX; and Hsiu-Min Tsai, PhD, Chang Gung Institute
of Technology, Taipei, Taiwan.
Studies have reported inconsistent findings on gender and ethnic
differences in cancer pain experience, and the inconsistency sug-
gests further investigations on this topic for appropriate cancer pain
assessment and adequate cancer pain management.
The purpose of the study was to explore gender and ethnic differ-
ences in pain experience of four ethnic groups of cancer patients.
A feminist perspective theoretically guided the research process:
gender and ethnicity were viewed as important factors that influenced
cancer pain experience within the U.S. multicultural contexts.
This was a survey study among 480 multiethnic cancer patients. The
instruments included questions on sociodemographic characteristics
and health/illness status, three unidimensional cancer pain scales, two
multidimensional cancer pain scales, the Memorial Symptom Assess-
ment Scale, and the Functional Assessment of Cancer Therapy Scale.
The data were analyzed using descriptive and inferential statistics.
Certain gender and ethnic differences in types of pain and symp-
toms that patients experienced were found. Also, the findings indi-
cated statistically significant gender difference in functional status
and ethnic differences in cancer pain and functional status. Women
reported higher cancer pain, symptom, and functional scores than
men. Compared with other ethnic groups, Asians reported the low-
est cancer pain scores and pain relief scores; African Americans re-
ported the lowest symptom scores; and Hispanics reported the high-
est functional status scores. The findings support gender and ethnic
differences in cancer pain experience and suggest further in-depth
national-scope studies on this topic.
1918
THE DECISION TO CREATE AN OFF-CAMPUS, HOSPITAL-BASED
CHEMOTHERAPY SATELLITE. Marcia Gruber, RN, MSN, MS, Debra
Smith, RN, OCN
®
, Nancy Bertran, BSN, OCN
®
, and Melissa Therrien,
BS, Roswell Park Cancer Institute, Buffalo, NY.
As the demand for cancer care increases, hospitals must accom-
modate more patients who require chemotherapy. We experienced a
12% increase in patient visits, an increase in average treatment time,
long wait times for treatment starts, and staff overtime costs that
more than doubled. Eventually, all space and staffing options in our
existing Infusion Center were exhausted. Before the growing volume
compromised patient safety, administrators and clinicians alike be-
lieved it was time to look for expansion options.
To maintain our quality of care and improve service delivery, a
team of clinicians, administrators, decision support and facility pro-
fessionals carefully examined the advantages and challenges of cre-
ating a remote chemotherapy location.
The multidisciplinary team assessed the financial and operational
impact, patient preferences, patient demographics and regulatory is-
sues and recommended that an off-campus satellite office be created.
A business plan and site selection criteria were developed. The nurse
and physician team members determined which drugs could be safely
administered off-campus. The proportion of research versus standard
protocol appointments and the number of patients who required same-
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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day labs and concurrent transfusions were determined. Nurses and
doctors were asked what issues they might have about an off-campus
location. Patient Focus groups were held and the literature reviewed for
evidence-based best practices. The Facilities representatives educated
us on regulatory and building codes. This information led the Team to
recommend that an off-site chemotherapy clinic be developed.
The business plan demonstrated that the project was viable and a
suitable location was found that met all criteria. The Center opened
to enthusiastic reviews in October 2006 and the Patient Satisfaction
Survey results reveal highly satisfied patients.
The nurses were integral in describing the operational processes
and patient safety considerations that had to be considered through-
out the development of the business and operations plans. At each
potential location, one or two nurses assessed accessibility, safety,
throughput potential, and the work environment. Once a location
was selected, the expertise of the oncology nurse became even more
important in the design of the space and operational processes.
1929
1928
AN EXPLORATION OF HOW CONTEXTUAL FACTORS INFLUENCE
THE HISPANIC CANCER PATIENTS’ ATTITUDES TOWARD INTERNET
CANCER SUPPORT GROUPS (ICSGS). Enrique Guevara, MSN, RN,
Eun-Ok Im, PhD, RN, MPH, CNS, FAAN, and Wonshik Chee, PhD, Uni-
versity of Texas at Austin, Austin, TX.
Cancer accounts for 20% of deaths in Hispanics in the United
States. Internet cancer support groups have been shown to be benefi-
cial in helping patients with coping strategies. Hispanic participation
in support groups is lacking.
The purpose is to explore how contextual factors influence the
Hispanic cancer patients’ attitudes toward Internet cancer support
groups through a secondary analysis of qualitative data from a larger
study on cancer pain experience of patients in the United States.
The feminist perspective forms the theoretical underpinnings for
this study.
A secondary analysis of the data collected from a larger study on
cancer pain management was conducted. The study included both
quantitative Internet survey and qualitative online forums. For this
secondary analysis, online forum data among 15 Hispanic cancer pa-
tients were evaluated using a thematic analysis to explore common
themes in their attitudes toward Internet cancer support groups. Also,
the Internet survey data among the 15 participants were analyzed
to describe their sociodemographic characteristics using descriptive
statistics. The participants of the online forum were recruited among
105 Hispanic Internet survey participants of the larger study using a
convenience sampling method, and the online forum data were col-
lected using 10 discussion topics related to cancer pain experience.
The Internet survey data analyzed in this study were collected using
Internet survey questionnaire including sociodemographic questions
and self-reported health/disease status.
Three themes related to Hispanic cancer patients’ attitudes toward
ICSGs emerged from this preliminary on-going analysis. First, the
cultural value of familism influenced cancer patients’ attitudes toward
ICSGs. Due to familism, the family often took the place of the for-
mal support group among Hispanic cancer patients. Hispanic cancer
patients tended to have negative attitudes toward ICSGs because the
Internet requires non-face-to-face interactions. Second, many of the
participants of the study were not able to participate in ICSGs due to
the language barriers. Lastly, Hispanic traditional gender roles had an
impact on Hispanic women’s participation in ICSGs. The research-
er should know the strengths and weaknesses of using the Internet
method for support group structure among Hispanic cancer patients in
order to further research with the Internet cancer support groups.
THE LEADERSHIP ROLE OF THE CNS IN ONCOLOGY PROGRAM DE-
VELOPMENT. Karen Stephenson, RN, OCN
®
, MSN, MBA, Mercy Hos-
pital, Miami, FL.
This poster describes the Clinical Nurse Specialist’s leadership
role in building an oncology service line through the advancement of
nursing practice, program improvement initiatives, and staff educa-
tion. This advanced practice nurse leads efforts to develop staff and
programs to provide evidence-based outcome-guided practice.
We designed our cancer program “pyramid” on a strong founda-
tion – the mission and vision of the organization; financial viability;
innovative, cutting edge cancer technologies; and nursing and physi-
cian excellence. Our “pyramid” includes basic and critical building
blocks: evidence based practice, patient care services across the con-
tinuum, collaboration with community liaisons, and health and well-
ness programs. Some challenges to growing this service line include
providing caring practices in a multicultural hospital, promoting our
reputation and long standing community relationships, and identify-
ing, defining, and promoting cancer services to our customers.
During our program expansion, the CNS created an environment
through mentoring and system change that empowered nurses to
serve as patient advocates.
Through the leadership of the CNS, in collaboration with members
of the healthcare team, our organization is committed to providing
and coordinating quality cancer care for our community.
1932
DEVELOPMENT OF AN ADVANCED PRACTICE ONCOLOGY NURSE
FELLOWSHIP. Joyce Dains, DrPH, JD, RN-BC, FNP, NAP, Carol Dall-
red, RN, MSN, WHCNP, Joyce Neumann, RN, MS, CNS, OCN
®
, and
Barbara Summers, PhD, RN, U.T. M.D. Anderson Cancer Center,
Houston, TX.
Preparation for advanced practice nursing in oncology was chal-
lenged when the state Board of Nurse Examiners ceased to recognize
oncology nursing as an advanced practice specialty. We developed a
year-long post-graduate fellowship in oncology nursing to provide
advanced practice nurses the opportunity to develop expertise in can-
cer care.
The purpose of the fellowship is to promote advanced practice
preparation in oncology nursing and to enhance expertise in cancer
care at the advanced practice level. Fellows gain in-depth knowledge
and experience in evidence-based clinical oncology practice through
a structured curriculum, and grow into increasingly independent
practice under the guidance of APN preceptors.
Chief elements of program development included gaining support
of stake holders, partnering with a school of nursing, establishing a
multidisciplinary curriculum, identifying appropriate outcomes and
evaluation criteria, marketing the program, and implementing a com-
petitive selection process. Unique to this program, fellows are hired
as employee-trainees in full salaried positions. All fellows complete a
core curriculum lasting 4-6 months that includes mandatory rotations
and classes that cover the full spectrum of cancer care, both inpatient
and outpatient, and 9 hours of post graduate credit at the school of
nursing. Each fellow selects a specialty focus for the remainder of the
fellowship for concentrated clinical practice and experiences.
We were successful in bringing the fellowship from inception to
implementation in less than a year. The competitive process ensured
selection of fellows with the skills, motivation, and flexibility es-
sential to their success. The employee-trainee status enables fellows
to participate in all aspects of patient care, congruent with roles and
function of APNs at the institution, and to enjoy full employee ben-
efits. Fellows are expected to complete an evidence-based practice
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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project and disseminate project results. Fellows are expected to
pursue AOCNP/AOCNS certification. Formal program and fellow
evaluation are ongoing. The fellows agree that the experience and
opportunities are unparalleled, and the institutional response has
been enthusiastic.
The length, depth and scope of the fellowship make it unique. The
fellowship fills a special need in the development of APNs with ex-
pertise in cancer care and contributes to workforce enhancement.
Program expansion is planned.
1936
INTRAPERITONEAL CHEMOTHERAPY AND INTRAPERITONEAL CATH-
ETER CARE: A NURSING MANAGEMENT PERSPECTIVE. Evelyn Ma-
rinas, RN, BSN, OCN
®
, and Stella Dike, RN, University of Texas M.D.
Anderson Cancer Center, Houston, TX.
A clinical trial conducted by the Gynecologic Oncology Group
(GOG), revealed a significant increase in the number of surviving
patients who received chemotherapy through Intraperitoneal (IP)
Chemotherapy when compared to outcomes of administration via
the traditional intravenous route. Intraperitoneal (IP) Chemotherapy
is a method to directly infuse chemotherapy into the abdominal cav-
ity where most ovarian cancer cells circulate and spread. The benefit
appears to be approximately a 12-month improvement in median
overall survival (range 0-16months). Chemotherapy agents, such as
Cisplatin and Paclitaxel can be administered via an external intraper-
itoneal tunneled catheter (Tenckhoff) or a subcutaneously implanted
intraperitoneal port. An increase in number of patients with IP cath-
eters on a gynecology oncology unit created a need for an evidence-
based policy and procedure for IP catheter care.
The purpose of this project was to develop a standardized, evi-
dence-based nursing procedure/policy to guide clinical nurses’ prac-
tice with catheter care and maintenance
The Nursing Practice Congress (NPC) governance structure in our
comprehensive cancer center supports professional nurses to influ-
ence practice outcomes and develop evidence-based nursing prac-
tice standards. Professional Action Coordinating Teams (PACTs) are
created to discuss and develop resolutions to issues identified at the
primary level of care. The need for a standardized nursing proce-
dure/policy for patients receiving IP chemotherapy was presented to
the NPC and a PACT was formed. Interdisciplinary IP PACT team
members reviewed available literature and guidelines to determine
best practices for IP catheter care.
The completed IP chemotherapy policy/procedure has been pre-
sented to the NPC for approval and will be communicated to the
nursing community as a practice guide.
The PACT identified that patients’ IP chemotherapy had been dis-
continued in other settings due to complications such as catheter
blockage, catheter leak and catheter infections. Based on the review
of literature, the IP PACT drafted an Intraperitoneal Medication Ad-
ministration Policy/Procedure. Recommendations included: (1) As-
sess the catheter or port for patency by flushing with normal saline
to ensure there is no resistance or leakage. (2). Recheck position of
the hueber needle and re-access if leakage occurs. (3). Use aseptic
technique for catheter managements to prevent catheter infection.
women, and they are often diagnosed with breast cancer at a younger
age. About 50% of the women are younger than 50 years of age at
time of diagnosis with advanced stages, which makes optimal treat-
ment difficult. Education of the importance of early screening and
detection could possibly improve and save lives in this population.
The purpose of this study was to evaluate the effects of a cultur-
ally sensitive educational intervention on breast cancer knowledge,
breast cancer health beliefs, breast-self-exam (BSE) knowledge,
BSE practices and its confidence levels, mammogram activities, and
clinical breast exam in a group of Vietnamese American women liv-
ing in the Houston vicinity.
The Health Belief Model (HBM) and components of Leininger’s
transcultural nursing theory were used as the theoretical framework.
Methods and Analysis: This was an experimental two-group pre-
test/post-test study. Using chi-square and one-way ANOVA statisti-
cal analysis, demographic data and the effects of the intervention
were evaluated in a sample of 94 Vietnamese American women who
were randomized to control and experimental groups. Data was ob-
tained at before and 3 months after the educational intervention
Two components of the HBM (perceived seriousness, p < 0.01, and
perceived benefit p < 0.01) were found to be significantly different
between the 2 groups. There were significant increases in the level
of BSE knowledge (p = 0.005), level of confidence in performing
BSE (p = 0.009), a higher self-report of BSE practice (p = 0.007),
and an increase in breast cancer knowledge within the intervention
group (p = 0.000). No significant changes were found in self-report-
ed mammogram activities and clinical breast exam. However, about
80% of the participants reported that they had made appointments
for mammograms.
These findings indicate that a culturally sensitive educational in-
tervention given by an oncology nurse had a positive impact on the
health beliefs and practices related to breast cancer screening and
early detection in this population. This intervention can be used as a
model for other ethnic- specific oncology educational programs.
1939
1938
EFFECTS OF AN EDUCATIONAL INTERVENTION ON BREAST CAN-
CER SCREENING AND EARLY DETECTION IN VIETNAMESE AMERI-
CAN WOMEN. Tuong-Vi Ho, RN, PhD, M.D. Anderson Cancer Center,
Houston, TX.
Cancer is the leading cause of death for the Asian American popu-
lation. Breast cancer is the most common cancer in Vietnamese
A SHARED GOVERNANCE MODEL—THE NURSING PRACTICE CON-
GRESS. Deborah Cline, BSN, RN, OCN
®
, and Patricia Johnston, RN,
MHA, OCN
®
, University of Texas M.D. Anderson Cancer Center, Hous-
ton, TX.
Implemented in February 2006, the Nursing Practice Congress
(NPC) has empowered the clinical nurses at a large comprehensive
cancer institute to have control over their practice.
Based on a shared governance congressional model, the 34 peer-
elected delegates have been presented with over 45 clinical nursing
issues. Each issue is evaluated by the NPC and if there is no exist-
ing committee in place to resolve the issue, a Professional Action
Coordinating Team (PACT) is formed. Each PACT is a short term,
multidisciplinary committee, charged with resolving the issue within
a timeline formulated by the group. In addition to a meeting structure
designed by the PACT to encourage attendance, the PACTs have the
use of an electronic bulletin board to increase the participation of
off-shift staff and those who work at off-site locations. The conclu-
sions are then presented before the NPC and are directed to the ap-
propriate area for implementation.
A case study workflow of a clinical issue will be included. From
the identification of the issue to the conclusion, the structure for re-
solving nursing practice issues will be detailed.
An additional charge of the NPC has been to increase nurse’s
awareness of current nursing practice issues. Working with our in-
formation systems department, a unique database was developed en-
abling nurses to submit new issues, track current issues, and review
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resolved issues. Monthly news letters and updates are provided by
the peer-elected delegates to their constituency.
Staff participation has been tracked and demonstrates an increase
in the participation from all levels of nursing within our institution.
Additionally, a quantitative study is in development to measure the
effectiveness of the shared governance structure.
The implementation of a new shared governance structure takes
time but, with the right tools in place and through management sup-
port, our institution is leading the way in empowering the clinical
nurses. To date, 22 PACTs have been formed and have completed or
are working towards issue resolution.
1940
pice for a variety of reasons. Consequently, these family caregivers
are not automatically enrolled in hospice programs of bereavement
follow-up. Oncology nurses caring for patients at end-of-life often
express a sense of helplessness, and are in a unique position to pro-
mote family caregiver bereavement support.
1) To conduct a pilot project of a formal program of bereavement
support targeting caregivers whose loved ones die on the oncol-
ogy wards.
2) To empower the oncology nurse by providing an opportunity to
participate in family caregiver bereavement support.
3) To improve family caregiver satisfaction, because prior to this pi-
lot project no such service existed in the hospital.
1) Developed booklet of educational materials about the grieving
process and community/hospital resources.
2) Identify primary caregivers of oncology patients who die on the
oncology wards.
3) Oncology nurse provides booklet to primary family caregiver at
time of death and completes caregiver contact information card.
4) Family caregiver information is entered into a database for be-
reavement follow-up.
5) Palliative care nurse practitioner, chaplain, or oncology nurse con-
tact family caregiver: phone call at one week; letter and phone call
at 1 month; letter at 6 months; and card at 1 year.
6) Invite all family caregivers to participate in a 6 week hospital-
based grief support group led by cancer center chaplains.
6 month and 1 year time points include a brief evaluation survey
for the caregiver to return to the project coordinators. Data collection
is on-going, but initial survey results suggest this is a helpful inter-
vention for family caregivers. It is hoped that results will serve as
a benchmark for implementation of similar bereavement programs
throughout the hospital.
Supporting family caregivers is an essential role of oncology nurs-
ing. Initiation of a simple, effective bereavement program targeting
caregivers whose loved ones die in the hospital provides critical as-
sistance to vulnerable caregivers, and enables the oncology nurse to
proactively engage in caregiver support at the end-of-life.
FACTORS AFFECTING PROSTATE CANCER SCREENING DECISION-
MAKING AMONG BLACKS. Randy Jones, PhD, RN, Richard Steeves,
PhD, RN, FNP, FAAN, and Ishan Williams, PhD, University of Virginia,
Charlottesville, VA.
Black men are 2-3 times more likely to be diagnosed with prostate
cancer than Whites. Cultural beliefs play a major role in screening
behaviors. These beliefs may assist in the decision whether or not to
be screened for prostate cancer. To provide culturally sensitive care,
healthcare professionals must be aware of these beliefs.
The purpose of this study is to understand prostate cancer screening
decision-making among rural Blacks. The study’s goal is to conduct
an in-depth analysis of beliefs on prostate cancer screening among
rural Blacks. How these beliefs and attitudes may or may not have
influenced their health decision-making process were explored also.
This study used a qualitative design. The data that is being analyzed
utilizes the hermeneutic/phenomenological approach to explore the
“lived experiences” of the participants. The “lived experiences” re-
lated to the participants’ views on prostate cancer screening.
The sample includes age 40 and older Black men who never been di-
agnosed with prostate cancer, but may or may not have been screened.
Participant recruitment takes place at rural community centers (i.e.
barbershops and churches). Semi-structured interviews explored
health status, demographics, prostate cancer screening knowledge,
healthcare providers and family interactions, and religious beliefs.
Data collection will be terminated upon moment of data saturation.
Data will be analyzed using qualitative and descriptive methods.
The study is still underway. Current findings include rural Black men
not being aware of the increase risks of being diagnosed with prostate
cancer, and the importance of family in deciding to have a prostate
screening performed. These men reported it was much later in life
until they heard about prostate cancer. More findings will emerge.
The results will give healthcare providers clues in how to sustain
and improve care they deliver to this vulnerable population. The
findings will aid in the development of a culturally-sensitive decision
aid. The study has great promise to improve interactions between
healthcare providers and patients and promote unity among the com-
munity and healthcare systems.
1944
1941
EMPOWERING THE ONCOLOGY NURSE AND CARING FOR THE FAM-
ILY CAREGIVER: MEETING CRITICAL NEEDS BY ESTABLISHMENT
OF A FORMAL PROGRAM OF BEREAVEMENT SUPPORT ON THE IN-
PATIENT ONCOLOGY WARDS. Virginia LeBaron, RN, ACNP, AOCN
®
,
University of Arizona College of Nursing, Tucson, AZ; and Sara Moore,
MA, LPC, Georgetown University Hospital, Lombardi Cancer Center,
Washington, DC.
Family caregivers of oncology patients who die in the hospital may
be at particular risk for difficult grief and isolation. Commonly they
care for patients with recalcitrant disease, who have not elected hos-
STEREOTACTIC RADIOTHERAPY PLUS AMIFOSTINE IN PATIENTS
WITH LOW-GRADE PROSTATE CANCER. Elaine Montchal, RN, Alan J.
Katz, MD, and Matthew Witten, PhD, Winthrop Hospital, Mineola, NY.
Radiation therapy (RT) for localized prostate cancer is associated with
bowel toxicities that adversely affect long-term quality of life (QOL).
Robotic stereotactic radiotherapy (Cyberknife
®
) uses x-ray imaging
to enable real-time corrections based on organ position. Although this
technique reduces radiation exposure of normal tissues, protecting the
anterior rectal wall remains difficult. Amifostine is a radioprotectant
that has been shown to reduce toxicity to rectal tissues when adminis-
tered to patients receiving RT for localized prostate cancer.
We investigated the efficacy of intrarectal amifostine administered
before RT for reduction of symptoms of bowel/rectal toxicity in
patients receiving Cyberknife as primary or boost RT for localized
prostate cancer.
Amifostine (1500 mg/40 cc normal saline) was administered 20
minutes before each session. In patients receiving Cyberknife as pri-
mary RT, 35 Gy (7 Gy × 5 fractions within 7 days) was administered.
Patients receiving boost RT had previously undergone external beam
radiation (45 Gy; 1.8 Gy × 25 fractions), then received RT (18 Gy; 6
Gy × 3 fractions over consecutive days).
Patients completed the bowel subscale of the Expanded Prostate
Cancer Index Composite (EPIC) questionnaire 1 to 3 weeks before
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
482
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treatment initiation, at treatment completion, and 3 months posttreat-
ment. Maximum possible EPIC score is 100; higher scores indicate
fewer symptoms and better QOL. Of 41 patients completing RT,
3-month follow-up data are available for 4 patients in the primary
RT group (n=22; mean age, 68.1 y) and 3 in the boost RT group
(n=19; mean age, 69.4 y). All primary patients had a baseline EPIC
score of 100; mean baseline score for the boost group was 57 (range,
41–73.2). Posttreatment EPIC scores showed reduced bowel func-
tion for primary patients (mean, 62; range 19.6–87.5), and slight im-
provement for the boost patients (mean, 64.6; range, 42.8–82.1). At
3-month follow-up, mean scores increased in both groups (primary:
87.5, range, 80.4–92.8; boost: 96.4, range, 94.6–98.2), indicating re-
covery of bowel function to near-normal levels.
Although intrarectal administration of amifostine is investigation-
al, these results support further study of Cyberknife with amifostine
pretreatment in the management of localized prostate cancer.
1947
WEAVING GOLD: TRANSITIONING NURSING PRACTICE FROM A
MEDICAL MODEL TO A NURSING MODEL. Nancy Thompson, RN,
MS, AOCNS, Swedish Cancer Institute, Seattle, WA; and Marilyn
Hammer, DC, RN, University of Washington School of Nursing, Se-
attle, WA.
As more health care institutions and oncology departments seek
magnet status as a step in optimizing evidence based patient care,
increasing numbers of nursing departments are transitioning their
nursing practice from a medically driven model based primarily on
physiologic data to a nursing driven model seeking a more holistic
approach that better reflects actual nursing practice. For many nurs-
es, this transition represents a major change in practice, leaving them
with a feeling of disorientation, confusion and frustration.
Using the transitions model by William Bridges and Associates
(1998) helps nurses to adjust to the change, normalize their feelings
and assure a positive outcome. The process of change can be viewed
as a three-step progression which includes 1) ending a current struc-
ture, 2) transitioning to the new model, and 3) entering the new be-
ginning of the remodeled system. It is within the transition phase,
or neutral zone, in which problems can arise which may negatively
affect productivity, morale, and outcomes.
To overcome these barriers, this hospital based oncology clinic pro-
vided unit based education on Bridges transition theory including ex-
ercises to identify losses and learn four possible responses: replace,
redefine, reinvent or relinquish. Staff nurses were encouraged to be
part of the model change process to gain the benefit of the creativity
associated with the neutral zone. Part of each staff meeting was de-
voted to talking through the feelings associated with the process.
The full integration of the nursing model is not yet completed, but
education of Bridges transition model has allowed nurses to normal-
ize their feelings, to feel a part of the process, and to facilitate its
application for a positive outcome and improved patient care. The
Bridges Model of transitions could be applied to many different
changes that occur in Oncology care such as changes in equipment,
administrative structures, safe handling practices, and/or patient
evaluation and follow-up.
Although transitioning from a medical model to a nursing model
can be disconcerting in an oncology setting, involving nursing per-
sonnel in the process can be a golden opportunity in weaving holistic
based nursing practice into evidence-based patient care.
RN, UCSD/Moores Cancer Center, La Jolla, CA; and RNs from the
Moores UCSD Cancer Center Clinic/Inf, UCSD, La Jolla, CA.
The Moores UCSD (University of California San Diego) Cancer
Center opened in 2005, combining four different infusion areas
at UCSD into one. The Center’s combined staff of more than 50
Clinic and Infusion Center RNs care for patients as they navigate
between Clinic visits and Infusion Center treatment sessions. These
RNs brought into practice many different perspectives about patient
education content and who should provide that content. Therefore,
patient education practices needed to be inclusive, consolidated and
streamlined to improve communication among Cancer Center nurses
and better focus education content for patients.
To create a prototype patient education checklist tool, listing topics
to include in the patient’s first Clinic visit and during Infusion Cen-
ter treatment appointments. The tool guides all RNs caring for the
patient about education content reviewed or needing re-review. The
tool also serves as a documentation of patient education covered, as
well as a means for quality assurance. By using the tool, RNs can,
in part, ease the patient’s level of anxiety about diagnosis, symptom
management and treatment by providing organized and consistent
education.
A joint RN task force initially established topics to be included on
the checklist tool. Topics included orientation to the Clinic and Infu-
sion Center, drug information, symptom management, parking poli-
cies, social services and contact information. From the task force,
both Clinic and Infusion Center RNs were surveyed about which
topics should be listed. Results confirmed which topics to include
and whether Clinic or Infusion Center RNs should initially cover
the material.
Of the 30 surveys distributed with 50% return: prior to first day of
infusion, 60% in favor of Case Manager (CM) giving patient specif-
ic drug information; 80% in favor of Infusion Nurse giving generic
symptom management information; 100% agreed that CM should
handle MD follow ups.
Further evaluation of the tool showed that 1) RNs used the tool; 2)
Patients received information consistently.
1950
1949
PATIENT EDUCATION CHECKLIST TOOL: IMPLEMENTING A METH-
OD TO PROVIDE CONSISTENT PATIENT EDUCATION. Victoria Vu,
MEANING AND EXPERIENCES OF DIGNITY TO URBAN POOR WITH
ADVANCED CANCER. Anne Hughes, RN, MN, AOCN
®
, FAAN, Laguna
Honda Hospital and Rehabilitation Center/SFDPH, San Francisco, CA;
and Maria Gudmundsdottir, RN, PhD, and Betty Davies, RN, PhD,
FAAN, University of California San Francisco, San Francisco, CA.
Vulnerable populations, such as the urban poor, are disproportion-
ately affected by cancer. Poor persons face barriers accessing quality
cancer care and when receiving care, may experience insensitivity to
their plight. Dignity is a ubiquitous concept in bioethics and theol-
ogy, and is often mentioned in the context of providing care to older
adults, the disabled, and to those who are dying. The everyday ex-
periences of the urban poor living with advanced cancer are largely
invisible in the literature and the psychosocial and existential conse-
quences of their illness and treatment rarely described.
The purpose of this study is to understand the meaning of dignity
to the urban poor and to describe their experiences living with ad-
vanced cancer.
Interpretive phenomenology is the qualitative approach used to un-
cover the meanings of dignity and to describe the experiences of the
urban poor with advanced cancer through their own stories.
Patients were recruited from providers caring for the urban poor.
Data were collected from in-depth interviews which were audiotaped
and transcribed. Patients were interviewed 1-3 times. Interview tran-
scripts and field notes are the data sources for this analysis, which
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
483
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is part of larger project. Researchers identified and analyzed themes
both within and across cases.
Fourteen patients with stage III or IV solid tumors (lung, breast,
colorectal, etc.) participated in the study. The sample of 6 men and
8 women, ranged in age from 38-69 years, half of the sample (50%)
were persons of color (5 African Americans and 2 Hispanic/Lati-
nos). A central finding for this urban sample coping with serious
illness was that most persons, even those only weeks from death,
focused on living not on dying. Moreover, participants’ descriptions
of their experiences focused not on dignity but rather on indignity.
Their indignity stories, such as being talked down to or not listened
to and the embarrassment of fecal or urinary incontinence, were
described in vivid detail. This research confirms the importance of
person centered communication that recognizes the humanity of the
patient regardless of their psychosocial circumstances and the need
to expediently meet hygiene and toileting needs to decrease threats
to their dignity.
1952
AN INNOVATIVE APPROACH FOR DECREASING THE INCIDENCE OF
FALLS IN ONCOLOGY PATIENTS: THE PATIENT/FAMILY FALLS PRE-
VENTION VIDEO. Escel Stanghellini, MSN, BSN, RN, Brigham and
Womens Hospital, Boston, MA; Martie Carnie, AD, Volunteer Patient
and Family Advisory Council, Dana-Farber/Brigham and Womens
Cancer Center, Boston, MA; Mrinalini Gadkari, MPHSA, Dana-Farber
Cancer Institute, Boston, MA; and Lela Tatarouns, RN, BSN, Susan
McDonald, RN, OCN
®
, and Joan Deary, RN, BSN, Brigham and Wom-
ens Hospital, Boston, MA.
The risk for patient falls is a constant concern for oncology nurs-
es, particularly on in-patient units. An increase in patient falls with
injury on the inpatient units of our NCI-designated Cancer Center
revealed that patients sometimes neglected to ask for help from the
nursing staff to get into and out of bed, even though appropriate fall
prevention interventions may have been in place. Not wanting to
relinquish their usual level of independence and not realizing how
much their therapies, procedures, surgeries, or illness could weaken
them, many patients experienced a fall during their hospitalization
because they tried to get out of bed or to the bathroom without as-
sistance. To address this problem, our nursing staff in collaboration
with patients developed a falls-prevention video.
A video, which featured re-enactment of patient falls and stories
shared by patients, with lessons learned, was developed to use as a
teaching tool with patients at risk for fall and their families. Con-
cepts from adult learning theory guided this project.
A patient from our institution’s Patient Family Advisory Council
narrated the video, which provided information about fall risk fac-
tors, re-enactments of three patient-fall cases, an interview with a
patient who recently fell and a summary of reasons why patients are
at risk, stressing the important role each patient has in preventing a
fall. The video, available in English with closed captioning or Span-
ish subtitles, will be shown to all patients who are at risk for fall.
Patient feedback about the video has been positive; ongoing moni-
toring of fall rates/trends will provide data to make pre- and post
intervention comparisons.
Innovative patient education strategies can improve patient safety
and risk management. Staff nurses, nurse educators and nurse man-
agers can apply our method to develop their own unique patient edu-
cation tools.
Brigham and Womens Hospital, Boston, MA; Martie Carnie, AS, Pa-
tient and Family Advisory Council, Dana-Farber/Brigham and Womens
Cancer Center, Boston, MA; Mrinalini Gadkari, MPHSA, Dana-Farber
Cancer Institute, Boston, MA; and Nancy Mahan, RN, OCN
®
, Catherine
Benedict, RN, BSN, and Christine Leonard, RN, BSN, Brigham and
Womens Hospital, Boston, MA.
Nighttime noise (any sound that patients identify as bothersome
or that disturbs their sleep or other activities) is a frequent patient
complaint on acute care oncology units despite recommendations
on the acceptable noise levels from the United States Environmental
Protection Agency. An evidence-based practice (EBP) project was
designed by nurses to address this problem on the in-patient units of
an NCI-designated Cancer Center located in the North East.
The purpose of this project was to develop evidence-based strat-
egies to reduce the nighttime noise levels on the inpatient oncol-
ogy units. A Plan-Do-Study-Act (PDSA) cycle was used to analyze
patient complaints about noise, develop noise reduction guidelines,
and pilot their use on two adult Hematology/Oncology/Bone Mar-
row Transplant patient units.
A masters-prepared oncology nurse led the Inpatient Quality Im-
provement Team that carried out this EBP project; the team included
staff nurses, a health and safety technologist, a quality improvement
specialist, and a representative of patients and their families. Evi-
dence were used to develop the guidelines included: benchmarking
data, expert opinion, patient/family input, published research and
other literature. A learning packet containing the guideline recom-
mendations for noise reduction was distributed to the nursing staff
via email and hard copies. In-services were provided to facilitate
discussion. Posters and small flyers with reminders to limit noise
were posted in the patient care areas.
Initial patient satisfaction on noise level after guideline implemen-
tation, measured, by the Press-Ganey survey instrument, showed an
increase of 1.5% on one pilot unit but a 3% decrease in satisfaction
on the other pilot unit. This data will continue to be collected and
analyzed to evaluate the effectiveness of on going noise reduction
efforts. The next step is to track the process measures to gauge com-
pliance and usage of noise reduction guidelines.
Nurse clinicians and managers can use the information from this
project in two ways: to implement these guidelines for nighttime
noise reduction on their patient care unit(s) and to use this model
for developing and implementing evidence-based guidelines that ad-
dress other issues of concern to oncology nurses and their patients.
1954
1953
AN EVIDENCE-BASED APPROACH TO REDUCING NIGHTTIME NOISE
ON ONCOLOGY INPATIENT UNITS. Escel Stanghellini, MSN, BSN, RN,
EVIDENCE-BASED PRACTICE: “BLOOD PRODUCT ADMINISTRATION
PUMP VERSUS GRAVITY.” Rochelle Contreras, RN, BSN, Cynthia
Murphy, RN, BC, MS, and Mihaela Fetea, RN, OCN
®
, UT M.D. Ander-
son Cancer Center, Houston, TX.
The nursing resource pool (NRP) at a large comprehensive can-
cer center in the southwestern United States provides supplemental
staffing to all inpatient nursing units. While providing staffing cov-
erage, NRP nurses identified a variation in nursing practice with the
administration of packed red blood cells (PRBCs). Over 37,000 units
of PRBC’s are administered annually by nurses at the cancer center.
Nurses’ practices for blood transfusion included administration by
volumetric pump or by gravity.
The evidence-based practice (EBP) process was utilized to identify
supporting literature for transfusion of PRBCs via volumetric pump
as a standard practice at our cancer center.
In 2005, the organization implemented an evidence based practice
program for clinical nurses to build nursing care practice on evidence
rather than traditional standards. Clinical nurses were challenged to
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
484
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learn techniques to search the literature, develop evidence tables, and
implement practices supported by evidence based research. The EBP
process was utilized by the NRP team to examine the practice of
packed red blood cell administration.
A PICO question was developed and literature review was con-
ducted to determine if a recommendation for blood administration
via volumetric pumps was supported by evidence. The first step
was to determine if the red blood cells administered by pump, de-
graded during transfusion thereby affecting the patient therapeutic
benefit. The manufacturer of the pump utilized at the cancer center
was contacted regarding independent research that evaluated the
risk of hemolysis and its significance with blood product admin-
istration.
The literature review revealed very little research supporting blood
administration via a volumetric pump. Several references and nurs-
ing standards supported use of transfusion by pump, as long as, the
pump manufacturer provided supporting evidence. Administration
of blood products at a consistent rate was noted to prevent fluid over-
load and decrease risk of contamination. The team identified these
factors as patient safety benefits
The team will share the EBP journey for development of a practice
recommendation. Based on the literature review, a recommendation
was made to use a volumetric pump for PRBC transfusion.
1957
1955
NEUTROPENIC DIET WITH LEUKEMIA PATIENTS. Alison Gardner,
PhD, RN, M.D. Anderson Cancer Center, Houston, TX.
Neutropenia continues to be a significant problem for leukemia
patients receiving chemotherapy. Various precautions have been in-
stituted once patients become neutropenic. One of these, the neutro-
penic diet has been very controversial with varying practices among
institutions and physicians. The practice started about 30 years ago
when Pseudomonas was cultured from tomatoes. There have been
various surveys regarding hospitals that use the neutropenic diet,
but there has not been a randomized clinical trials to evaluate infec-
tion rates based on the neutropenic diet versus a diet including fresh
fruits and vegetables.
The purpose of this study is to evaluate the infection and death rate
of leukemia patients who eat a regular diet including raw fruits and
vegetables compared with patients who eat a neutropenic diet which
excludes raw fruits and vegetables.
The inclusion criteria includes newly diagnosed patients with acute
myelogenous leukemia or myelodysplastic syndrome who are re-
ceiving frontline chemotherapy in the protective environment (PE).
Exclusion criteria includes patients with a pneumonia or bacteremia
on admission and those who refuse to eat raw fruits or vegetables.
Patients were randomized according to an ERM (early risk mor-
tality) score and were asked to keep a diary of their food intake.
Questionnaires were done weekly to document fever, bacteremia or
pneumonia. The study will be conducted from the time the patient
initiates chemotherapy until they are discharged from the hospital or
their absolute neutrophil count is over 1000.
The statistical design is a posterior and predictive probability com-
putation to evaluate for interim monitoring. A Chi-Square was used
to compare the infection and death rates between the two treatment
arms. Presently 150 patients have been enrolled on the study. The
infection rate in the raw fruit and vegetable group is 29% with 16
bacteremia and 2 pneumonia. The infection rate in the neutropenic
diet group is 32% with 9 bacteremia and 12 pneumonia. There was
one death in the neutropenic group.
Infection rates in both groups are similar raising the question of the
necessity of the neutropenic diet.
KEEPING THE LID ON PRESSURE: A QI PROJECT MONITORING THE
MANAGEMENT OF HYPERTENSION DURING INFUSION OF HEMATO-
POIETIC STEM CELLS FROM MATCHED UNRELATED DONORS. Rox-
ann Blackburn, RN OCN
®
, Joyce Neumann, RN, BSN, MS, APN, OCN
®
,
and JoAnn Mick, RN, MSN, MBA, PhD, UTMDACC, Houston, TX; Geri
Wood, RN, PhD, University of Texas, Houston, TX; and Joy Mok, RN,
BSN, MS, APN, OCN
®
, UTMDACC, Houston, TX.
Patients undergoing hematopoietic stem cell transplants from
matched unrelated donors (MUD) at a university-based bone mar-
row transplant unit were noted to have a higher incidence of acute
hypertension during infusion of cells. Acute hypertension in this
population can be life threatening due to profound thrombocytope-
nia and the subsequent risk of central nervous system bleed. Cell
products from MUDs are collected the morning of transplant, trans-
ported to the patient and infused later the same day, so many of these
infusions occur in the evening when there is less clinical support in
the institution.
To provide guidance to the nurses for the management of infusion
related hypertension a multidisciplinary group developed a physi-
cian order set that included “what if” orders for hypertension occur-
ring during MUD infusions.
Medical records of patients receiving MUD cell infusions are being
reviewed to determine how often the order set is used and to evaluate if
BP is maintained within normal range when the order set is used.
Data collection is ongoing. Preliminary information collected on
85 patient charts suggests that implementation of interventions in the
order set is helping to manage hypertension. Additional information
will be accumulated and presented.
Acute hypertension can be a life-threatening event in patients re-
ceiving hematopoietic stem cell infusions. When nurses have stand-
ing orders to treat infusion related hypertension blood pressure can
be maintained within a normal range.
1969
PATIENT TREATMENT ORIENTATION 101: EMPOWERING PATIENTS
TO BECOME ACTIVE PARTICIPANTS OF THEIR HEALTHCARE TEAM.
Leah Scaramuzzo, MSN, RN, C, AOCN
®
, Cancer Institute of New Jer-
sey, New Brunswick, NJ.
Several mandated standards and guidelines indicate nurses have a
legal, moral, and ethical responsibility for patient education. Oncol-
ogy nurses at an outpatient NCI-designated Comprehensive Cancer
Center provided one-on-one teaching during patients’ initial cancer
treatments and found they were often anxious and overwhelmed by
the amount and complexity of information; this decreased their abil-
ity to comprehend and retain information essential to self-care man-
agement. In addition, nurses were challenged to integrate in-depth
teaching into their busy schedules and numerous patients underuti-
lized support resources.
The purpose in initiating a treatment orientation program was to
provide patients with a general understanding of cancer treatments
and specific information about the Center and available resources
using principles of adult teaching-learning. Evidence demonstrates
that knowledge decreases distress, and therefore facilitates coping
and adaptation to a cancer diagnosis thus enabling patients to be-
come active participants in their healthcare, a goal of JCAHO’s
“Speak Up” program. Effective patient education can increase
compliance with treatment regimens, facilitate recognition of ad-
verse events, improve clinical outcomes, and decrease healthcare
expenses.
Program content was developed through literature reviews, indus-
try benchmarking, sessions with interdisciplinary experts, and focus
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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groups of patients undergoing treatment. Patients/families are now
offered a 90-minute class where they learn about the Center, roles of
their healthcare team, evidence-based self-care strategies, and sup-
port resources. The program concludes with a tour of the treatment
facility, Q&A, and networking opportunities with others newly fac-
ing treatment.
219 written evaluations revealed participants felt less anxious,
more informed, and better prepared. Staff feedback has been over-
whelmingly positive, as the program has improved effectiveness and
efficiency of the education process. Reduced variability in teaching
content and increased compliance with documentation of patient ed-
ucation has been found since the program’s inception. Nursing feed-
back; patients now ask more questions, utilize supportive services,
and participate in healthcare decisions.
Oncology nurses are in a key position to develop and implement
this “best-education” didactic template as the nursing shortage re-
duces time available for patient education. The orientation program
paradigm is currently being adapted for new patients receiving care
in the surgical and radiation oncology sections and various multi-
media alternatives are being explored.
1972
1970
CONSUMER KNOWLEDGE: THE ROLE OF THE ONCOLOGY AD-
VANCED PRACTICE NURSE. Tracy Krimmel, RN, MSN, AOCN
®
, APN-
C, Beth Knox, RN, APN-C, AOCN
®
, and Kristen Fessele, MSN, RN,
APN-C, AOCN
®
, Cancer Institute of New Jersey, New Brunswick, NJ.
The Oncology Nursing Society identified important issues facing
advanced practices nurses (APNs) in April of 2001. One issue that
was addressed was the role ambiguity of the APN. Moreover, a re-
cent poll suggested that only 25% of consumers when asked knew
what an advanced practice nurse was. This role ambiguity is a cause
of concern for advanced practice nurses.
The purpose of this study is to utilize a pre and post- test instru-
ment to evaluate consumer knowledge regarding the role of the Ad-
vanced Practice Nurse (APN) in an oncology practice before and
after the distribution of an informational brochure. The specific re-
search questions that will be investigated are 1) What is the base-
line level of knowledge of CINJ patients regarding advance practice
nurses? 2) Does the number of visits with an APN at CINJ increase
the patient’s knowledge of the role of the oncology APN at CINJ? 3)
Does an educational instruction, increase patient’s knowledge about
the role of oncology APN’s independent of the number of visits with
an oncology APN at CINJ.
The conceptual framework that has been chosen for this study is
from the work of Malcolm S. Knowles’ adult learning theory andra-
gogy.
This is a quasi-experimental, descriptive study using a pre-test,
post-test design strategy to investigate the level of consumer knowl-
edge before and after and educational intervention. Two groups of
patients will be invited to participant in the study. For each group,
those returning the consent form will be randomly assigned to either
the intervention or control group until the required sample size is
reached. The intervention group will receive CINJ’s APN brochure
and the control group will not. The patients will be asked to answer a
set of questions at two time points: pre and post study. These 10 sub-
questions will be summarized by the total number of questions an-
swered correctly for increased statistical power, easier interpretation
and to avoid the multiple testing issue. The descriptive statistics for
each of the 10 sub-questions will be provided, however. The second
part is patients’ knowledge of the required education for APN.
This study is currently in data analysis phase and will hopefully be
completed by Congress.
FILLING THE GAP: CREATING A COMMUNITY ASSISTANCE PRO-
GRAM. Brenda Jo Gillund, RN, MS, OCN
®
, Altru Health System, Grand
Forks, ND; and Sarah Heitkamp, Gap, Inc., Grand Forks, ND.
Quality of life for cancer patients is so important, yet often hard
to quantify, making it hard to achieve. Working with cancer patients
is both rewarding and empowering, as caregivers try to help people
enjoy every minute of every day. When the necessity for additional
assistance for our cancer patients became apparent, a plan to help
solve the problem evolved. Our patients often asked for direction in
three major areas of financial burden: transportation, housing and
nutritional supplements.
Using critical thinking skills, planning, implementation, and evalu-
ation, we have been able to effectively improve our patients’ quality
of life.
The purpose of this presentation is:
• To assist other nurses to identify patient/family needs in their area
of practice;
• To describe the process of finding grant availability;
• To describe process of writing a grant;
• To identify how to initiate a community assistance program.
We identified the patients’ needs, explored grants available to fa-
cilitate change, wrote a grant, received funding, and implemented
the “Filling the Gap” program. Brenda Jo and Sarah can speak about
advocacy for our community, and how a great idea can become a
reality.
Patients have been utilizing the “Filling the Gap” program since
October of 2005. We have assisted over 250 patients with gas cards,
housing assistance, and nutritional supplements. Patient surveys
are used to review perceived quality of life improvement, as well
as tracking nutritional response, including weight gain, loss, or sta-
bilization.
Many areas of the USA are comprised of rural areas, some hundreds
of miles away from cancer treatment. In our community, services to
provide financial assistance with gas money, lodging and nutritional
supplements were non-existent. The Filling the Gap program was cre-
ated to help ease the financial burden while offering support to our
cancer patients and families throughout diagnosis & treatment.
Nurses and family members are often the ones who hear the pa-
tient’s story of how a disease affects their whole life. We help make
a difference in their lives every day, and sometimes a simple plan
can snowball into an amazing journey... helping our patients every
step of the way.
1975
FAILURE MODE EFFECT ANALYSIS TEAM FACILITATOR: A NOVEL
ROLE FOR THE ONCOLOGY NURSE TO IMPROVE CHEMOTHERAPY
SAFETY. Norma Sheridan-Leos, RN, MSN, AOCN
®
, CPHQ, M.D. An-
derson Cancer Center, Houston, TX; and Steven Hartnaft, MPH, CPHQ,
City of Hope, Duarte, CA.
Chemotherapy is associated with serious and potentially life threat-
ening side effects, and thus has a high risk of causing significant
patient harm when errors occur. Throughout the chemotherapy pro-
cess, from prescribing to patient monitoring, there is a high risk for
life threatening errors to occur. The Joint Commission on Accredi-
tation of Healthcare Organizations expects healthcare organizations
to conduct an annual proactive risk management activity for high
risk processes. Failure Mode Effect Analysis (FMEA) is a proactive
risk management assessment that has been successfully used in the
non-healthcare industry to prevent errors from occurring. Because
oncology nurses have many roles in the chemotherapy process, they
are in a unique position to improve this process.
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The purpose of this project is to describe how an oncology nurse
facilitated the FMEA process to proactively improve the safety of
the chemotherapy process. The Oncology nurse facilitator used a
variation of the FMEA process developed by the manufacturing in-
dustry. Using this process, all of the steps involved in chemotherapy
were studied, failure modes were identified, risk analysis and priori-
tization of risk were completed. Then risk reduction techniques were
used to proactively improve the chemotherapy process.
FMEA is useful in identifying potential errors that oncology nurses
and other healthcare team members may not realize exist at the orga-
nization. Although conducting a FMEA can not ensure that the che-
motherapy process will be “fail-safe,” FMEA participants strongly
felt that the FMEA process has:
1. Reduced the likelihood of errors occurring,
2. Helped them feel more confident in the chemotherapy process,
3. Improved understanding of the chemotherapy process,
4. Improved the working relationship with other members of the
chemotherapy team.
Promoting a culture of safety involves shifting from error measure-
ment to a proactive assessment of potential harm. Because of their
pivotal role in chemotherapy, oncology nurses are ideally suited to
improve chemotherapy safety.
Phase-specific interventions are needed to target concerns at critical
transition points during the illness. Future research should evaluate
creative interventions including group support and complementary
therapy approaches to enhance perceived support, control, and hope
in this population.
Funding Sources: ONS Foundation, ONCC Research Grant
1981
1979
THE EXPERIENCE OF HOPE IN WOMEN WITH ADVANCED OVARIAN
CANCER. Anne Reb, RN, PhD, NP, U.S Military Cancer Institute/Henry
Jackson Foundation, Washington, DC.
Women with advanced ovarian cancer (OVCA) experience signifi-
cant losses and quality of life concerns upon realizing that they have
a life-threatening illness. Maintaining hope may be a difficult chal-
lenge given the ongoing uncertainty and fears of cancer recurrence.
Greater focus is needed on the psychosocial impact of this illness to
identify nursing interventions to facilitate hope in this population.
The purpose of this study was to describe the experience of hope in
women with advanced OVCA.
Modified grounded theory methodology with interview approach
guided this research. The conceptual orientation was based on sym-
bolic interactionism and constructivist paradigms, which seek to
discover the participants’ meaning that arises through social interac-
tions.
Purposive sampling was employed to collect data on 20 women
with advanced OVCA who had not experienced a recurrence. A Per-
sonal Data Form (PDF) and focused interview guide supported data
collection. The PDF addressed demographic and illness information;
the interview guide included open-ended questions about hope. Data
were analyzed using the constant comparative process including
theoretical coding and memoing.
“Facing the death threat” emerged as the women’s main concern;
the core variable in dealing with this concern was “transforming the
death sentence.” Three distinct phases emerged: (a) shock: rever-
berating from the impact, (b) aftershock: grasping reality and (c)
rebuilding: living the new paradigm. Hope, provider communica-
tion, and spirituality influenced women’s ability to move through the
phases. Four dimensions of the core variable were identified in rela-
tionship to two key variables, perceived support and control. Women
with low perceived support and control aligned with the dimension
“trapped in the illness,” and had difficulty moving through the phas-
es. Women with high support and control seemed most hopeful and
able to face the death threat. Focusing on attainable goals and finding
meaning in the experience enhanced perceived sense of control.
This study suggests a need for improved provider communication
strategies and screening measures assessing distress and symptoms.
TURNING LICENSE PLATES INTO CLINICAL BREAST EXAMS. Andria
Caton, RN OCN
®
, Northeast Georgia Medical Center, Gainesville, GA.
In the State of Georgia, health disparities exist for women who
are indigent, rarely or never screened. Several counties in Northeast
Georgia have overall poverty rates about 13%, Latino and African
American populations where poverty rates are higher than other
races, and counties where no mammography facilities or community
hospitals exist.
In an effort to reduce some of the disparities, the State of Georgia
designed a Breast Cancer license plate which can be purchased for
$25. $22 of the special fee for the license plate funds breast cancer
screening and treatment services for Georgians in need.
In 2006, fifteen $50,000 grants funded from the sale of the Breast
Cancer license plates were awarded to various organizations.
The Medical Center Foundation of Northeast Georgia Medical
Center was awarded one of these grants entitled “Clinical Breast
Exam Training”.
Nurses will be trained in CBE using MammaCare Training offered
through the University of Florida. With this training, the nurses will
be able to perform CBE at community screenings, offices, and clin-
ics, teach CBE to nurses, students, and BSE to community groups.
Increasing the number of BSE programs and CBE nurses in the
region will help detect breast cancers at an earlier stage, improve ac-
cess to quality care for women that are indigent, and rarely or never
screened.
15 nurses will be selected to participate in the CBE Training Pro-
gram. Nursing instructors, Lanier ONS members, and community-
based nurses will be considered for training.
Nurses will perform CBE at screenings, clinics, or offices, train
nursing students or nurses to perform CBE, and/or teach community
groups.
A. Train nurses in CBE
1. Number of CBE Specialists
2. Number of nurses trained in CBE
B. Train future nurses to be CBE providers
1. Number of CBE training programs
2. Number of students trained in CBE
C. Provide CBE to indigent, rarely or never screened women
1. Number of hours spent performing CBE in clinics/offices
2. Number of community CBE screenings provided
D. Provide breast health and BSE education to community
1. Number of BSE education events provided
2. Number of women referred for screening mammography
Promoting the early detection of breast cancer, and empowering
and educating women at high risk are very important roles for oncol-
ogy nurses.
1983
CANCER SCREENING INITIATIVES WITHIN A COMMUNITY CANCER
PROGRAM. Tara Baney, RN, MS, AOCN
®
, Mount Nittany Medical Cen-
ter, State College, PA.
The American Cancer Society (ACS) has established that early de-
tection exams and testing can help save lives due to cancers of the
breast, colon, rectum, cervix, prostate, testis, oral cavity, and skin.
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The five-year relative survival for people with cancers for which the
ACS has early detection recommendations is 82%.
As a comprehensive community cancer center accredited by the
American College of Surgeons, education/screening activities are a
responsibility of our program. Based on the ACS recommendations,
disease statistics, and community needs, our cancer programs has
chosen to provide screening for prostate, skin and head and neck
cancers.
The screenings are held once a year with coordination from the
Oncology Clinical Nurse Specialist (CNS) and volunteer assistance
from physicians and healthcare professionals. The screenings pro-
vide a focused exam and prevention/early detection education. Over
the past ten years, the prostate program has provided thousands of ex-
ams and PSA tests, with this year’s screening having 95 participants.
The skin cancer and head and neck cancer screenings have only been
in place for the last three years, yet have provided screening to 86
and 39 participants respectively. In 2006, all of the screenings had
participants that required follow up. 13 (14%) men were referred for
elevated PSA and/or abnormal digital rectal exams, 8 (32%) partici-
pants were referred for abnormal skin lesions and 6 (29%) required
follow up for abnormal head and neck exams. All of those requiring
follow up were provided with contact information for the CNS who
could assist with appointments and financial resources.
Other screenings are being explored since these programs have
been successful. In previous years the cancer program has been in-
terested in a colorectal cancer screening, but due to physician limi-
tations, it was not possible. However, with newer resources in the
community, the cancer program will be exploring this possibility
once again.
Approximately 80% of cancer care is provided within communi-
ties. Therefore, community programs must identify the screening
/early detection programs that will be the beneficial to their commu-
nities. With the vast knowledge that oncology nurses have regarding
the cancer, they are primary candidates to develop and implement
these programs.
were sequentially assigned to either receive an incentive gift, or to
not receive an incentive gift when arriving for their appointment.
Participants were aware of their assignment. The incentive gift was a
beauty gift provided by Avon with a five-dollar value. The prospec-
tive randomized control group design study compares a standard of
care group to a second group told they will receive an incentive in
addition to the standard materials when they arrive for their sched-
uled appointment. The outcome measure was whether or not the pa-
tient maintained the appointment.
The incentive did not statistically increase adherence rates. There
was no statistical difference demonstrated in either group. Both
groups were similar in the percentage of attendance. The non-in-
centive group still received the incentive gift without knowing in
advance. Authors attribute several possibilities for the increase in
attendance in both groups including information sharing among en-
rollees, and extra attention during verbal consent providing a more
personalized approach. Opportunities exist for further research on
more personalized approaches with appointment scheduling.
1986
1985
PATIENT COMPLIANCE/INCENTIVE STUDY. Rhea Debari, RN, MSN,
OCN
®
, Hartford Hospital, Cancer Clinical Research Office, Hartford,
CT; and Camille Servodidio, RN, MPH, OCN
®
, Maria Palomares, BA,
Maria Rodriguez-Furlow, and Ilene Staff, PhD, Hartford Hospital, Hart-
ford, CT.
Early screening and detection of breast and cervical cancer is criti-
cal and of great interest to Oncology Nurses. The opportunity to be
screened however, requires attendance at scheduled appointments.
Care providers need to examine strategies to increase patient com-
pliance in attending appointments as a means to improve in cost ef-
fectiveness and resource utilization.
The purpose of this study was to determine if awarding an incen-
tive gift to women enrolled in the Center for Disease Control (CDC)
Connecticut Breast and Cervical Cancer Early Detection Program
would increase the adherence rate for attending appointments. The
study is congruent with the ONS Research Agenda health promotion
goal and targets priority indigent women.
The theoretical framework is the Tran theoretical Model and the
Processes of Change concept. Prochaska’s model has promotes op-
timal health by promoting behavioral change. The authors hoped to
affect positive changes in behavior, and demonstrate an increase in
the appointment compliance rate for clinical breast exams, mam-
mography and Pap screening.
Women scheduling initial or annual appointments were presented
with the opportunity to participate. After verbal consent, participants
COLLABORATING TO DEVELOP EVIDENCE-BASED SYMPTOM MAN-
AGEMENT GUIDELINES IN A COMMUNITY ONCOLOGY PRACTICE.
Miriam Scholl, RN, MSN, Sandy Purl, RN, MS, AOCN
®
, Laurel Barbour,
RN, MS, AOCN
®
, Maureen Gibbs, RN, MS, NP, Mary Beth Mardjetko,
RN, MN, Abigail Dillon, RN, BSN, OCN
®
, and Rossini Dy, PharmD,
Oncology Specialists, Park Ridge, IL.
Many patients have problems with symptoms related to cancer
treatment despite significant advances in supportive care options.
The literature suggests that new knowledge is inconsistently applied
in the clinical setting. One strategy for improving this situation is
the implementation of evidence-based symptom management guide-
lines. Oncology Specialists is part of the AIM Higher Initiative, de-
signed to aid in the assessment, information provision, and manage-
ment of cancer treatment-related symptoms. We are a 10-physician
community oncology private practice with 3 locations in the north
and northwest suburbs of Chicago, each of which utilizes a primary
nursing model.
The purpose of this quality-improvement project was to standard-
ize the assessment, education, management, and documentation of
symptoms in our practice through the use of evidence-based practice
(EBP) guidelines. A Chemotherapy and Biotherapy-Induced Nausea
and Vomiting (CBINV) guideline was the first to be developed and
became the template for other symptom guidelines.
Our process began with a literature review and the development of
a multidisciplinary task force. The National Comprehensive Cancer
Network (NCCN) (v. 1.2006) and the Multinational Association of
Supportive Care in Cancer (MASCC) (2004) guidelines provided
EBP data to update the practice’s previous CBINV guidelines (writ-
ten in 1998 and first updated in 2003). A baseline chart audit was
performed to assess adherence with and effectiveness of the prac-
tice’s previous CBINV guidelines.
Data from the chart audit revealed there was an inconsistent and
inadequate nursing standard for assessing, educating, managing, and
documenting CBINV. The anticipated outcome of this project is im-
proved symptom management for nausea and vomiting as well as
greater adherence to the practice’s new CBINV guidelines. Chart
audit data will be collected six months post implementation of the
CBINV pocket guide.
Evidence-based guidelines are tools that empower clinicians to
make appropriate decisions. We used a collaborative approach to
develop guidelines for CBINV and subsequently for diarrhea, con-
stipation, and hypersensitivity reactions.
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1987
MULTIDISCIPLINARY DEVELOPMENT OF PALLIATIVE CARE SYMP-
TOM MANAGEMENT GUIDELINES. Kerry Mahar, RN, MSN, AOCN
®
,
Nancy Murphy, RN, and Eileen Molina, RN, Brigham and Womens
Hospital, Boston, MA.
Evidence-based symptom management is important for all areas
of oncology nursing practice, but especially in palliative care where
worsening symptoms can significantly decrease patients’ quality
of life. Prior to opening an acute palliative care unit we formed a
multidisciplinary team to develop evidence-based guidelines for the
symptoms commonly seen in the patients treated in our Pain and Pal-
liative Care program. Nurses from several roles (staff nurse, nurse
educator and palliative care NP) were part of this team.
The goal was to develop a set of evidence-based guidelines to man-
age five symptoms: pain emergency, nausea, dyspnea, constipation
and delirium. Since oncology nurses (through information published
by the Oncology Nursing Society) are very familiar with evidence-
based guidelines, they are often highly valued members of guideline
development teams.
After the guidelines were developed we implemented them on the in-
patient palliative care unit. Whenever a patient on the unit experienced
one or more of the symptoms, a member of the palliative care team,
(physicians and nurse practitioners), wrote an order to implement the
relevant guideline so that all of the staff would manage that patient’s
symptoms according to protocol. Nurses soon became accustomed to
referring to the guidelines when communicating with the medical in-
terns about a symptom and the recommended course of action.
The nursing staff found the guidelines easy to use and very ef-
fective in managing their patients’ symptoms. Being an integral
part of the development team, the nursing staff readily accepted the
guidelines, even when recommendations required more aggressive
interventions to maintain patient comfort. Tracking of Press Ganey
scores were used to compare patient satisfaction pre-and post guide-
line implementation and between the palliative care unit and non-
palliative care units.
The process that we followed to develop and implement evidence-
based guidelines to manage these symptoms on our inpatient palliative
care unit may help other oncology nurses with guideline development.
Involvement of the end-users and advocates for optimal patient care in
the palliative care setting was key in the success of this program.
The EBP Committee found minimal evidence in published nurs-
ing literature to answer these questions. Consequently, the committee
decided to obtain (expert opinion) evidence by implementing focus
groups interviews with nursing staff who were active members of mul-
tiple committees. The EBP Committee developed a series of open-end-
ed questions. Nurses belonging to multiple committees were invited to
attend one of two ninety-minute, focus group sessions. Two EBP Com-
mittee members facilitated the sessions and a third member took notes.
By consensus, the sessions were audio-taped. Synthesis of information
from these sources provided detailed information about what factors
motivate and impede nursing staff involvement on committees.
The project successfully provided answers to the two questions
posed to the EBP Committee. Several recommendations were present-
ed to the Nursing Council, including the re-examination of the Council
and committee structure. To date, numerous practice changes have oc-
curred and have contributed to increased staff participation.
Information gained from focus groups can be an excellent source of
evidence when there is little available in the published literature. The
description of how we collected new evidence through focus groups
will be useful to nurses in a variety of specialties and/or settings.
1992
1990
ADDRESSING THE CHALLENGE OF INCREASING FRONTLINE ON-
COLOGY NURSES’ INVOLVEMENT IN COMMITTEE WORK. Lillian
Pedulla, RN, BSN, MSN, and Marsha Fonteyn, PhD, RN, Dana-Farber
Cancer Institute, Boston, MA; and Katherine McDonough, RN, MS,
The McDonough Group, Norwood, MA.
Many health care institutions struggle with the dilemma of how
to attract and sustain staff nurse participation in committee work.
Based on shared decision-making, the Nursing Council at our aca-
demic ambulatory oncology center inherently depends upon nursing
staff involvement. Several committee chairpersons reporting into the
Council expressed concern regarding low attendance and participa-
tion among the staff nurses. Data on staff nurses’ membership in
hospital based committee work showed that approximately 10%
were active members of multiple hospital wide committees, while
the remaining 90% had minimal to no involvement.
To address the problem of low staff nurse involvement on commit-
tees, the Council asked the Evidence Based Practice (EBP) Commit-
tee to explore two primary questions: What factors motivate nursing
staff to become actively involved in committee work? What factors
impede participation?
CONFLICT OF INTEREST: MORE THAN YOU THINK. Sally Brown,
RN, BSN, MGA, OCN
®
, CCRP, Franklin Square Hospital Center, Bal-
timore, MD.
Conflict of interest is inherent in clinical research. The concept has
come under increased scrutiny in recent years as clinical research has
expanded from academic centers to community hospitals and private
physicians’ offices. The most visual form of conflict of interest is fi-
nancial as the majority of oncology research receives external financial
support. Cooperative trials groups and pharmaceutical and device com-
panies provide financial support for entering patients into clinical trials.
Cooperative trials groups are increasing their collaboration with and
funding from industry sources. This escalates the potential for conflict
of interest in cooperative group studies. Physicians may have a financial
stake in the success of the involved pharmaceutical or device company
by holding stock or functioning as a private contractor with a company
by participating in a speakers’ bureau or on an advisory board.
Conflict of interest does not necessarily mean there is inappropri-
ate conduct, but it could be viewed as potentially inappropriate.
Non-financial conflict of interest is less visual involving coordina-
tors as well as investigators.
Coordinators have a potential conflict of interest if accrual and de-
linquency rates are linked to evaluations and promotions. The need
or desire to publish paradigm-changing results can be perceived as
conflict of interest in the conduct of research. Another form of con-
flict of interest is physician-investigator confusion. If the treating
physician is also the research investigator, the patient who has confi-
dence in his/her physician, has the potential to agree to participate in
research in order to maintain that relationship with the physician.
Several authorities have addressed aspects of financial disclosure.
There remains a need to determine the degree of disclosure that
should be presented to potential participants. Exploration of the con-
sequences of non-financial conflict of interest and the development
of methods to reduce any impact are needed.
1994
INTRASPINAL ANALGESICS IN THE MANAGEMENT OF CANCER
PAIN. Ellen Debondt, RN, BSN, OCN
®
, Seattle Cancer Care Alliance,
Seattle, WA.
Pain management can be a challenge in certain patients with can-
cer because of inadequate analgesia and intolerable side effects from
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systemic analgesic medications. In intraspinal analgesic therapy,
opioids and other analgesic agents are introduced directly into the
central nervous system by infusion (epidural or intrathecal) and can
be highly effective for the management of cancer pain. The role of
nursing in patients receiving intraspinal analgesics is crucial to suc-
cessful management of these patients.
The purpose of this is to provide education to oncology nurses on
the use, appropriateness and nursing care of patients receiving intra-
spinal analgesics in the management of cancer pain.
In this poster I will provide an overview of the intraspinal routes,
the differences and nursing care of implanted versus externalized
intrathecal catheters, the medications used and the potential compli-
cations and side effects. I will also discuss appropriate patient selec-
tion, titration, and home care management. A case study will be pre-
sented outlining pain management options used prior to intraspinal
analgesics and the trial, titration and rotation of various intraspinal
analgesics used to come up with a successful pain regimen.
Oncology Nurses functioning as care coordinators, patient advo-
cates and patient educators need to be knowledgeable on the avail-
ability and use of intraspinal analgesics as an option for management
of cancer pain.
Although most patients with cancer pain, estimated at greater than
90% can be effectively managed with the use of systemic opioids, in-
traspinal analgesics should be considered in patients with intractable
pain or experiencing intolerable side effects with systemic analgesic
medications. The use of intraspinal analgesics can provide profound
analgesia with minimal side effects. Nursing care and assessment
is a crucial part of effective and on-going management of patients
receiving intraspinal analgesics.
agery. Once mastered, some techniques may be used unobtrusively
while working.
Group techniques rely on members sharing and accepting informa-
tion, assistance, and support with each other. These include formal
debriefing, grief support, and Critical Incident Stress Debriefing
groups as well as unstructured acts of caring and assistance. Exis-
tential techniques try to find meaning in life and suffering. Prayer,
personal reflection, meditation, and restoring a life balance represent
these strategies.
Providing oncology nurses with multiple self-care techniques min-
imize the consequences of stress, promotes better patient care, and
increases their job satisfaction.
Future research might focus on matching specific strategies to indi-
vidual nurses or specific circumstances.
1996
1995
STRESS, COMPASSION FATIGUE, AND BURNOUT: EFFECTIVE SELF-
CARE TECHNIQUES FOR ONCOLOGY NURSES. John Luquette, MA,
LPC, LCDC, CGP, University of Texas M.D. Anderson Cancer Center,
Houston, TX.
Implicit in patient care is the nurse’s interpersonal and empathetic
connection with patients and their families. Continual negotiation
between professional standards, personal ego integrity, and patient
needs within the therapeutic relationship leave the nurse vulnerable
to stress, compassion fatigue, and burnout. Effective use of self-care
techniques by oncology nurses contribute to improved patient care
and increased job satisfaction.
Research links stress to physiological conditions like cardiovascular
distress, immunosuppression, and gastro-intestinal problems. Stress
adversely impacts attention, concentration, critical thinking, and other
cognitive functions. Family and social relationships suffer. Stress levels
contribute to reduced patient satisfaction, increased employee health
costs, increased spending for recruiting, and unnecessary turnover.
Meta-analyses of stress research support the effectiveness of in-
terventions. Research suggests that combinations of interventions
appear to be more effective than any single intervention. Nurses
usually learn self-care strategies through personal experience or the
advice of colleagues.
This presentation identifies and describes effective self-care tech-
niques employed by oncology nurses.
Research supports the effectiveness of cognitive-behavioral inter-
ventions. This broad class of interventions includes such detachment
techniques as distancing and debriefing, guided imagery, assertive-
ness or other skills training, and establishing professional or per-
sonal boundaries.
Relaxation training includes such techniques as diaphragmatic
breathing, meditation, progressive muscle relaxation, and guided im-
PALLIATIVE CARE FROM THE INSIDE OUT: DRAWING UPON EXIST-
ING RESOURCES TO DELIVER EFFECTIVE SERVICES. A PILOT PROJ-
ECT OF A PALLIATIVE AND SUPPORTIVE CARE SERVICE (PSCS) ON
THE ONCOLOGY UNITS AT THE UNIVERSITY OF ARIZONA MEDICAL
CENTER (UMC). Virginia LeBaron, RN, ACNP, AOCN
®
, University of
Arizona College of Nursing, Tucson, AZ; and Susan Bohnenkamp, MS,
APRN-BC, CNS, CCM, and Ana Maria Lopez, MD, MPH, FACP, Univer-
sity Medical Center, Tucson, AZ.
Palliative medicine is now recognized as an essential component
of comprehensive cancer care, and the literature demonstrates that
patients and oncology nurses benefit from access to effective pallia-
tive care teams. UMC is a leading referral site for oncology services
in the State of Arizona, but prior to initiation of this project had no
organized palliative care services. The vision of the hospital pallia-
tive care committee served as a foundation to begin a pilot pallia-
tive care service and education project to enhance quality of life for
patients and caregivers while improving patient, caregiver, and staff
satisfaction.
• To implement a palliative care pilot project with the inpatient
medical oncology team.
• To deliver a palliative care nursing curriculum that will establish
a corps of “Palliative Care Resource Nurses” within UMC, the
Arizona Cancer Center, and in the state.
• Created an interdisciplinary PSCS team from preexisting clini-
cians within UMC.
• Conduct bi-weekly PSCS meetings to discuss patient needs and
round daily with the oncology team.
• Develop and implement formalized PSCS assessment and out-
come measurement tools.
• Refine referral criteria and methods to market the PSCS.
• Self-selected RNs participate in monthly End of Life Nursing Con-
sortium (ELNEC) educational programs, which will be broadcast
using telemedicine technology to nurses throughout Arizona.
• Ongoing palliative care education is planned.
• Primary endpoint is to assess feasibility and acceptability of the
PSCS.
• Referred patients/families and referring staff will assess their
experience and comment on perceived benefits and areas for im-
provement.
• Staff participating in palliative care education will evaluate each
session and pre and post testing will occur.
The implementation of a pilot PSCS, along with the concurrent
training of a cadre of Palliative Care Resource Nurses, will enhance
the delivery of palliative care and improve the oncology nurse’s abil-
ity to identify and manage the complex, holistic needs of seriously
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ill patients. It is hoped that results from this pilot work will serve as a
foundation for expanding palliative care within UMC, and may also
serve as a guide for other hospitals with limited resources who desire
to develop palliative care services.
2004
SUCCESSFULLY INTEGRATING THE NURSE PRACTITIONER ROLE
INTO AN ONCOLOGY PRACTICE. Nancy Leahy, RN, MSN, CRNP,
AOCN
®
, Albert Einstein Medical Center, Philadelphia, PA.
In the changing oncology environment it is even more important
to establish a collaborative practice between all the members of the
oncology practice. More nurse practitioners are being employed by
oncologist to provide quality, cost-effective care with high levels of
patient satisfaction.
The process and requirements of successful integration of the nurse
practitioner role into an oncology practice will be discussed. The
success of the integration of the nurse practitioner role requires a
clear, articulated job description, mentoring, support and willingness
to delegate. The factors that inhibit successful integration also must
be recognized and addressed to facilitate the success of the nurse
practitioner in oncology practice. The true success of the integration
into practice is the willingness of the physician to utilize the nurse
practitioner, understand the nurse practitioner scope of practice and
to understand the value of the role of the nurse practitioner.
The practice will experience increased revenue, efficiency, patient
satisfaction and collegial input. The self-evaluation of the perfor-
mance appraisal will demonstrate the NP’s satisfaction with the role
integration.
The nurse practitioner in oncology is becoming an efficient ad-
dition to the practice in providing cost-effective care to the patient
while providing the practice with expertise and revenue. The success
of the integration of the role into practice will benefit all of the prac-
tice and especially the patients.
The specialty nurse practitioner needs to be able to treat the patient
population in total, not only partly. This is imperative when pain is
the symptom not being able to be treated efficiently and effectively
due to the current prescriptive authority. Medical oncologists are em-
ploying more nurse practitioners to provide efficient, cost-effective
care to their patients working autonomously under the collaborative
practice agreement. The current limitation of 72-hour supply for
Schedule II drugs impedes this autonomy and diminishes the effi-
ciency of the patient encounter.
2006
2005
ADVOCATING FOR ONCOLOGY NURSE PRACTITIONER SCHEDULE
II NARCOTIC PRESCRIPTIVE AUTHORITY IN PENNSYLVANIA. Nancy
Leahy, RN, MSN, CRNP, AOCN
®
, Albert Einstein Medical Center, Phila-
delphia, PA.
As a certified registered nurse practitioner (CRNP) practicing in
the state of Pennsylvania, the current prescriptive authority limits
prescribing Schedule II narcotics to a 72-hour supply. This includes
any Schedule II medication regardless of the patient and their pain
regimen. Working under a collaborative practice agreement, the
nurse practitioner (NP) can prescribe chemotherapy, treat and pre-
scribe for most symptoms and side effects the oncology patient may
encounter, but not treat pain with Schedule II narcotics.
The purpose of this project is to develop a method to assist nurse
practitioners in advocating for a change in their prescriptive author-
ity in Pennsylvania.
CRNPs of Pennsylvania must network with peers and organiza-
tions such as Nurse Practitioner groups, Advanced Practice Nurses
groups and ONS. It is imperative for the NP to discuss this matter
with their collaborating physicians to gain their support in getting
heard. Once more NPs become aware of this serious problem, they
must contact their local officials and the governor to seek their sup-
port in bringing this to the State Board.
The success of the intervention will be determined by the num-
ber of NPs writing, emailing, networking etc to tell the State Board
something needs to change. As we move forward, Governor Rendell
will learn of the need of his support for this specific matter as he
continues to support the NP role in Pennsylvania.
“SUN SAFE SAFARI”: A UNIQUE METHOD OF EDUCATING SCHOOL
AGE CHILDREN ABOUT SUN SAFETY. Victoria Chambers, RN, OCN
®
,
Helen Roorda, RN, BSN, OCN
®
, and Patricia Wang, RN, OCN
®
, Florida
Hospital Cancer Institute, Orlando, FL.
In 2006, there were approximately 63,000 new cases of melanoma
and over a million new cases of basal and squamous cell skin cancer.
American Cancer Society recommends the following guidelines for
prevention: Limit or avoid sun exposure, wear a hat and sunglasses
to protect the face, neck and ears, wear a long-sleeved shirt, and use
sunscreen with a SPF of 15 or higher. According to the American
Cancer Society, severe sunburns in childhood can greatly increase
risk of melanoma in later life. Knowledge, passion for teaching and
sense of commitment put Oncology nurses in the best position to
reach out to the community, especially young children, and provide
education regarding sun safety.
Given the short attention span of young children, the information
needs to be presented in a short, fun, entertaining format. Sun Safe
Safari was created with the goal of reaching 100 children every
month.
This is accomplished by contacting elementary schools and after
school programs. The Sun Safe Safari team consists of 4 actors, 1
musician and a director. There is a pretest and a post test that the
children take home and complete with their parents. Both tests are
collected and returned to the director for grading. The program lasts
20 minutes and revolves around a grape named Alex, a raisin named
Randi and a storyteller named Moondoggy. Randi the raisin tries
to convince Alex the grape that he will turn into a raisin too if he
doesn’t use sun safety. “Slip on a shirt, slop on some sunscreen and
slap on a hat”. Bright colorful costumes, music and games encourage
the children to participate. The children also receive a packet which
includes a safari hat, sun screen, lip balm, a bottle of water and an
activity booklet. To date, the scores of the pretest and post-test have
shown an improvement of 75% in sun safe knowledge.
Currently in development is collaboration with the Girl Scout
Council to create a Sun Safe Safari patch. With a little creativity, tal-
ent and motivation, this concept could easily be recreated and used
in any community setting.
2007
ONCOLOGY NURSING AND COMPASSION FATIGUE: CARING UNTIL
IT HURTS. WHO IS CARING FOR THE CAREGIVER? Lori McMullen,
BSN, RN, OCN
®
, University Medical Center at Princeton, Princeton,
NJ.
The feeling of empathy which is a key component to a therapeutic
relationship with a client and family can become overwhelming in a
field that demands strength and resiliency. Working with cancer pa-
tients challenges the oncology nurse with a variety of difficult issues,
from ethical concerns and palliative care, to intense interactions with
patients and families to intricate treatments and end of life decisions.
The consequence of this constant expenditure of empathy is called
compassion fatigue, literally caring until it hurts. Compassion fa-
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tigue, a stress response that is sudden and acute has been defined as
a physical, emotional and spiritual fatigue or exhaustion that takes
over a person and causes a decline in his/her ability to experience joy
or care for others.
If not recognized and treated, compassion fatigue can interfere
with the ability to give quality nursing care that is safe and effective,
can cause physical and emotional exhaustion, and result in deperson-
alization and ultimately burnout.
The purpose of this study is to examine the ability of the oncol-
ogy nurse to recognize compassion fatigue and to examine the orga-
nizational support systems available to the inpatient and outpatient
oncology nurse.
This study is supported by the humanistic theory of Paterson &
Zderad and Baston’s social psychology theory, the empathy altruism
hypothesis. The relationship of compassion fatigue and stress is sup-
ported by the work of Lazarus and Folkman.
A descriptive and correlational survey will be used by distributing
a self-completed survey to ~30 oncology nurses at a local chapter
meeting of ONS. Inpatient and outpatient oncology nurses at a com-
munity based hospital will be asked to participate in the study. The
measure will be the Professional Quality of Life Scale (ProQOL):
Compassion Satisfaction, Burnout and Compassion Fatigue/Sec-
ondary Trauma Scale by Stamm (1997-2005). Demographics will
be collected to establish field of practice and availability of organi-
zational support system.
Preliminary implications suggest that oncology nurses are ignorant
of the term and associated symptoms of compassion fatigue. While
prevention is clearly the most effective means of coping with com-
passion fatigue, it seems that health organizations are not supporting
the psychological well being of staff.
Emergencies” as an educational series with analysis of case studies;
and enhancement of the Emergency Department’s reference libraries
with the addition of two new oncology emergency resources.
This collaborative initiative achieved outcomes in the following
domains: enhanced nursing staff competency and confidence in on-
cology emergency care; improved time to treatment with the oncol-
ogy patient identified as a triage Emergency Severity Index score of
“2”; and expanded network of oncology care collaboration across
outpatient, inpatient, and emergency care settings in order to stan-
dardize best care practices. This has resulted in the development of a
continuum-based oncology neutropenic pathway.
The interdisciplinary cooperation between emergency and oncolo-
gy specialties cultivates professional development, quality improve-
ment initiatives and opportunities for oncology-emergency educa-
tion to enhance patient outcomes.
2009
2008
RECOGNIZING ONCOLOGY CRISES IN THE EMERGENCY DEPART-
MENT: A STAFF-DRIVEN IMPROVEMENT PROCESS. Lisa F. Cull, BS,
RN, OCN
®
, Middlesex Hospital Cancer Center, Middletown, CT; Mary-
Beth Nolan, MSN, RN, CEN, Middlesex Hospital, Middletown, CT;
Anne Campbell-Maxwell, MBA, BSN, RN, Middlesex Hospital Cancer
Center, Middletown, CT; and Jacquelyn G. Calamari, MS, BSN, RN,
CEN, Kathy Palaski, RN, and Cyndy Marotta, RN, Middlesex Hospital,
Middletown, CT.
Increasingly, oncology patients present in the Emergency Depart-
ment seeking care during their disease continuum. Knowledge of
new treatment modalities as well as astute assessment skills to rec-
ognize a related host of symptoms and side effects are now criti-
cal competencies for safe emergency management of these patients.
Specialized care for cancer-related emergencies has evolved as a hy-
brid of oncology and emergency medicine.
The purpose of this clinical project was to use an evidence-based,
interdisciplinary approach to improve the quality of emergency on-
cology care through collaboration, education, resource support and
creation of best practice protocols.
An interdepartmental project team comprised of nursing staff, man-
agers and nurse educators from the Emergency Department and the
Cancer Center examined current care practices, patient outcomes,
available education and resources to determine the quality of emer-
gency oncology care. Based on the data, communication between
staff and a review of the current literature in oncology emergencies,
a number of areas were identified to improve patient management.
The improvement initiatives included: design and implementation
of a “Vital Oncology Facts” guide for the triage reference manuals
with pocket versions provided to staff; standardization of the on-
cology triage process; development and presentation of “Oncology
ONCOLOGY NURSE AS A COLON SCREENING NURSE NAVIGATOR.
Charlene Marinelli, RN, BSN, OCN
®
, Nora Katurakes, RN, MSN, OCN
®
,
and Sandra Donnelly, RN, OCN
®
, Helen F. Graham Cancer Center,
Christiana Care Health Services, Newark, DE.
Colorectal cancer deaths in Delaware are the third highest. Mortal-
ity is higher among African Americans then Caucasians. Colonos-
copy is a reliable screening test. Few Delawareans take advantage
of this life saving test. Behavioral Risk Factor Surveillance Survey
(BRFSS) 1999 data reported, 45% Caucasians and 39.6% African
American Delawareans ever having a sigmoidoscopy or colonos-
copy screening.
In 2002, the Delaware Cancer Consortium initiated a comprehen-
sive statewide community-focused colorectal cancer screening pro-
gram. A full time Colorectal Screening Nurse Navigator (CRCNN)
was housed in each major health system. Christiana Care Health
System (CCHS) hired 2 part-time Oncology Certified Nurses spe-
cializing in community outreach to provide culturally sensitive
outreach and recruitment, ensure screening access and scheduling,
monitor screening compliance, and ensure prompt clinical evalua-
tion and follow-up to positive testing.
The CCHS CRCNN shared their oncology nursing expertise to
create program materials and recruit individuals 50 years and older,
mostly African Americans, uninsured living in geographic areas de-
termined to be high risk. Assistance was provided to overcome bar-
riers to screening e.g., if uninsured, enroll in the state funded colon
screening program. Partnerships were fostered with community or-
ganizations and the medical community to assist with referrals. The
CCHS CRCNN participated in the development and implementation
of a web-based data system designed to assist in case management
and tracking through intake, planning, screening and follow up.
BRFSS data 2004 reported a statistically significant increase in
Caucasians and African Americans (62.3% and 58.4% respectively)
ever having a sigmoidoscopy or colonoscopy. CCHS CRCNN case
managed 690 individuals. A portion (230) were found to have un-
surmountable barriers (comorbid conditions and unable to contact)
could not complete screening. Colonoscopy was completed by 274
(40%) individuals, 85 were enrolled in the state funded program, and
86 were African American. Using the web-based data system, 166
individuals continue to be case managed with new enrollees added
daily.
Oncology nurses contribute key attributes and experiences to in-
crease public awareness and educate about colon cancer. Further,
they assist with access to insurance and navigate difficult or com-
plex families from diverse populations to increase screening rates
in Delaware.
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2010
A NURSE CAN SAFELY DELIVER RITUXIMAB OVER 90 MINUTES.
Peggy Corey, RN, BSN, OCN
®
, Ronald Go, MD, and Ana Schaper, RN,
PhD, Gundersen Lutheran Health System, La Crosse, WI.
Implementation of evidence-based practice protocols for cancer
treatment can benefit patients’ quality of life and maximize utiliza-
tion of available resources. Recently, three studies from academic
centers suggest that rapid rituximab infusion (RRI), which reduces
infusion time from 4 hours to 90 minutes in the treatment of non-
Hodgkins lymphoma (NHL), is well tolerated and safe. However,
cohorts in these studies were small and may not be reflective of the
patient population treated in the community setting. Nurses, as pa-
tient advocates, need to be cautious of changes in treatment regimes,
when based on limited evidence.
For this project, the oncology nursing staff partnered with a physi-
cian to investigate the feasibility of RRI at a community-based can-
cer center.
Patients, with NHL, were enrolled in this modified treatment pro-
gram if they had received rituximab according to product monograph
within the last 4 months, no prior grade 3 or 4 infusion related toxici-
ties, no contra-indication to fluid infusion of 200 ml/hr, and an abso-
lute lymphocyte count of <10,000. Patients were pre-medicated with
acetaminophen and diphenhydramine. Rituximab was infused in 90
minutes (20% dose first 30 minutes; 80% dose next 60 minutes).
Nurses monitored patients during and after infusion for toxicity as
defined in common terminology for adverse events.
Thirty-three patients were treated for total of 88 infusions (median
3). Clinical profile includes: median age of 69 years (range 32 to
88), 70% male, 67% stage III/IV disease. Chemotherapy regimens
included: 33% CHOP (cyclophosphamide, vincristine, doxorubicin,
prednisone), 21% CVP (cyclophosphamide, vincristine, prednisone),
3% CF (cyclophosphamide, fludarabine), 6% CEP (cyclophospha-
mide, etoposide, prednisone), and 36% rituximab alone. No adverse
events were observed for the 90-minute rituximab infusions.
Rituximab infused over 90-minute was safe in the treatment of
NHL and well tolerated in this community cohort. Both rituximab
and chemotherapy were infused within 4 hours. The reduced infu-
sion time allowed patients more control and flexibility in treatment
scheduling, and more time away from the facility. In addition, short-
er infusion times improved access in the chemotherapy suite.
tionnaires conducted at Accrual, 1-month, and 3-month, and a chart
audit at 1-month.
An interdisciplinary Advisory Board provides input and direction
regarding patient care and education. This team includes Psycholo-
gy, Chaplaincy, SW, Nutrition, Rehab, Medical Oncology, and Phar-
macy. Phase II includes intensive patient and professional education
along with peer audit and feedback to address each category of barri-
ers. In Phase III, investigators will continue to move the intervention
to a more realistic model of care to be maintained and replicated in
other clinical settings.
Phase I: Of the 83 patients, 64% were disease stage III or IV, mean
age was 61, and 81% were currently on treatment. Overall mean
score for quality of life was 5.4 (0=negative to 10-positive). 85%
reported fear of addiction, 45% were reluctant to report pain for fear
of being seen as a “bad patient.” Overall score for patient knowledge
pain tool was 75% correct. Chart audits revealed a lack of document-
ing presence of pain. Regarding fatigue, 80% reported > 4 severity
and 84% reported > fatigue as emotionally distressing. Overall score
for patient knowledge fatigue tool was 82%. Chart audits revealed
lack of documentation of the presence of fatigue.
This clinical intervention has identified key barriers to symptom
relief and should create a replicable model for other oncology set-
tings.
These findings represent the need to provide further education and
interventions to patients and professionals to better address existing
barriers to pain and fatigue management and resulting psychosocial
issues.
2015
2014
REDUCING BARRIERS TO PAIN & FATIGUE MANAGEMENT FOR CAN-
CER PATIENTS. Tami Borneman, RN, MSN, CNS, Betty Ferrell, PhD,
FAAN, Virginia Sun, RN, MSN, and Marianna Koczywas, MD, City of
Hope National Medical Center, Duarte, CA; Barbara Piper, DNSc, RN,
FAAN, AOCN
®
, University of Arizona, Scottsdale, AZ; and Gwen Uman,
RN, PhD, Vital Research, LLC, Los Angeles, CA.
Pain and fatigue impact all dimensions of the patient’s life includ-
ing physical, psychological, social, and spiritual well being.
The overall purpose of this prospective longitudinal study funded
by NCI is to test an innovative model of reducing barriers to manag-
ing pain and fatigue in cancer patients using evidenced-based guide-
lines from the National Comprehensive Cancer Network.
The model, “Passport to Comfort” addresses patient, professional
and system barriers to the relief of pain and fatigue, and is based on
evidence based guidelines developed by the National Comprehen-
sive Cancer Network.
The study, conducted in a comprehensive cancer center is designed
in three phases. In Phase I: Usual care, we described the current sta-
tus of pain and fatigue management in 83 patients with breast, lung,
colon or prostate cancer. Methods of data collection included 7 ques-
POPULATION-BASED NURSE-INITIATED CANCER SYMPTOM MAN-
AGEMENT: DESCRIPTION OF AN ONGOING PROGRAM. Carol Kamhi,
MSN, APRN, BC, Oxford Health Plans, a United Healthcare Company,
Trumbull, CT; Richard Weininger, MD (board certification: heme, onc),
OncoMetrix, Inc., Claverack, NY; Ramona Hays, RN, BSN, Oxford, a
United Healthcare Company, Trumbull, CT; and Elizabeth Micholovich,
BS, MPA, SecureHorizons, a United Healthcare Company, Trumbull,
CT.
A major Northeast health insurance company recognized an oppor-
tunity to reduce complication prevalence and related hospitalizations
in patients undergoing cancer treatments using an innovative nurse
case management model.
This program’s purpose is to reduce admissions related to prevent-
able treatment and disease complications. This telephonic care man-
agement (TCM) model was designed for patients undergoing active
chemotherapy or radiation cancer treatments focusing on those at
highest risk of preventable hospitalization.
Selection criteria were developed and tested to identify those pa-
tients at highest risk. These criteria were used to create a “risk index”
based on: diagnosis (excluding childhood malignancies and acute
leukemias); disease stage; particular treatments (e.g.: platinum based
therapy); caregiver support; and hospital admission history. The risk
index was used to stratify the TCM intervention’s intensity provided
to the patient.
Preventable hospitalization criteria were developed based on ICD-
9 codes to create a matrix from which hospital claims could be used
to identify preventable hospitalizations for nausea, vomiting, diar-
rhea, dehydration, infection, hematologic abnormalities, respiratory
problems, and others.
Telephonic nursing assessment tools were created to evaluate signs
and symptoms of treatment complications to intervene proactively
with patients and their healthcare team to help establish care in the
appropriate setting.
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Program results were assessed by the ability to demonstrate a re-
duced level of preventable hospital admissions. Admissions were as-
sessed for ICD-9 codes fitting these criteria over time and compared
to an unmanaged population. Initial, early, results have shown a pos-
itive effect on complication measures: prevalence, admits per 1,000,
admits, and average length of stay for managed patients versus those
patients who did not receive case management. These outcome pa-
rameters represent core goals for oncology nurses.
By intervening proactively with patients and their healthcare team
and helping support timely care in the appropriate setting, preventable
hospitalizations are reduced. The approach and developed tools out-
lined here can be adapted for use by oncology nurses in other clinical
settings to reduce morbidity of cancer and related treatments. Addi-
tional analysis will be conducted on this model’s impact on enhancing
the health care team’s care coordination as it relates to preventable
hospitalizations, treatment outcomes, and patients’ quality of life.
2016
THE CLINICAL SCHOLAR: FORMAL RECOGNITION OF NURSE CLI-
NICIANS’ COLLABORATIVE ACTIVITIES. Marsha Fonteyn, RN, PhD,
OCN
®
, Martha Healey, RN, MSN, FNP, Naoe Suzuki, MFA, and Susan
Bauer-Wu, RN, DNSc, Dana-Farber Cancer Institute, Boston, MA.
The nurse scientists and other staff in our nursing research center,
located in a NCI-designated Cancer Center, are continuously seek-
ing ways to encourage the nurse clinicians at our institution to be-
come more involved in the research, evidence-based practice and
scholarly activities of the research center. Such collaboration is not
only mutually beneficial, but also provides a mechanism for more
rapid translation of new knowledge into clinical practice.
To encourage and promote greater involvement of nurse clinicians
with our nursing research center activities, we have developed the
Clinical Scholars Program. Guided by principles of Transformation-
al Leadership theory, we use role modeling and ceremony to build
and sustain a nursing culture committed to inquiry and scholarship.
The Clinical Scholar was originally conceived (four years ago) as
a mentored research experience that would link a clinician with a
nurse scientist by providing a mechanism for the Scholar to receive
release time and funding to carry out a small research project. This
expensive and labor-intensive approach meant that we had to limit
the number of Clinical Scholars to one a year, thus slowing progress
towards our goal of creating a culture of inquiry and scholarship
in nursing practice at our Cancer Center. Now, three years since its
inception, we have expanded the Clinical Scholar Program to en-
compass more of our nursing staff.
In the spring of 2007, we will formally recognize over 30 nurse
clinicians as Clinical Scholars for their collaborative work with the
nurses from our research center. Correspondingly, the number of
collaborative projects (evidence-based practice and research), pre-
sentations and publications has remarkably increased and feedback
from those involved has been very positive.
Establishing a mechanism to encourage and reward collaboration be-
tween nurses from clinical practice and a nursing research center can
be transformational in creating a culture of inquiry and scholarship in
nursing practice. Our recognition program could be easily adapted to a
variety of settings as an effective strategy for increasing the involvement
of clinical oncology nurses in research and other scholarly activities.
medical futility and bad deaths, burnout and compassion fatigue,
which can lead to poor nurse satisfaction.
Allowing staff the opportunity to verbalize and discuss their feel-
ings of work related stress in a forum, validated their feelings and
allowed them an opportunity to share similar experiences with one
another.
The purpose of this program was to provide the ICU staff an op-
portunity to relax their minds and participate in activities that includ-
ed: song, yoga, mediation, affirmations and therapeutic massages.
The model behind this theory was adapted from an oncology article
which supported a retreat day to allow staff to decompensate due to
stressful work encounters.
My program was designed as a corroboration of staff issues re-
garding some ethical issues that recently occurred in the unit. This
program offered them a safe place, among their colleagues to discuss
their recent feelings and de-stress with some activities which pro-
mote healthy work environments. Participants who provided services
included convenient employees who have been trained in their fields
of expertise such as in yoga, meditation and therapeutic massage.
Some of the activities included having staff complete a Compas-
sion Fatigue Survey, utilization of the American Association of Crit-
ical Care Nurses: The 4 A’s to Rise Above Moral Distress, Good
Death versus Bad Deaths, Reviewing the ANA Code of Ethics, Re-
viewing Fox Chase Cancer Center policies on ethical dilemmas. All
staff were treated a 45 minute therapeutic massage.
This program is designed to be offered every other month until all
of the ICU staff attend. Staff are required to be off from work the day
before the program in preparation for this educational offering.
Implications for nursing practice include employers to be aware
of issues such as moral distress that can be affecting their staff and
allow an interdisciplinary team to begin to manage these issue which
affect the work environment. As an employer, being aware of the
culture of the work environment is invaluable to produce high qual-
ity health care providers.
2025
2019
REVITALIZING YOURSELF: MAKING TIME 4U. Susan Politsky, RN,
MSN, CNA, BC, Fox Chase Cancer Center, Philadelphia, PA.
Oncology nurses, particularly those who work in critical care set-
tings are at risk for developing moral distress which can be from
EDUCATION: THE KEY TO SAFELY IMPLEMENT A CLINICAL TRIAL.
Anna Vardeleon, RN, OCN
®
, and Donna Gerber, RN, MN, PhD, AOCN
®
,
M.D. Anderson Cancer Center, Houston, TX.
New scientific discoveries have led to the discovery of pathways
that can be targeted in the battle against cancer. New targeted therapy
clinical trials are more complex and require planning and education
to safely execute.
Ensuring patient safely during their participation in a clinical trial
requires careful planning and development of materials to educate
the staff nurses, patient and family members what measures are re-
quired for participation and their role in the successful completion
of the trial. Also, patients who travel to a comprehensive care center
to participate in a clinical trial may present to the local emergency
room after returning to their home area and information is needed
by the local physician regarding the medications that the patient is
receiving.
The research nurse needs to review the clinical trial requirements
and receive input from the principal investigator as needed. Then
educational material needs to be developed for the patient and fam-
ily to ensure safe participation. These materials will also assist in
the success of the clinical trial. These materials include drug-drug
(including herbal supplements) interactions, food-drug interactions,
clinic appointments, specimen collection, instructions on what to do
for anticipated side effects of treatment, proper handling and storage
of medication and contact information. A patient can give a copy of
this material to their home area physician so that they can under-
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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stand what the patient is receiving and do appropriate interventions
if required.
Evaluation is seen in the execution of clinical trials with fewer de-
viations and violations. Safety is enhanced as those involved with
the care of the patient have access to these educational materials.
Thus, research nurses must be innovative in creating educational
material that patients can use so that clinical trials can be executed
safely for everyone involved.
2028
WHO, WHAT, WHEN, WHERE AND WHY: IMPLEMENTATION OF AN
EVIDENCE BASED PRACTICE MODEL IN AMBULATORY CARE. Mau-
reen Major Campos, RN, MS, Ethel Law, RN, MA, Melanie Carrow, RN,
OCN
®
, ACRN, and Rori Salvaggio, RN, MS, Memorial Sloan-Kettering
Cancer Center, New York, NY.
To promote nursing science and best practice at this NCI-desig-
nated Comprehensive Cancer Center, an Evidence Based Practice
(EBP) initiative was implemented by the Director of Nursing Re-
search and Practice, with support of the Chief Nursing Officer. A
Departmental Practice Committee was established with representa-
tion from all patient care areas, and its mission is to foster and guide
EBP throughout the institution.
The Ambulatory Practice Council was designated to develop and
oversee EBP initiatives in the outpatient setting. Membership con-
sisted of staff nurses with varying levels of professional experience.
A Chair and Co-Chair were selected to facilitate group processes and
report activities to the Departmental Practice Committee.
Our goal was to educate nurses on the theory and application of
EBP methodology so that our institutional guidelines and standards
of practice reflected the latest scientific evidence.
Educational methods included didactic lectures and individual
guidance throughout project development. Four practice questions
were identified as models for application of learning. The nurses
were educated on framing the practice question, searching and ana-
lyzing the evidence, applying the evidence to practice and evaluat-
ing outcomes. Internal and external consultation with experts and
development of partnerships with other disciplines was encouraged.
The creation of a virtual office and utilization of centralized tools for
reporting and presentation eased communication among the nurses.
Mentors, including a librarian and research assistant were available.
An evaluative measure of success was the completion of four EBP
projects, demonstrating members’ learning and competency. Nurses
from each project were able to present their clinical question to vari-
ous audiences. Project members indicated that the success of this
EBP model was dependent on nursing leadership support and desig-
nated “protected time” for EBP activities. A survey of knowledge ac-
quisition and satisfaction was performed and will be reported. Future
educational initiatives will be based on survey analysis.
Expansion of EBP methodology in this outpatient department will
require reorganization of members throughout our council structure
to allow experienced nurses to mentor other outpatient staff in the
EBP process. This presentation can provide a demonstration for oth-
er oncology nurses on successful implementation of an EBP model
of care at the bedside.
strictive, a gap was created in many academic medical centers. In-
creasingly, at this institution the gap is filled by Nurse Practitioners.
Currently, few Nurse Practitioners are trained for the acute care set-
ting and it is difficult to recruit acute care NPs to a non-ICU setting.
Therefore, in addition to an extensive orientation plan, administra-
tion identified the need to provide ongoing education for the Nurse
Practitioners.
A Needs Assessment was developed that asked the Nurse Practi-
tioners to evaluate the importance of specific competencies when
providing acute oncology care and the current skill level that the cur-
rent mid-level providers demonstrate. First, the Nurse Practitioners
were asked to rate the importance of a variety of competencies using
a 1-5 Likert scale with 1 = “Not Important” and 5 = “Extremely Im-
portant”. The broad topics for the competencies included: symptom
management, oncologic emergencies, infectious disease, hematol-
ogy, cardiovascular, Respiratory/ENT, Endocrine, Neurology, Geni-
tourinary, Diagnostic testing including laboratory testing, surgical
pathology, radiology, and other testing, pharmacology, and specific
diseases. Under each broad topic, more specific competencies were
identified.
The Nurse Practitioners were then asked to rate the knowledge
level that the majority of the Nurse Practitioners demonstrated using
a Likert scale with 1 = “Little or No Knowledge” and 5 = “Expert
Knowledge”.
Interestingly, the respondents found most competencies “Very Im-
portant” to their practice with an average score of 4.49 with symp-
tom management of neutropenia and anemia ranked the highest at
4.91. On the other hand, they rated the current knowledge level of
most competencies as “Adequate” with an average score of 2.9.
After analyzing the responses, it appeared that the highest learning
needs are diagnostic testing including laboratory testing, radiologic
testing, pulmonary function tests, and echocardiograms. In addition,
staging and response to treatment for specific diseases were also iden-
tified as learning needs. Continuing educations programs with CE
credit have been planned for the next year on these topics using ad-
vanced practice nurses, physicians, and other experts as presenters.
2031
2030
HITTING THE JACKPOT: ENHANCING APN KNOWLEDGE FOR THE
ONCOLOGY ACUTE CARE SETTING. Janet Sirilla, RN, MSN, OCN
®
,
and Phyllis Kaldor, RN, MS, OCN
®
, OSU James Cancer Hospital &
Solove Research Institute, Columbus, OH.
As the ACGME (American Council for Graduate Medical Edu-
cation) Guidelines for resident and fellow hours became more re-
STRATEGIES TO SUPPORT ONCOLOGY NURSES’ SCHOLARLY AC-
TIVITIES. Marsha Fonteyn, RN, PhD, OCN
®
, and Susan Bauer-Wu,
DNSc, RN, Dana-Farber Cancer Institute, Boston, MA.
Developing and implementing strategies to promote and support
nurses’ scholarly activities is an essential component of best practice
that results in the wider dissemination of exemplars of best practice
through presentations and publications, thus benefiting the entire
nursing profession. As nurses at our NCI-designated Cancer Center
became increasingly interested in submitting abstracts to conferenc-
es for poster and podium presentation and developing manuscripts
to submit for publication, we, the nurses, scientists and staff in the
nursing research center, recognized the need to devise creative ways
to encourage and support these efforts.
To promote and facilitate nurses’ scholarly activities at our institu-
tion, we developed a repertoire of strategies that would allow us to
provide support for these activities while still carrying out our re-
search studies and the other important work of our nursing research
center. We used principles of adult learning theory as the guiding
framework for the strategies that we developed to support nursing
scholarship.
Among the strategies developed and implemented were:
• Scheduling drop-in work sessions for nurses to obtain help de-
veloping abstracts, Power Point or poster presentations, or manu-
scripts
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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• Providing a mentored writing program for nurses who had never
previously published
• Offering in-house peer review of abstracts prior to submission to a
national conference, and critique and feedback of planned presen-
tations or research projects
• Establishing an annual Excellence in Writing award for published
work
• Instituting a Clinical Scholar Program to recognize nurses’ col-
laborative work with our research center
Since implementing these strategies, feedback from clinicians and
nurse managers has been positive, nurses’ interest in scholarship has
steadily increased, and the number of conference presentations has
more than tripled, while the number of manuscripts submitted for
publication has grown substantiality.
Many of the strategies we describe in this presentation could be
easily adapted for use with nurses in a variety of settings. Promot-
ing and supporting nurses’ scholarly activities directly contributes to
evidence-based practice through dissemination and thus has impor-
tant implications for oncology nursing practice.
ing a survey, auditing patient records, and observing nursing prac-
tice.
The goal of the wound care workgroup is to implement evidence
based practices for oncology patients with skin care alterations re-
lated to incontinence.
2034
2033
STAFF NURSE IMPLEMENTATION OF AN EVIDENCE-BASED PRAC-
TICE STANDARD: CARING FOR ONCOLOGY PATIENTS WITH AL-
TERATION IN SKIN INTEGRITY RELATED TO INCONTINENCE. Susan
O’Donnell, RN, BSN, OCN
®
, Heather Robertson, RN, BSN, Cynthia
Harrington, RN, BSN, Laura Brown, RN, BSN, OCN
®
, Ginette Audette,
RN, BSN, and Aura Vasquez, RN, BSN, Massachusetts General Hos-
pital, Boston, MA.
Patients with cancer are at an increased risk for developing skin
breakdown. They are susceptible for perineal-rectal skin integrity
impairment related to multiple factors including side effects of che-
motherapy/radiation, altered nutritional status, immobility/weak-
ness, and immunosuppression. Incontinence of urine and or stool
can further complicate this problem. Perineal skin damage second-
ary to incontinence is painful, preventable, and prevalent, occurring
in approximately 33% of hospitalized adults (Lyder, 1992). Nurses
play a crucial role in assessing, treating, and preventing perineal skin
breakdown related to incontinence.
After attending a two-day workshop on wound care, a work group
on a hematology/oncology unit was created to identify common skin
care problems in our patient population. Altered perineal skin in-
tegrity related to incontinence was the chosen issue. An extensive
review of evidence-based literature was completed examining the
current protocols in use for the management of perineal-rectal skin
alterations. Although there is a significant amount of literature focus-
ing on skin maintenance of the medical-surgical patient population
there remains a paucity of research focusing on skin care of inconti-
nent oncology patients.
Utilizing available information, a skin care initiative was started to
create a perineal skin care protocol on the unit. A focus was placed
on cleaning, assessing, protecting, and treating the affected skin in
both patients with a breakdown or those we felt were at risk for fu-
ture complications. A staff survey was conducted to evaluate current
standards for skin care on the unit when caring for a patient with
incontinence. This survey collected information on current practices
of cleaning, assessing, protecting and treating the skin of incontinent
patients in an oncology setting.
The survey results will be analyzed and evidence based guidelines
will be developed. This work is ongoing. A series of staff education
programs will be conducted and members of the unit based wound
care work group will serve as consultants/resources in planning care.
The wound care work group will evaluate this initiative by conduct-
A PILOT STUDY TO DETERMINE NUTRITIONAL NEEDS OF AMBU-
LATORY CHEMOTHERAPY PATIENTS. Louise Goldstein, RN, OCN
®
,
CHPN, Duke University Hospital, Durham, NC.
Research has demonstrated a connection between nutrition and
health. People with cancer, undergoing treatment, experience weight
loss and poor nutritional status, which can have a detrimental effect
on the response to cancer treatment and patients’ quality of life. The
outpatient oncology infusion clinic currently does not receive any
nutritional support from a dietitian. The RN is the only resource for
nutritional guidance.
The purpose of this project was to determine how many patients
receiving chemotherapy or combination therapy needed to be evalu-
ated and supported by a dietitian. The goal was to demonstrate the
need for a paid position for a dietitian in this outpatient treatment
area.
The Scored Patient-Generated Subjective Global Assessment (PG-
SGA) was selected as the patient assessment tool. This tool was cho-
sen because it has multiple levels of nutritional triage recommen-
dations and established reliability and validity. A demographic tool
was used to collect data on type of cancer, if receiving single or com-
bination therapies, what agents were being used, and the frequency
of treatments. Nurses used the PG-SGA and demographic tool to
collect information on a random sample of 90 patients.
The assessment tools were completed and entered into an Access
database. Of the 90 patients surveyed, it was determined that 72%
of those patient receiving chemotherapy alone and 93% of patients
receiving combination therapy required dietitian evaluation and
support based on the triage guidelines. Of the cancer disease sites
reviewed, breast, gastrointestinal, head & neck and gynecological
cancers predominantly required dietitian intervention.
Based on the above information, presentations have been made at
both the department and service line level stressing the need for nu-
tritional support for this vulnerable population. The data has also
been shared with the Director of Nutrition Services for the hospital,
who is benchmarking with other programs. The need for this new
position has been established and accepted. The position is currently
being worked into the next fiscal budget. This is an example of how
nurses can use clinical data to advocate for improved patient care.
2038
ONE PRACTITIONER’S EXPERIENCE WITH COUNSELING AND TEST-
ING WOMEN AT RISK FOR HEREDITARY BREAST AND OVARIAN
CANCER SYNDROME. Tracey Tatum, RN, MS, FNP, OCN
®
, Thomas
Johns Cancer Center at CJW Medical Center, Richmond, VA.
The Oncology Nursing Society and American Society of Clinical
Oncology have identified that genetic testing for Hereditary Breast and
Ovarian Cancer Syndrome (HBOCS) is not appropriate for screening
of the general population, but is an important tool for cancer preven-
tion and early detection in specific groups. Important characteristics
that have been identified include: breast cancer < 50 years, bilateral
breast cancer, male breast cancer, Ashkenazi Jewish ancestry, and
ovarian cancer at any age. Therefore, it is important to obtain a thor-
ough medical and family history to identify appropriate candidates.
The purpose of this review was to evaluate my practice and the
patients that proceeded to genetic testing for HBOCS. This review
ONCOLOGY NURSING FORUM – VOL 34, NO 2, 2007
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included: my patients’ hereditary characteristics, risk factors of pa-
tients tested, testing results, medical management advised and pa-
tient’s medical treatment decisions.
A retrospective chart review was conducted to assess patients re-
ferred for genetics services, who received pre and post-test counsel-
ing and BRACA Analysis testing for HBOCS. Also, outcomes data
on patients testing positive for a deleterious BRCA mutation was
obtained.
Out of the seventy-nine patients evaluated, 15% tested positive for
a deleterious mutation. Two or more risk factors for HBOCS were
identified in 65% of these patients. Additionally, eighty-four percent
of patients had breast cancer before the age of fifty diagnosed in
themselves and/or a family member.
The overwhelming majority of patients referred to me had a di-
agnosis of either breast or ovarian cancer and were referred by on-
cology providers. These test results were utilized to make medical
decisions to reduce the risk of recurrence or to prevent new diag-
noses in patients and their family members. Optimally, to improve
prevention and early detection of hereditary cancer, primary care
providers and gynecologists need to be targeted. As the U.S. Surgeon
General has advised, a review of all patients’ family histories should
be obtained. Thus, indicators of risk for HBOCS could be identified.
Then, changes to medical plans to reduce risks of HBOCS associ-
ated diseases could occur before cancer is diagnosed.
2039
QUESTION OF THE DAY: AN EDUCATIONAL INTERVENTION TO AS-
SIST IN IMPROVING SPECIALTY KNOWLEDGE ASSIMILATION BY
NOVICE NURSES. DeWayne Gallenberg, RN, MS, OCN
®
, Mayo Clinic,
Rochester, MN.
The complexity of care on an acute care inpatient unit at a tertiary
referral teaching hospital is frequently intimidating to the novice
nurse. Competing time pressures of providing care while trying to
continue to expand their knowledge base has been cited by novice
nurses as a factor frequently associated with dissatisfaction and deci-
sions to leave the bedside. This is further complicated by the rapid
pace of change in oncology care as new medications and treatment
regimen are discovered or evolve.
This project involves a “just in time” educational intervention on
a daily basis to assist the unit team in learning new information or
reinforcing previously discussed concepts on a hematology unit at a
large midwestern teaching hospital.
A Masters-prepared RN on a daily basis receives report on all pa-
tients in the area, and constructs and delivers a one to five minute
inservice to the team present at that report. The questions addressed
are compiled, and on a weekly basis distributed via an email distri-
bution list to interested nurses within the organization at large on
a voluntary basis. Current research topics are able to be included
because the project coordinator is a member of the medical specialty
research committee.
Over half of the inpatient hematology/oncology/BMT nursing staff
at the organization across multiple nursing units have voluntarily
subscribed to the electronic distribution list.
With the increasing pace of change in the scientific basis of on-
cology nursing practice and the improved availability of electronic
communications platforms, novel methods of information distribu-
tion may assist in keeping oncology nurses informed about cutting
edge topics.
BSCN, Tom Baker Cancer Center/Alberta Cancer Board, Calgary, Can-
ada.
Sexuality is a broad term and is comprised of physical, psychologi-
cal, social and functional components. It is an integral part of one’s
quality of life and is significantly influenced by a cancer diagnosis
and subsequent treatment. Several authors have identified that sexual
dysfunction in post bone marrow transplant patients occurs in ap-
proximately 50% of patients. Further, close to 70% of female trans-
plant survivors and 20% of male survivors reported ongoing sexual
difficulties three years following treatment.
Patients are often hesitant to discuss sexual health concerns with
their health care provider for a variety of reasons. Often, patients
will wait for the health care professional to initiate discussion in the
area.
Review of the literature revealed a lack of standardized instruments
available for assessing sexual health in oncology patients. Very few
existing tools were developed systematically with subsequent pau-
city of psychometric data available. Additionally, few of the tools are
comprehensive. Most assess sexual function/dysfunction and not the
broader concept of sexuality.
Objectives:
1. to field test a novel sexual health assessment guide in patients who
have undergone blood cell/bone marrow transplant
2. to identify patients’ concerns about sexuality following blood cell/
bone marrow transplant (autologous and allogeneic)
3. to identify areas of patient concern requiring further assessment
and intervention
Following review of the literature and existing assessment tools,
the Sexual Health Assessment Guide was developed. This tool uses
the sexual response cycle as a conceptual framework. The tool was
created with input from BMT psychologists. The tool incorporates
physical, psychological and social/relational domains. A 6-point
Likert scale assesses patients’ sexual health concerns and the related
distress that these concerns impose.
This pilot study will employ a descriptive exploratory design to
examine the sexual health needs of patients who have undergone
hematopoietic stem cell transplantation.
In addition, psychometric properties of the sexual health assess-
ment guide will be assessed as part of this pilot.
No findings available at this time.
2042
2041
ASSESSING THE SEXUAL HEALTH NEEDS OF RECIPIENTS OF BLOOD
CELL OR BONE MARROW TRANSPLANTATION. Reanne Booker, RN,
WEARING FACE MASKS FOR THE NEUTROPENIC POPULATION:
WHAT IS THE EVIDENCE? Elizabeth Sorensen, MSN, APRN, BC, UT
M.D. Anderson Cancer Center, Houston, TX.
Community respiratory viruses are a potential cause of pneumonia
and death among hematopoietic stem cell transplantation recipients
and patients with hematologic malignancies. Oncology nurses com-
monly wear masks while in the presence of severe and prolonged
neutropenic patients to protect the patient from any potential air-
borne infections. Currently, there are no evidence based guidelines
to support this practice. Furthermore, there are many possible dis-
advantages to this practice including: social isolation of the patient,
delayed response time by nurses, less frequent visits by the nurse,
increased equipment requirements and cost, and finally, masks can
impair communication from the nurse to the patient resulting in less
effective interactions and teaching opportunities.
Currently, variability exits in mask type used, length of time used,
and frequency of mask changing by the health care provider (HCP).
This current practice is implemented in many health care facilities
and little evidence exists to support or guide the practice. The pur-
pose of this project is to identify and evaluate the evidence support-