Reflections on the Emotional Hazards of Pediatric Oncology Nursing: Four Decades of Perspectives and Potential.

THEORETICAL PRINCIPLES: Pediatric oncology nurses are particularly vulnerable to emotional distress. Responsible for the oversight of a child's care, these nurses sustain close interactions with multiple patients and families over time, many of whom are coping with life-limiting diagnoses. The world of pediatric oncology nurses is one where tragedy is routinely witnessed thus demanding self-care and healing across a continuum. PHENOMENON ADDRESSED: The aim of this article is to outline and review the emotional sequelae of pediatric oncology nurses' work and to suggest interventions to support well-being in light of prolonged caregiving. Three major categories that are addressed include the aspects of clinical practice that influence caregiving, the risks of burnout, compassion fatigue, moral distress and grief, and interventions to counteract these phenomena. RESEARCH LINKAGES: Future-nursing research should focus upon the development of validated, psychometrically sound measurement tools to assess nurse-specific variants of burnout, compassion fatigue, moral distress, and nurse grief. Qualitative research should investigate the relationship between personal variables, workplace and team characteristics, age and experience, and their influence on the predominance of burnout, compassion fatigue, moral distress, and nurse grief. Lastly, the phenomena of resiliency demands further study.

Clamp for Safety: Improving Intravesical Chemotherapy Practices.

Processes for intravesical chemotherapy after transurethral resection of nonmuscle invasive bladder tumors may lack standardization. In 2019, at a large health care system in Los Angeles, California, five incident reports involving chemotherapeutic agent spills from urinary catheters after bladder tumor procedures necessitated a quality improvement project. The project lead determined that a cost-effective alternative device for securing the chemotherapeutic agent in the bladder was needed at four surgical locations of the health care system. In addition, a review of the literature and an observational assessment revealed lack of adherence to standard and recommended processes for using personal protective equipment (PPE) when handling hazardous medications. After revising existing processes, acquiring a cost-effective clamp and recommended chemotherapy PPE, instructing personnel on the clamping process and use of PPE, and implementing use of the clamp, there have been no spills associated with intravesical chemotherapy across the four surgical locations.

Prone Positioning in Patients With COVID-19 and Non-COVID-19 Acute Respiratory Distress Syndrome.

BACKGROUND: Patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) and may undergo prone positioning. OBJECTIVE: To compare the effects of prone positioning on oxygenation, intensive care unit length of stay, and intubation days in patients with COVID-19 ARDS and patients with non-COVID-19 ARDS. METHODS: A convenience sample of intubated patients with COVID-19 and moderate to severe ARDS (per Berlin criteria) was compared with historical data from a retrospective, descriptive medical record review of patients with non-COVID-19 ARDS. The historical comparison group was age and sex matched. RESULTS: Differences in Po2 to fraction of inspired oxygen ratios between the COVID-19 ARDS group (n = 41) and the non-COVID-19 ARDS group (n = 6) during the first 7 days of prone positioning were significant at the end of prone positioning on day 1 (P = .01), day 3 (P = .04), and day 4 (P = .04). Wilcoxon signed-rank tests showed that prone positioning had a positive impact on Po2 to fraction of inspired oxygen ratios from day 1 through day 6 in the COVID-19 ARDS group and on day 2 in the non-COVID-19 ARDS group. CONCLUSION: This retrospective review found greater improvement in oxygenation in the COVID-19 ARDS group than in the non-COVID-19 ARDS group. This finding may be attributed to the assertive prone positioning protocol during the pandemic and teams whose skills and training were likely enhanced by the pandemic demand. Prone positioning did not affect intensive care unit length of stay or intubation days in either group.

Integration of Behavioral Cough Suppression Therapy Into Lung Cancer Care: Nonpharmacologic Interventions for Chronic Cough.

BACKGROUND: Chronic cough is a demanding symptom of lung cancer. Clinical research tends to underestimate the impact of lung cancer-related cough on patient quality of life. Current guidelines do not describe how oncology nurses, as a vital part of the interprofessional team, can use nonpharmacologic interventions described by behavioral cough suppression therapy (BCST) techniques for patients with lung cancer. OBJECTIVES: This article aims to provide oncology nurses with insight into BCST and investigates how to integrate BCST into lung cancer care. METHODS: A literature search for primary articles related to BCST was conducted using the electronic databases PubMed® and CINAHL®. The 2017 American College of Chest Physicians' guideline and expert panel report served as a major resource. FINDINGS: Oncology nurses can investigate the use of BCST techniques for patients with lung cancer with chronic cough as a nonpharmacologic intervention. Assessment of patients with chronic cough should be carried out before initiating referral for BCST, including identifying cough triggers, causes of cough, and cough types.

Using a Quality Improvement Model to Implement Distress Screening in a Community Cancer Setting.

BACKGROUND: Quality cancer care includes routine screening for psychosocial distress. This quality improvement project focused on the implementation of distress screening at a licensed affiliate of Cancer Support Community, a community-based non-profit organization that provides professionally led cancer support. METHODS: An advanced practice oncology nurse assisted the staff in implementing and evaluating the process of distress screening. CancerSupportSource (CSS), a validated web-based distress screening program developed by Cancer Support Community for use in community cancer settings, was employed to screen for distress, identify potential resources, and improve in-house and community referrals. For purposes of this quality improvement project, CSS was administered in interview format by staff. The Plan-Do-Study-Act (PDSA) quality improvement approach was used to implement CSS. RESULTS: To implement the practice of distress screening, 21 patient participants were initially screened and evaluated for distress, including risk for clinically significant levels of depression, using CSS. The tool identified participant concerns and flagged thirteen persons as at risk for depression. After implementation and evaluation of distress screening using PDSA, in a year, 51 participants were screened. Participants stated that distress screening allowed for discussion of intimate questions that may not have otherwise occurred in an intake interview. CONCLUSION: It was demonstrated that CSS identified psychosocial and practical needs, facilitating the referral process and identification of community resources. Application of the PDSA model was an effective quality improvement model that can be used for the implementation and sustainability of distress screening across settings.

Cancer-related anemia: clinical review and management update.

Anemia is a decrease in circulating red blood cells that contributes to a complex group of symptoms. Anemia may be present in more than half of all patients with cancer but often is assessed, documented, prevented, and treated inadequately. Individuals with cancer are living longer, and the number of cancer treatment options provided at various points in the cancer continuum is growing; however, many treatments contribute to anemia. Because anemia can develop from multiple causes, treatment must be tailored to the underlying etiology. Cancer-related anemia can significantly affect therapeutic outcomes and patients' quality of life. Therapeutic interventions may include blood transfusions, administration of recombinant human erythropoietin, and interventions to support patient symptoms, most significantly, fatigue. Oncology nurses play a central role in risk assessment, symptom management, treatment planning, and evaluation and therefore must understand the etiology and physiology of cancer-related anemic states as well as evidence-based interventions to ensure optimal outcomes.

Advances in hormonal therapy for breast cancer.

OBJECTIVES: To describe recent developments in hormonal therapy for breast cancer, focusing on SERMs and AIs. DATA SOURCES: Published journal articles and texts, research reports and monographs, government publications, and professional organization guidelines. CONCLUSION: Research continues to identify the effectiveness of hormonal therapy in breast cancer, including adjuvant treatment in early and advanced stages as well as a chemopreventive measure. The individual drug profile must be evaluated for safety and efficacy, and the impact on QOL must be considered. IMPLICATIONS FOR NURSING PRACTICE: It is imperative that oncology nurses understand the physiology, application, risks, and benefits of hormonal therapies.

Five years and counting.

Oncology professionals are fully aware that the five-year mark of being disease-free after the diagnosis of cancer is not a magical number. Cancer is now considered a chronic disease and recurrence can happen at any time, which is unexpected and frightening. Yet, for me, and for many other cancer survivors, the five-year mark is one to be celebrated.