Clinically relevant lessons from Family HealthLink: a cancer and coronary heart disease familial risk assessment tool.

PURPOSE: A descriptive retrospective study was performed using two separate user cohorts to determine the effectiveness of Family HealthLink as a clinical triage tool. METHODS: Cohort 1 consisted of 2,502 users who accessed the public website. Cohort 2 consisted of 194 new patients in a Comprehensive Breast Center setting. For patient users, we assessed documentation of family history and genetics referral. For all users seen in a genetics clinic, the Family HealthLink assessment was compared with that performed by genetic counselors and genetic testing outcomes. RESULTS: For general public users, the percentage meeting high-risk criteria were: for cancer only, 22.2%; for coronary heart disease only, 24.3%; and for both diseases, 10.4%. These risk stratification percentages were similar for the patient users. For the patient users, there often was documentation of family history of certain cancer types by oncology professionals, but age of onset and coronary heart disease family history were less complete. Of 142 with high-risk assignments seen in a genetics clinic, 130 (91.5%) of these assignments were corroborated. Forty-two underwent genetic testing and 17 (40.5%) had new molecular diagnoses established. CONCLUSION: A significant percentage of individuals are at high familial risk and may require more intensive screening and referral. Interactive family history triage tools can aid this process.Genet Med 17 6, 493-500.

Describing Remembrance & Renewal: A Holistic Self-Care Program.

Background: Holistic care interventions include support for healthcare worker grief in a relationship-based care paradigm. Few programs support oncology healthcare worker grief and renewal prior to and during the COVID-19 pandemic. Objective: Describe "knowledge of" and "engagement with" a program about grief and resilience, Remembrance & Renewal (R&R). Method: An anonymous, electronic survey was available to healthcare workers at an academic, comprehensive cancer center. Demographic questions were analyzed against "knowledge of" and "engagement with." Results: Of 105 responding to "awareness of," 81 knew about R&R and 48 had "engaged with" the program. Statistically significant relationships between a characteristic and awareness were found for education (p = .03), setting (p < .01), and the frequency of learning about a death (p = .04). Statistically significant relationships between a characteristic and level of participation were found for profession (p = .02) and length of time in job (p = .03). Open-ended questions asked about impact of patient death (n = 93), barriers to participation (n = 54), and feelings after "engagement with" (n = 45). Responses to impact, barriers, and feelings were respectively: sadness (75.3%); time (77.8%); and calm (75.6%). Conclusion: This study describes "knowledge of" and "engagement with" a holistic grief and renewal program. Further study will add to healthcare worker holistic self-care.

Current Practice and Practice Competencies of Clinical Nurse Specialists Working in US Emergency Care Settings: A Survey Study.

PURPOSE/AIMS: The aim of this study was to investigate the current practice of clinical nurse specialists working in US emergency care settings to (1) explicate the application of the Emergency Nurses Association core competencies and define the specialized clinical nurse specialist role in emergency care and (2) align current clinical nurse specialist practice in emergency settings with the National Association of Clinical Nurse Specialists core competencies and the identified substantive areas of clinical nurse specialist practice. DESIGN: This study used a quantitative exploratory descriptive approach using survey data. METHODS: A purposive convenience sample was recruited from the Emergency Nurses Association and the National Association of Clinical Nurse Specialists. Participants completed a 39-item survey based on a consensus process to develop competencies for emergency department (ED)-situated clinical nurse specialists. RESULTS: Respondents (n = 285) reported spending more than 50% of their work time in a primary clinical nurse specialist role. Significant differences in practice were found between geographic location, setting, educational preparation, title protection status, and type of institution. CONCLUSIONS: Our findings suggest that that the competencies ascribed to ED-situated clinical nurse specialists are valid in both frequency and importance. However, ED-situated clinical nurse specialists are not fully credentialed or practicing to the full extent of their education and licenses, because of professional, legislative, and environmental limitations.

Feasibility of stopping paclitaxel premedication after two doses in patients not experiencing a previous infusion hypersensitivity reaction.

PURPOSE: Paclitaxel-based chemotherapy continues to be an integral component in the treatment of many solid tumors. Prolonged use of paclitaxel may result in repeated doses of premedications and potential unwanted side effects. Infusion hypersensitivity reactions occurring beyond the second dose are infrequent and not well characterized. We hypothesized that patients whose paclitaxel premedications were discontinued after two doses were unlikely to experience infusion hypersensitivity reactions with subsequent paclitaxel doses. METHODS: Patients receiving paclitaxel-based chemotherapy who did not experience an infusion hypersensitivity reaction with their first or second dose had their paclitaxel premedications discontinued. The primary endpoint was to estimate the incidence of rescue medication for the treatment of paclitaxel infusion hypersensitivity during doses 3 to 6 for patients whose paclitaxel premedications had been discontinued. RESULTS: After receiving the first two doses of paclitaxel-based chemotherapy without experiencing an infusion hypersensitivity reaction (any grade), 55 breast cancer patients had their premedications discontinued for all remaining paclitaxel doses. None of these patients required rescue medication to treat an infusion hypersensitivity reaction with subsequent doses. CONCLUSIONS: In patients who have not experienced an infusion hypersensitivity reaction with the first two doses of paclitaxel, discontinuation of paclitaxel premedications may be considered an option without an increased risk of infusion hypersensitivity requiring rescue medication.

What Are We Talking About in Oncology Nursing?

Looking through past Clinical Moment columns, I noticed we have been talking and continue to talk about who we are and what we do as oncology nurses.

Supporting Advanced Practice Fellowship During COVID-19.

With the aging population and increasing number of cancer survivors contributing to a projected provider shortage, one solution is the specialization of nurse practitioners and physician assistants (part of the advanced practice provider [APP] workforce) in oncology. However, a lack of preparation in caring for the patient with cancer has led to burnout and stress in these groups. The authors studied an APP fellowship program to describe resilience, stress, and compassion in a transition-to-practice program and explore the experience of intentional, facilitated conversations. During 2019 and 2020, 18 APP fellows at a large, academic comprehensive cancer center participated in this descriptive study. The fellowship started in-person but changed to a virtual setting due to the COVID-19 pandemic. Resilience was measured through the Connor Davidson Resilience Scale 10, the Perceived Stress Scale, and the Professional Quality of Life Scale at four points in time: baseline, 6 months, 12 months, and 18 months. The experience of intentional, facilitated conversations was captured through simple theme collection as part of a standard program evaluation. Resilience, perceived stress, and compassion showed no statistical significance over the course of the fellowship. Evaluations of an intentional, facilitated conversation program found focal areas that included challenges, fatigue, empathy, relationships, role, self-awareness, and self-care. Despite the challenges of the pandemic on the health-care provider, the retention rate of APPs remained steady during the fellowship. The findings from this study suggested there was a benefit in an oncology fellowship for advanced practice and that intentional, facilitated conversations provide reflection and support during this experience.

Efficacy of Inhaled Essential Oil Use on Selected Symptoms Affecting Quality of Life in Patients With Cancer Receiving Infusion Therapies.

OBJECTIVES: To evaluate the effects of inhaled ginger, German chamomile, and bergamot essential oil (EO) versus an odorless control oil on appetite, anxiety, fatigue, and nausea in individuals with cancer receiving IV therapy. SAMPLE & SETTING: 248 adults with gastrointestinal, neuroendocrine, or skin cancer receiving IV therapy from an academic cancer center. RETHODS & VARIABLES: Participants were randomized to EO or control oil groups. Participants rated their symptoms during a seven-day period using a Likert-type scale ranging from 0 (no symptoms) to 10 (worst symptoms ever). RESULTS: Symptom burden was low. More men than women completed the study. The majority of participants had gastrointestinal cancer, followed by skin and neuroendocrine cancer. Ginger EO produced statistically significant results for anxiety and fatigue. IMPLICATIONS FOR NURSING: Most participants were men and had gastrointestinal cancer. The high number of zero scores for symptoms may indicate the success of current symptom management regimens. Improvements in anxiety and fatigue using ginger EO warrant further study for validation.

As an Oncology Nurse, What Does It Look Like to Be a Well-Being Clinician?

For me, becoming a well-being clinician required a journey that does not end. I discovered four relationships to pay attention to as an oncology nurse, and each requires care. They are self, colleagues, community, and patients and families. My journey to becoming a well-being clinician meandered through a variety of clinical practice, educational, and leadership opportunities. At each stopover, I developed knowledge, skills, and abilities in caring relationships. Three in particular were pivotal in my well-being practice development: my first nursing job as a float nurse in a small community hospital, a therapeutic communication class in my BSN completion program, and my Master of Arts in Lay Ministry (MALM) degree.

Take-a-Break Intervention: Improving Oncology Nurse Wellness.

Staff stress, burnout, and compassion fatigue related to increasing demands of oncology care have been further compounded by the impact of the COVID-19 pandemic. Ambulatory oncology nursing care, with a central focus on the collaborative partnership with patients and families, requires cultivation of the caring and healing environment. The relationships that the oncology nurse has with self, colleagues, and the community support safe, high-quality, and patient- and family-centered oncology care. To foster a caring environment, Take-a-Break, a well-being intervention for oncology clinic nurses, was designed, implemented, and promoted by an oncology clinic nurse and an ambulatory oncology mental health advanced practice RN.

Remembrance and Renewal: Health Care Staff Spiritual Self-Care.

Relationship-based care (RBC), a holistic framework of caring, models partnerships in caring to permeate at levels of patient, provider-self, provider-teams, and community. Remembrance and Renewal (R&R) is a RBC practice addressing spiritual self-care. At a dedicated time and space, R&R is offered monthly, rotating through six different buildings at an academic, medical center. To date, close to 2,000 visits have occurred. Those engaging in the practice express appreciation for the space to grieve and space to renew their spirit. R&R is a RBC practice in alignment with the scope and standards of holistic nursing practice and addresses the Quadruple Aim of improving health care staff's work-life balance.

Caring for Staff: The Role of Psychiatric Mental Health Advanced Practice RNs in Supporting Oncology Nurses.

Compassion fatigue and burnout are well-established experiences for oncology nurses, often resulting in distress and reduced job satisfaction and prompting nurses to leave the profession altogether. Multiple interventions have been developed to better support nurses experiencing these phenomena, with varying success.

Breast cancer, panic disorder, and CYP2D6: a case study.

When patients with breast cancer also present with mental health issues, the psychiatric-mental health advanced practice RN is an appropriate provider for treatment and medication management. Collaboration with the oncology advanced practice nurse and the rest of the healthcare team can provide personalized, comprehensive care to this patient population. This article describes one example.

From unit based to population focused: transforming the role of oncology clinical nurse specialists.

PURPOSE/OBJECTIVES: The aim of this study was to describe how the clinical nurse specialist (CNS) role can be positioned to proactively plan and facilitate evidenced-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum. This model capitalizes on the spheres of CNS practice (patient, nurse, and organization) through the functional roles of the CNS (clinical expert, researcher, educator, and consultant) to maximize quality care. BACKGROUND/RATIONALE: The CNS practice in a Midwest comprehensive cancer center has been unit based, focused on nursing staff education, skills, and competencies. Practice varied based on the needs of the unit. With the aging population, rapid growth in research accrual, increasing referrals, and expansion of facilities and programs, a reexamination of CNS practice was undertaken. DESCRIPTION OF THE PROJECT/INNOVATION: Nursing administration and CNSs evaluated the efficacy of transitioning to a population-focused model. Some responsibilities transitioned to other roles, the reporting structure was changed, and the role was realigned to a specific disease focus that encompassed care across the entire cancer continuum. OUTCOME: There was significant improvement in the areas of physician collaboration, autonomy, administrative support, teamwork, and contribution to the mission of the cancer program. INTERPRETATION/CONCLUSION: In this model, CNSs proactively plan and facilitate evidenced-based best practices in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory, maximizing quality care and nursing-sensitive patient outcomes. IMPLICATIONS: Healthcare organizations need to examine various roles for opportunities to focus on incorporating evidenced-based practices that will result in improved patient care and satisfaction.

Supportive patient care in the guise of a quilt.

Attention to the physical environment of an oncology center and the therapeutic potential of the environment are concepts to consider in nursing care. Art can enhance the human elements of caring and touch. Colorful quilts, whether hanging on the walls or given to patients, can provide emotional and physical warmth as well as represent a caring environment.