Leadership Meeting Redesign: Optimizing Information and Collaboration.

Efficient and effective meetings are critical for busy health care leaders who are often juggling multiple demands on their time. Creating a shared sense of purpose post COVID and having engagement with all leaders are critical to a department's success. This improvement project offers leaders direction on thinking through meeting redesign.

Safety Culture and Workforce Well-Being Associations with Positive Leadership WalkRounds.

BACKGROUND: Interventions to decrease burnout and increase well-being in health care workers (HCWs) and improve organizational safety culture are urgently needed. This study was conducted to determine the association between Positive Leadership WalkRounds (PosWR), an organizational practice in which leaders conduct rounds and ask staff about what is going well, and HCW well-being and organizational safety culture. METHODS: This study was conducted in a large academic health care system in which senior leaders were encouraged to conduct PosWR. The researchers used data from a routine cross-sectional survey of clinical and nonclinical HCWs, which included a question about recall of exposure of HCWs to PosWR: "Do senior leaders ask for information about what is going well in this work setting (e.g., people who deserve special recognition for going above and beyond, celebration of successes, etc.)?"-along with measures of well-being and safety culture. T-tests compared work settings in the first and fourth quartiles for PosWR exposure across SCORE (Safety, Communication, Operational Reliability, and Engagement) domains of safety culture and workforce well-being. RESULTS: Electronic surveys were returned by 10,627 out of 13,040 possible respondents (response rate 81.5%) from 396 work settings. Exposure to PosWR was reported by 63.1% of respondents overall, with a mean of 63.4% (standard deviation = 20.0) across work settings. Exposure to PosWR was most commonly reported by HCWs in leadership roles (83.8%). Compared to work settings in the fourth (< 50%) quartile for PosWR exposure, those in the first (> 88%) quartile revealed a higher percentage of respondents reporting good patient safety norms (49.6% vs. 69.6%, p < 0.001); good readiness to engage in quality improvement activities (60.6% vs. 76.6%, p < 0.001); good leadership accessibility and feedback behavior (51.9% vs. 67.2%, p < 0.001); good teamwork norms (36.8% vs. 52.7%, p < 0.001); and good work-life balance norms (61.9% vs. 68.9%, p = 0.003). Compared to the fourth quartile, the first quartile had a lower percentage of respondents reporting emotional exhaustion in themselves (45.9% vs. 32.4%, p < 0.001), and in their colleagues (60.5% vs. 47.7%, p < 0.001). CONCLUSION: Exposure to PosWR was associated with better HCW well-being and safety culture.

ONS Guidelines™ for Cancer Treatment-Related Radiodermatitis.

PURPOSE: Radiodermatitis is a side effect of radiation therapy. Evidence-based interventions to minimize severity or delay progression are important for clinical care. This guideline intends to support individuals with cancer, clinicians, and others in decisions regarding radiodermatitis treatment. METHODOLOGIC APPROACH: A panel of healthcare professionals with patient representation was convened to develop a national clinical practice guideline for the management of radiodermatitis. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology and the National Academies of Sciences, Engineering, and Medicine criteria for trustworthy guidelines were followed. The Cochrane Collaboration risk-of-bias tool was used, and certainty of the evidence was assessed using the GRADE approach. A quantitative and narrative synthesis of the evidence was completed. FINDINGS: The panel agreed on eight recommendations and made a conditional recommendation for deodorant/antiperspirant. Aloe vera and oral curcumin had knowledge gaps and were recommended only in the context of a clinical trial. The panel suggested against emu oil, calendula, and nonsteroidal interventions. IMPLICATIONS FOR NURSING: This guideline summarizes evidence-based interventions for the management of radiodermatitis to guide clinical care. SUPPLEMENTARY MATERIAL CAN BE FOUND AT&NBSP;HTTPS: //bit.ly/2GEwJtT.

Oncology Nursing During a Pandemic: Critical Reflections in the Context of COVID-19.

OBJECTIVES: To provide a critical reflection of COVID-19 in the context of oncology nursing and provide recommendations for caring for people affected by cancer during this pandemic. DATA SOURCES: Electronic databases, including CINAHL, MEDLINE, PsychINFO, Scopus, professional web sites, and grey literature were searched using Google Scholar. CONCLUSION: Nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic. This pandemic poses several challenges for oncology services. Oncology nurses are providing a pivotal role in the care and management of the novel COVID-19 in the year landmarked as the International Year of the Nurse. IMPLICATIONS FOR NURSING PRACTICE: It is too early to tell what shape this pandemic will take and its impact on oncology care. However, several important clinical considerations have been discussed to inform oncology nursing care and practice.

Addressing Incivility and Bullying in the Practice Environment.

OBJECTIVE: To identify knowledge related to incivility in the workplace, explore the impact that incivility can have on nursing and patient outcomes, and identify interventions to help promote a positive work environment. DATA SOURCES: Published literature, internet, books, and clinical guidelines. CONCLUSION: Incivility detracts from the caring environment of oncology care. Incivility can negatively affect oncology nurse's ability to work together as collaborative teams and may have detrimental consequences on patient outcomes. IMPLICATIONS FOR NURSING PRACTICE: Oncology nursing is a highly collaborative specialty; therefore, nurse leaders need to ensure all team members have the tools needed to mitigate workplace incivility.

The Symptom Experience in Rectal Cancer Survivors.

CONTEXT: As the number of rectal cancer survivors grows, it is important to understand the symptom experience after treatment. Although data show that rectal cancer survivors experience a variety of symptoms after diagnosis, little has been done to study the way these symptoms are grouped and associated. OBJECTIVES: To determine symptom prevalence and intensity in rectal cancer survivors and if clusters of survivors exist, who share similar symptom-defined survivor subgroups that may vary based on antecedent variables. METHODS: A secondary analysis of the Cancer Care and Outcomes Research and Surveillance database was undertaken. Cluster analysis was performed on 15-month postdiagnosis data to form post-treatment survivor subgroups, and these were examined for differences in demographic and clinical characteristics. Data were analyzed using cluster analysis, chi-square, and analysis of variance. RESULTS: A total of 275 rectal cancer survivors were included who had undergone chemotherapy, radiation therapy, and surgery. Most frequently reported symptoms included feeling "worn out" (87%), feeling "tired" (85%), and "trouble sleeping" (66%). Four symptom-defined survivor subgroups (minimally symptomatic n = 40, tired and trouble sleeping n = 138, moderate symptoms n = 42, and highly symptomatic n = 55) were identified with symptom differences existing among each subgroup. Age and being married/partnered were the only two antecedents found to differ across subgroups. CONCLUSION: This study documents differences in the symptom experience after treatment. The identification of survivor subgroups allows researchers to further investigate tailored, supportive care strategies to minimize ongoing symptoms in those with the greatest symptom burden.

The Role of the Advanced Practice Nurse in the Academic Setting.

OBJECTIVES: To explore how advanced practice nurses implement practice change in academic medical centers to support optimal patient and staff outcomes. DATA SOURCES: Published peer reviewed literature, web-based resources, and professional society materials. CONCLUSION: Cancer care is rapidly evolving and advanced practice nurses can shape the future of how care is delivered as well as the setting it is delivered in. IMPLICATIONS FOR NURSING PRACTICE: Advanced practice oncology nurses (Nurse Practitioners and Clinical Nurse Specialists) have an opportunity to significantly shape the patient experience by implementing programmatic changes across the continuum of care by engaging stakeholders in project design. Knowledge of change management and implementation science is critical to success.

Practice Innovations, Change Management, and Resilience in Oncology Care Settings.

Our commitment to advancing nursing practice and quality care for our patients must be at the forefront of our minds. Nursing's role in designing and implementing new innovations is integral to the advancement of healthcare delivery across the country.

A tailored nurse coaching intervention for oral chemotherapy adherence.

Although patients frequently express a preference for oral medications, compliance to these medications varies. Patients often have difficulty adhering to their medication schedules due to lack of understanding, inadequate support, or unwelcome side effects. Fostering adherence to oral chemotherapy regimens improves patients' chance of survival and long-term quality of life. This randomized trial tested the effectiveness of a tailored intervention to promote adherence to oral chemotherapeutic agents in 45 adult patients with cancer. The control group received the standard chemotherapy education provided at the cancer center. The intervention group received standard education and a tailored adherence plan developed by an advanced practice nurse. The nurse coaching intervention was administered via telephone. Adherence was measured using self-report and pharmacy refill rates. For adherence measures at both 2 and 4 months, the intervention group adherence rates were superior to the control group rates. Pharmacy refill rates of adherence were lower than self-reports. Results suggest that for some participants, the tailored coaching intervention was bene-ficial. Barriers to and facilitators of better adherence are discussed.

Measuring oncology nurses' psychosocial care practices and needs: results of an Oncology Nursing Society psychosocial survey.

PURPOSE/OBJECTIVES: To develop and implement a survey of Oncology Nursing Society (ONS) members focused on their current practices and needs in relation to providing psychosocial care. DESIGN: Descriptive, cross-sectional. SETTING: Web-based survey of ONS members. SAMPLE: An invitation was e-mailed to 11,171 ONS members. Of those, 623 followed the link to the electronic survey and 64% of those (n = 401) completed the survey. METHODS: An ONS Psychosocial Project Team was convened in 2009. One of the team's goals was to develop a survey to assess members' needs. The final survey consisted of 24 items, including five items related to demographic characteristics. Response formats included Likert-type scale, yes and no, and open-ended questions. MAIN RESEARCH VARIABLES: Psychosocial care practices, education, and research. FINDINGS: Psychosocial concerns are assessed using a variety of methods. Nurse perceptions regarding primary responsibility for providing psychosocial services differ by group. Barriers to the provision of psychosocial care exist at the individual, institutional, and community levels. CONCLUSIONS: Although nurses assess patients' psychosocial needs, multiple barriers still exist related to interdisciplinary communication; knowledge of the Institute of Medicine's recommendations; and resources at the individual, institutional, and community levels. IMPLICATIONS FOR NURSING: The survey results were presented to the ONS Board of Directors, along with a three-year plan that included recommendations for future development of advocacy, practice, education, and research initiatives. Additional work is needed to effectively support RNs in their provision of psychosocial care to patients and families.

Interventions to promote adherence with oral agents.

OBJECTIVES: The advent of oral therapies has dramatically changed the landscape of cancer therapy. Yet the degree to which patients actually take the prescribed agents as ordered remains unknown. This article outlines the challenges that oral chemotherapy agents present to both patients and providers and suggests interventions for promoting adherence. DATA SOURCES: Published articles and web resources. CONCLUSION: Barriers and facilitators to medication adherence are reviewed and interventions to promote medication adherence are presented. Strategies that include patient education and symptom management can promote adherence. IMPLICATIONS FOR NURSING PRACTICE: Maximizing adherence to oral chemotherapy agents can have many positive outcomes, but most important is improvement in overall survival and life expectancy. Other outcomes include improved safety and quality of life. Patients risk improper dosing and an increase in disease recurrence when there is nonadherence with medications. Correct dosing, education, and symptom management are all critical to ensuring adherence. Nursing interventions that incorporate education, early symptom identification, and reminder prompts can improve outcomes.

Sexual functioning along the cancer continuum: focus group results from the Patient-Reported Outcomes Measurement Information System (PROMIS®).

OBJECTIVE: Cancer and treatments for cancer affect specific aspects of sexual functioning and intimacy; however, limited qualitative work has been done in diverse cancer populations. As part of an effort to improve measurement of self-reported sexual functioning, we explored the scope and importance of sexual functioning and intimacy to patients across cancer sites and along the continuum of care. METHODS: We conducted 16 diagnosis- and sex-specific focus groups with patients recruited from the Duke University tumor registry and oncology/hematology clinics (N=109). A trained note taker produced field notes summarizing the discussions. An independent auditor verified field notes against written transcripts. The content of the discussions was analyzed for major themes by two independent coders. RESULTS: Across all cancers, the most commonly discussed cancer- or treatment-related effects on sexual functioning and intimacy were fatigue, treatment-related hair loss, weight gain and organ loss or scarring. Additional barriers were unique to particular diagnoses, such as shortness of breath in lung cancer, gastrointestinal problems in colorectal cancers and incontinence in prostate cancer. Sexual functioning and intimacy were considered important to quality of life. While most effects of cancer were considered negative, many participants identified improvements to intimacy after cancer. CONCLUSION: Overall evaluations of satisfaction with sex life did not always correspond to specific aspects of functioning (e.g. erectile dysfunction), presenting a challenge to researchers aiming to measure sexual functioning as an outcome. Health-care providers should not assume that level of sexual impairment determines sexual satisfaction and should explore cancer patients' sexual concerns directly.

NCCN Task Force Report: Specialty Pharmacy.

The use of specialty pharmacies is expanding in oncology pharmacy practice. Specialty pharmacies provide a channel for distributing drugs that, from the payor perspective, creates economies of scale and streamlines the delivery of expensive drugs. Proposed goals of specialty pharmacy include optimization of pharmaceutical care outcomes through ensuring appropriate medication use and maximizing adherence, and optimization of economic outcomes through avoiding unwarranted drug expenditure. In oncology practice, specialty pharmacies have become a distribution channel for various agents. The use of a specialty pharmacy, and the addition of the pharmacist from the specialty pharmacy to the health care team, may not only provide benefits for care but also present challenges in oncology practice. The NCCN Specialty Pharmacy Task Force met to identify and examine the impact of specialty pharmacy practice on the care of people with cancer, and to provide recommendations regarding issues discussed. This report provides recommendations within the following categories: education and training of specialty pharmacy practitioners who care for individuals with cancer, coordination of care, and patient safety. Areas for further evaluation are also identified.

A prospective randomized, placebo-controlled skin care study in women diagnosed with breast cancer undergoing radiation therapy.

PURPOSE/OBJECTIVES: To compare the effectiveness of three different skin care products versus a placebo in reducing the incidence of radiation therapy-induced skin reactions prophylactically. DESIGN: Prospective randomized, double-blinded, placebo-controlled study. SETTING: A radiation oncology department at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States. SAMPLE: 208 women with breast cancer who were to receive whole breast radiation therapy. METHODS: Patients were invited to participate after radiation therapy was documented as part of their treatment plan. Patients applied a skin care product starting on the first day of treatment and were assessed weekly by their radiation oncology nurse. MAIN RESEARCH VARIABLES: Skin reaction score and skin product. FINDINGS: None of the products were statistically better than placebo in preventing skin reactions. Increases in skin reaction over time did not vary with treatment group for the linear (p = 0.16) and nonlinear (p = 0.94) effects of time and for both time components tested together (p = 0.41). CONCLUSIONS: Ninety-five percent of women participating in this study experienced a radiation therapy-induced skin reaction. IMPLICATIONS FOR NURSING: The development of guidelines to support safe patient care is encouraged because patients prefer to take action rather than do nothing. However, the findings do not demonstrate improved clinical outcomes with the use of skin care products. Healthcare providers should proactively educate patients about acute skin reactions and self-care strategies to minimize skin breakdown.

Developing a high-dose-rate prostate brachytherapy program.

This article provides oncology nurses with an overview of high-dose-rate brachytherapy for the treatment of prostate cancer. Many treatment options are available for men diagnosed with prostate cancer. Oncology nurses must know about this potential treatment option so they can provide appropriate education, support, and self-care management advice. Program requirements, patient eligibility, and essential planning recommendations are discussed.

Assessing the need for a dietitian in radiation oncology.

Nutritional care is an integral component of quality cancer treatment. Patients undergoing cancer therapy are at risk for developing a variety of side effects that impact their intake, absorption, and nutritional status. The issue becomes compounded in newly diagnosed patients who have preexisting poor nutritional status, comorbid diseases, mechanical obstruction, and metabolic abnormalities. Standards related to the role of dietitians are well defined in the literature and by the Joint Commission. The quality improvement project illustrated in this article clearly demonstrated the need for a dietitian in the radiation oncology clinic by using the Patient-Generated Subjective Global Assessment.