Improving cancer survivorship care: oncology nurses' educational needs and preferred methods of learning.

Oncology nurses are essential in all phases of cancer care; however, their role in survivorship care is unclear. To better understand the self-reported knowledge and educational needs on topics of survivorship care and oncology nurses' learning preferences, an online survey was conducted. Respondents self-reported knowledge level for 31 care topics, identified areas of most interest, topics needed to assist patients and address patient questions, and reported participation in continuing education and preferred learning methods. Knowledge was rated highest for topics of fatigue, anxiety, and fear of recurrence and lowest for issues related to finance, employment, and insurance. Nurses were most interested in late and long-term physical effects of cancer or treatment, managing emotional issues, cancer screening and surveillance, and complementary and alternative therapies. Study findings suggest that online learning methods would be feasible and well accepted by nurses to meet continuing education needs related to cancer survivorship.

Shift work and hospital employees: A descriptive multi-site study.

BACKGROUND: Hospitals staff with 12-hour and other shift work patterns to account for daily and seasonal workload requirements. Research in healthcare and industries requiring shift work suggests there may be negative health consequences to the workers related to fatigue and other factors. Due to the 24/7 nature of healthcare, it is important to understand the impact of shift work on employees. OBJECTIVES: The objectives of this study were to investigate how shift work impacts satisfaction with time for social and home activities, based on the Social and Domestic Survey, and chronic fatigue. In addition, an exploration of drowsy driving was undertaken. DESIGN AND SETTING: This study was a multi-site, descriptive survey study, conducted in 4 acute care hospitals in one metropolitan area in the central United States. PARTICIPANTS: Participants included healthcare workers in five 24/7 departments: nursing, respiratory therapy, laboratory, radiology and pharmacy. METHODS: Measures included demographics, work characteristics, and scales including the: Social and Domestic Survey, Circadian Type Inventory, and Chronic Fatigue Scale along with data regarding drowsy driving and automobile accidents/near misses. Data were analyzed using descriptive statistics for sample characteristics. An exploratory factor analysis was conducted on the Social and Domestic Survey. Group differences were tested using Mann-Whitney U tests and regression analyses. RESULTS: The sample included 1563 subjects (24% RR). The mean age was 40 years. Nursing comprised 77% of the sample, 88% were female, 85% were in a direct patient care role, 67% worked day shift, and 49% worked 12-hour shifts. Pay was important for working night shift, but home life was important for day shift. Night shift (p<0.001) and 12-hour shift workers (p<0.001) had higher chronic fatigue. However, after controlling for other factors, working night shift remained a significant predictor of chronic fatigue and lower satisfaction with time for daily tasks and family/social life, whereas working 12-hour shifts predicted higher satisfaction with daily tasks and periodic life activities. Thirty-five percent of workers reported altering their driving behavior at least half the time due to drowsy driving and 19% had an automobile accident or near miss due to drowsy driving. CONCLUSIONS: Findings suggest that night and long shifts can have negative effects on fatigue, family, and social life. Drowsy driving and accidents/near misses frequently occur due to drowsy driving. Leaders should continue to study the 24/7 work environment and test measures to improve the safety of shift workers.

Educating Healthcare Employees about Advance Care Planning.

The objective of this descriptive article is to provide a background of current research and data on advance care planning. Additionally, a proposed and detailed education initiative for increasing completion and understanding of advance care planning documents is presented.

Comparison of Bone Marrow Biopsy Specimens Obtained Using a Motorized Device and Manual Biopsy Systems.

OBJECTIVE: Bone marrow biopsy is an essential component in the diagnosis of hematopoietic disorders. Researchers evaluated the quality of bone marrow biopsy tissue acquired with a motorized bone marrow biopsy device versus a standard manual device based on the following criteria: biopsy length, percentage of aspiration artifact/intrastromal hemorrhage, length of nonhematopoietic bone, and overall quality of the sample. METHODS: Bone marrow biopsies (motorized, n = 30; manual, n = 120) from two academic medical centers were evaluated by two board-certified hematopathologists. For each specimen, the following parameters were recorded: biopsy length (cm), aspiration artifact (assessed in intervals of ≤10%, 11%-25%, 26%-50%, 51%-75%, and >75%), length (cm) of nonhematopoietic biopsy (e.g., cortical bone and skin), and overall quality of sample (inadequate, suboptimal, adequate, and excellent). RESULTS: Operators from two centers included physicians and nurse practitioners. The manual system was superior to the powered drill with respect to the amount of crush artifact (0.15 cm ± 0.01 vs. 0.24 cm ± 0.04, P = 0.01 [t-test]). There was a trend toward less aspiration artifact/intrastromal hemorrhage with the use of the manual biopsy; however, the difference was not statistically significant (P = 0.06). There was no statistically significant difference in the overall biopsy size, biopsy length, amount of nonhematopoietic elements, and overall adequacy of the sample. CONCLUSIONS: There was no significant difference in the biopsy length, amount of nonhematopoietic elements, and overall adequacy of the sample. Results suggest that the manual bone marrow biopsy device has significantly less crush artifact of the specimen and has a trend toward less aspiration artifact/intrastromal hemorrhage as well.

Use of Virtual Reality to Distract From Pain and Anxiety.

OBJECTIVES: To determine the effects of a virtual reality intervention on pain and anxiety in patients undergoing a bone marrow aspiration and biopsy procedure. SAMPLE & SETTING: 97 adults in an outpatient cancer center in the midwestern United States. METHODS & VARIABLES: In this quasiexperimental study, participants were assigned to either the experimental group (use of virtual reality goggles) or the control group (standard treatment). Vital signs, pain, and anxiety were measured before and after the procedure. T tests and chi-square tests were used to compare the two groups based on demographic data, pain, anxiety, and total amount of medication used during the procedure. RESULTS: Participants who wore virtual reality goggles during a bone marrow aspiration and biopsy procedure did not experience a statistically significant decrease in pain and anxiety. However, the experimental and control groups showed a decrease in pain and anxiety levels from pre- to postprocedure. IMPLICATIONS FOR NURSING: Virtual reality goggles may be a feasible, noninvasive alternative to traditional pharmacologic treatment. The cost of any intervention would need to be considered. Virtual reality should be researched and adapted to benefit patients in appropriate settings.

A nurse-developed prechemotherapy education checklist.

Many patients diagnosed with cancer receive chemotherapy. Oncology nurses are responsible for educating patients prior to the chemotherapy experience. Studies have examined what topics should be covered for such patients and how education should be delivered, but little literature exists regarding how to help nurses organize the data and perform education. This article examines how a community oncology practice developed a checklist to assist oncology nurses in organizing and delivering chemotherapy education to patients. Principles of adult education are reviewed briefly. The principles can aid nurses in understanding how adult patients learn and how sessions can be most effective.

DepoDur extended-release epidural morphine: reshaping postoperative care. What perioperative nurses need to know.

Epidural morphine as a single bolus dose has demonstrated analgesia that lasts up to 24 hours. Recent advances in drug delivery mechanisms have resulted in a formulation of morphine, DepoDur, which is a lipid-encapsulated extended-release epidural morphine that provides up to 48 hours of analgesia. The efficacy of DepoDur has been established after hip arthroplasty, lower abdominal surgery involving an incision below the umbilicus, and elective cesarean section delivery. The unique characteristics of DepoDur dictate that clinicians must be aware of the benefits and risks, and facilities must have a comprehensive system to allow for the safe administration of DepoDur. This article provides information on this novel drug delivery system, reviews research findings reported in the literature, and describes the relational collaboration system designed and implemented at Duke University Health System for safe patient care of DepoDur recipients.

Cultural influences on health care in Palestine.

International cancer care efforts are focusing increasingly on why cancer typically is diagnosed at later stages in the developing world. In Middle Eastern countries, cancer usually is diagnosed at a more advanced stage of disease. For example, in Palestine, 42% of cases were reported stage III and 18% were stage IV. Receiving a cancer diagnosis and seeking treatment is influenced by cultural values and how the community views cancer. Healthcare providers need to understand the disparities and the influence of those disparities on health outcomes. This article is constructed using the Culture Care Theory,which depicts the importance of culture on the health behavior of the individual, and will focus on how cultural values of Palestinian patients with cancer and their families affect attitudes toward and decisions about cancer care.

Oncology nurses' perspectives on the state of cancer survivorship care: current practice and barriers to implementation.

PURPOSE/OBJECTIVES: to describe current survivorship care from the perspectives of oncology nurses. DESIGN: descriptive. SETTING: e-mail invitation to Web-based survey. SAMPLE: 399 Oncology Nursing Society members providing care for patients initially treated more than one year previously. METHODS: an online survey was used to evaluate current aspects of survivorship care. MAIN RESEARCH VARIABLES: practice settings, services provided, and barriers to delivering survivorship care. FINDINGS: few nurses (27%) worked in settings with a formal survivorship program. Several program components were provided significantly more often in outpatient settings, pediatric facilities, and workplaces with a formal survivorship program. At the transition from acute to follow-up care, the survivorship nursing care provided most often was scheduling for ongoing monitoring (71%) and the least likely was assistance for employment or legal issues (16%). The greatest barriers to providing survivorship care were lack of time and funding (46%). Among nurses new to oncology (fewer than five years), 49% indicated they lacked sufficient knowledge compared to 36% of nurses with more than five years of oncology experience. CONCLUSIONS: findings describe current aspects of survivorship care across practice settings. Nurses reported that the greatest barriers are lack of time, funding, and lack of knowledge about survivorship issues. IMPLICATIONS FOR NURSING: a need exists for education to enhance knowledge and skills of nurses who will provide survivorship care. Research is warranted to develop empirically supported guidelines and care-delivery models that address the barriers to providing survivorship services.

Lung Cancer Awareness Week.

Smoking is the most preventable cause of death in our society. Tobacco use is responsible for nearly one in five deaths in the United States and the cause of premature death of approximately 2 million individuals in developed countries. Smoking accounts for at least 30% of all cancer deaths and is a major cause of heart disease, cerebrovascular disease, chronic bronchitis, and emphysema. The North Carolina Triangle Oncology Nursing Society applied for a competitive grant through the national Oncology Nursing Society and Cancer Care, Inc., in partnership with the Wellness Community and Bristol-Myers Squibb. The grant could be used for any lung cancer issue or project. Because North Carolina is deep in the tobacco belt, it was decided to focus on the largest group of new smokers in the United States, children and teens, for the project. Over 80% of adult smokers surveyed in 1991 had begun smoking by the age of 18. The oncology nurses wanted to focus on prevention, not cessation. Therefore, grade school children were the population selected for this project. This age group is impressionable and able to understand the negative consequences of smoking. This article outlines the content of the educational intervention and evaluation of the program.