The THRIVE© Program: Building Oncology Nurse Resilience Through Self-Care Strategies.

OBJECTIVES: To develop an evidence-based program for addressing the concerns of burnout and secondary trauma and building on the concept of resilience in oncology healthcare providers. SAMPLE & SETTING: 164 oncology staff, of which 160 were nurses, at the Arthur G. James Cancer Hospital and Richard J. Solove Research Institute in Columbus, Ohio. METHODS & VARIABLES: Oncology nurses and other providers participated in the THRIVE© program, which consists of an eight-hour retreat designed to teach self-care strategies, a six-week private group study interaction on a social media platform, and a two-hour wrap-up session. The Compassion Fatigue Short Scale and the Connor-Davidson Resilience Scale were used to evaluate the program. RESULTS: In self-assessments prior to THRIVE, nurse managers demonstrated the greatest degree of burnout, and bedside/chairside nurses demonstrated the greatest degree of secondary trauma. The greatest improvement in average scores from pre- to postprogram assessment was in increased resilience and decreased burnout. Increased resilience scores were sustained for a six-month period after THRIVE participation. IMPLICATIONS FOR NURSING: Oncology healthcare providers must identify self-care strategies that build their resilience for long, successful careers.

Acute Leukemia: Diagnosis and Treatment.

OBJECTIVE: To provide an overview of acute leukemia, comparing incidence, presenting symptoms, diagnosis, prognosis, and treatment of the major subtypes. DATA SOURCES: Review of articles dated 2010 to present in PubMed and CINAHL, and National Comprehensive Cancer Network Guidelines. CONCLUSION: The diagnosis of acute leukemia is comprised of a variety of hematopoietic neoplasms that are both complex and unique. Each subtype of acute leukemia has defining characteristics that affect prognosis and treatment. IMPLICATIONS FOR NURSING PRACTICE: Nurses play an integral role in the care of the patient with acute leukemia during and beyond hospitalization. Therefore, baseline knowledge of these diseases is essential. Early symptom recognition is central in the management of oncologic emergencies.

The Use of Comfort Kits to Optimize Adult Cancer Pain Management.

BACKGROUND: Pain is one of the most feared of all symptoms for the cancer patient. Some studies estimate that up to 90% of all cancer patients experience pain. Advances in pharmaceuticals and expert provider knowledge have improved pain management overall for the patient with cancer; however, complementary therapies can synergize medications to provide optimal pain relief while decreasing the side effect profile. Despite this, nurses may have limited access to such resources. Many therapies can be administered directly by the bedside/chairside nurse with minimal training and the nurse can then teach the patient and family how to use the selected complementary therapy after leaving the hospital or clinic. OBJECTIVES: The oncology nurse will be able to identify several easy-to-implement complementary therapies that can supplement pharmacologic pain management for cancer patients. METHODS: As a quality project, comfort kits, containing such items as handheld massagers, guided imagery audiotapes, and aromatherapy essential oils, were distributed for use with patients through unit-based pain resource nurses. ANALYSIS: More than 500 comfort kit items were tracked by the pain clinical nurse specialist during the comfort kit trial, both by medical record review and by follow-up phone calls to patients. During the comfort kit trial, average pain intensity decreased by 2.25 points on a 0-10 scale in the 24-hour period after use of the item from the comfort kit. Patients also had an overall decrease in the use of pharmacologic pain interventions and an increase in ambulation in the 24-hour period after implementation. CONCLUSIONS: Comfort kits allow nurses easy access to inexpensive tools to supplement pharmaceutical pain management. Optimizing nonpharmacologic pain management can increase patient and nurse satisfaction, improve overall pain management, and decrease untoward side effects.

Pain Assessment: Use of the Defense and Veterans Pain Rating Scale in Patients With Cancer.

BACKGROUND: Thorough, consistent pain assessment and reassessment are critical to guide and evaluate interventions designed to improve pain. OBJECTIVES: Based on a literature review about functional pain assessment, clinicians selected and then implemented the Defense and Veterans Pain Rating Scale (DVPRS) as a pain assessment instrument option in a comprehensive cancer center. METHODS: The DVPRS was added as a pain assessment instrument in clinical oncology practice. From postimplementation chart review and clinician satisfaction surveys, the DVPRS was evaluated for the following. FINDINGS: Seventy-eight percent of nurses surveyed (N = 64) preferred the DVPRS over any other pain assessment tool. Inpatient and ambulatory patients surveyed (N = 144) agreed that a Likert-type scale in the DVPRS was easier to understand, easier to use, and better in describing their pain than the numeric rating scale.

Leukostasis: Management to Prevent Crisis in Acute Leukemia
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BACKGROUND: Hyperleukocytosis, a peripheral white blood cell count greater than 100,000/mm3,is most commonly seen in patients with newly diagnosed or relapsed acute lymphoblastic leukemia and acute myeloid leukemia. Leukostasis is a reduction in blood flow related to hyperviscosity. Hyperleukocytosis, causing leukostasis, is an oncologic emergency and requires an exacting assessment and rapid response with appropriate intervention to prevent morbidity and mortality in the first week after diagnosis. OBJECTIVES: The objectives of this article are to equip oncology nurse to identify patients with hyperleukocytosis and to provide nursing interventions that will ensure safe, quality care. METHODS: A case study is used to demonstrate key concepts that are critical in early assessment, identification, and treatment of patients with leukostasis.
. FINDINGS: Oncology nurses well versed in the pathophysiology, clinical presentation, and management of leukostasis can make a significant contribution to the safe management of patients with cancer.

Impact of an Alert System on Quality Indicators in Patients With Acute Promyelocytic Leukemia.

BACKGROUND: Acute promyelocytic leukemia (APL), once the most lethal form of adult acute leukemia, has become the most curable. The goal of early and well-managed treatment induction is to reduce the malignant burden of promyelocytes to below the cytologically detectable level. OBJECTIVES: Oncology nurses who care for patients with APL need to be acutely aware of the basic differences in this disease from other forms of leukemia, including the two main complications for the newly diagnosed patient. METHODS: This article will briefly review APL and its associated presenting symptoms, prognosis, treatment, and complications. FINDINGS: These complications require immediate activation of expert staff and resources to protect critically ill patients with APL from associated morbidity and mortality.

Fecal microbiota transplantation in patients with cancer undergoing treatment.

Fecal microbiota transplantation (FMT) is a technique used to restore the normal body flora to the gut in cases of Clostridium difficile infection (CDI). It involves instillation of the stool of a healthy donor through a nasogastric tube or colonoscopy into the gastrointestinal tract of the patient. More research is needed to determine the parameters of FMT use in patients with cancer.

Using failure-to-rescue simulation to assess the performance of advanced practice professionals.

The use of advanced practice professionals (APPs) has been established in oncology care. APPs are frequently the most readily available ordering provider for care guidance when it becomes evident that a patient with cancer is failing. The purpose of the current preliminary descriptive project was to determine the best method for assessing APP performance in oncology-specific circumstances, particularly in the failing patient with cancer. A test group of 14 APPs completed a competency self-assessment, the Basic Knowledge Assessment Tool (BKAT)-8SR, and attended a four-hour simulation and classroom experience. Competency checklists with 30 priority interventions for each scenario had been anticipated by an expert panel. The APP competency self-assessment was measured for knowledge base and critical thinking. All of the APPs scored at or above the level of a critical care nurse with one year of experience on the BKAT-8SR. Twenty-seven of the anticipated interventions were enacted by all APPs. Five additional interventions were ordered that had not been anticipated. The success of this educational strategy has stimulated new learning opportunities, including initiation of a full-team oncology failure-to-rescue simulation, course restructuring, and other innovative simulation experiences.