Managing Chemotherapy Side Effects: Achieving Reliable and Equitable Outcomes.

Receiving information about treatment-related side effects is a high priority for patients receiving chemotherapy. Infusion nurses typically assume responsibility for teaching patients how to manage treatment-related side effects, but providing reliable and equitable information across visits and across different infusion centers can present a problem. Implementing a standardized, patient-centered, departure encounter checklist can help ensure that nurses consistently provide patients with targeted, timely, and regimen-specific information about treatment-related side effects.
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Standardizing Assessment of Competences and Competencies of Oncology Nurses Working in Ambulatory Care.

A nursing quality consortium standardized nursing practice across 17 independently functioning ambulatory oncology sites. Programs were developed to validate both competences and competencies. One program assessed nine competences needed to develop systems of care to detect and treat treatment-related side effects. A second program was developed to assess competencies needed to prevent harm to oncology patients. This manuscript describes a successful approach to standardizing nursing practice across geographically distant academic and community sites.

Patient Preference for Instructional Reinforcement Regarding Prevention of Radiation Dermatitis.

BACKGROUND: Although patient preference is a core value within the context of patient-centered models of care, little attention has been paid to determining patient preference for instructional media. Nurses have traditionally used verbal face-to-face instruction as the mainstay of patient education, with written materials being used extensively as teaching guides to supplement verbal instruction or for instructional reinforcement. However, advances in technology have made possible the adding of video instruction to nurses' repertoire of instructional media. OBJECTIVES: The purpose of this study was to determine patients' media preferences (verbal, video, written) when receiving instructional reinforcement about self-care needed to prevent radiation dermatitis. METHODS: The current study was conducted as a secondary analysis of data from a process improvement initiative. In the parent study, patients received multimedia education related to skin care to prevent radiation dermatitis. This secondary analysis examined patient preference for verbal, video, or written education reinforcement at treatment weeks 1 and 3. FINDINGS: Results suggest that, when given a choice, verbal and video reinforcement are preferred over written reinforcement.

Minimizing Staff Exposure to Antineoplastic Agents During Intravesical Therapy.

Exposure to chemotherapy is a daily risk for nurses in oncology infusion centers. Although significant advances have been made in developing systems to make IV administration of antineoplastic agents safer, less attention has been given to developing systems to minimize exposure risk during instillation of intravesical chemotherapy. This article describes the use of a closed system developed at a comprehensive cancer center and compares it to two closed systems reported in the literature. At a Glance • Safe handling of biohazard medications is important for all healthcare workers involved in the administration of antineoplastic agents. • Nurses need to advocate for use of chemotherapy administration systems that minimize exposure to staff and patients. • Infrequently performed procedures need to be supported by clearly specified procedural steps that are readily accessible to the nurse.

Workplace fatigue among oncology nursing personnel.

Workplace fatigue is common among occupations that have prolonged work hours, rotating shifts, night-time work hours, inadequate time for rest during work, and insufficient time for recovery between shifts. Available evidence suggests that workplace fatigue poses a substantial threat to patient safety and contributes to worker injury and decreased vigilance. However, little is known about workplace fatigue among nursing personnel working in institutions dedicated solely to the care of patients with cancer. This study describes the scope and severity of workplace fatigue among nursing personnel working in the inpatient and ambulatory care divisions of a comprehensive cancer center.


The Environment of care model: a paradigm shift in comprehensive breast care.

The delivery of comprehensive breast care seems to be undergoing a paradigm shift driven by advances in technology, interprofessional collaboration and patient dissatisfaction with interruptions in care. This paradigm shift includes the emergence of new models of care that optimize the use of embedded radiology services and encourage greater interprofessional collaboration. This paper briefly reviews the three drivers (advances in technology, expectations regarding interprofessional collaboration and patient dissatisfaction with interrupted care) underlying the paradigm shift in comprehensive breast care as well as introduces the environment of care model, which describes the proximity of radiology services and interprofessional collaboration between the Women's Wellness Clinic (WWC) and Radiology at the Karmanos Cancer Institute (KCI) - both based in the United States. In addition, this model is proposed as a way to facilitate improved patient satisfaction and early appropriate referral. Finally, plans for evaluating the effectiveness of this model are presented.

Multisite Web-based training in using the Braden Scale to predict pressure sore risk.

OBJECTIVE: To evaluate the effect of a Web-based Braden Scale training module on nurses' knowledge of pressure-ulcer risk assessment and prevention. DESIGN: Pre-experimental, posttest-only design. SETTING: Web-based learning environment. PARTICIPANTS: Registered nurses (N=1391) working at 3 medical centers in the Midwest. MAIN OUTCOME MEASURES: Primary outcomes of interest were reliability and competence associated with using the Braden Scale for pressure-ulcer risk assessment. Secondary outcomes of interest focused on program evaluation, specifically nurses' perceptions of program adequacy and ease of use. MAIN RESULTS: After training, nurses correctly rated Braden Scale level of risk 82.6% of the time. Numeric ratings for Braden subscales were generally more reliable when case-study data indicated extreme risk levels (generally not at-risk level, high-risk level, and very high level) than when data indicated midlevels of risk (mild-risk level and moderate-risk level). Nurses' knowledge of appropriate risk-based preventive interventions was high, but correlated poorly with the ability to correctly assign numeric ratings to Braden subscales. CONCLUSION: Web-based training alone may not ensure reliable, competent estimates of pressure-ulcer risk for patients at all risk levels. Other strategies, such as clinical practice with expert supervision, should be considered. Further research is needed to clarify the links between scoring Braden subscales correctly and selecting appropriate risk-based preventive interventions.

Nursing attitudes and beliefs toward human sexuality: collaborative research promoting evidence-based practice.

PURPOSE AND OBJECTIVES: The purpose of this study was to use a collaborative process between Advanced Practice Nurses and a nurse researcher to identify barriers to incorporating sexuality assessment and counseling into nursing practice. DESIGN/APPROACH: This article provides an historical account of the collaborative group processes leading to the development and testing of the Sexuality Attitudes and Beliefs Survey (SABS). BACKGROUND/RATIONALE: Nurses often are called upon to talk to patients about their sexuality and sexual concerns. Many nurses believe that sexuality assessment, evaluation, and counseling is a part of their professional role, however, nurses do not necessarily integrate this awareness into their patient care. Discomfort, embarrassment, or strongly held attitudes about the nurse's role in discussing sexuality with patients can act as barriers to responding to these patient concerns. SETTING: A Midwestern urban healthcare facility, affiliated with a university served as the setting. SAMPLE: : Thirty-five nurses working outpatient and inpatient settings in oncology and HIV/AIDS. METHOD: Instrument development and voluntary survey. OUTCOMES: The collaborative initiative developed and piloted an instrument to measure nurses' attitudes and beliefs about human sexuality. Results of the pilot study suggest that what nurses believe patients expect from them, time availability, and confidence in one's ability to address issues related to human sexuality present significant barriers to incorporating sexuality assessment and counseling into nursing practice. CONCLUSION: Successful collaboration among clinicians and researchers required administrative support as well as a individual commitment and is a model that can be adapted to other settings and for other projects. IMPLICATIONS FOR PRACTICE: This study highlights the benefits of collaboration between clinicians and researchers to support evidenced based practice. The findings from this study will be used to develop strategies for removing barriers to sexuality assessment by nurses.

The effects of health state, hemoglobin, global symptom distress, mood disturbance, and treatment site on fatigue onset, duration, and distress in patients receiving radiation therapy.

PURPOSE/OBJECTIVES: To describe the fatigue experience of patients with cancer receiving radiation therapy and determine to what extent diverse correlates of fatigue affect fatigue onset, duration, and distress. DESIGN: Descriptive correlational study completed by secondary data analysis. SAMPLE/SETTING: Data were obtained from 384 subjects recruited from two urban, university-affiliated, radiation oncology clinics located in a large, Midwestern city. METHODS: The effects of health indicators and treatment site on fatigue onset, duration, and distress were examined using correlational analyses and analyses of variance. MAIN RESEARCH VARIABLES: Hemoglobin, health status, global symptom distress, mood disturbance, treatment site, and fatigue onset, duration, and distress. FINDINGS: Fatigue started near the middle of the second week of treatment, was moderately distressing, and lasted approximately 32 days. Higher levels of health and hemoglobin at the start of therapy were associated with a delayed onset, shorter duration, and lower levels of fatigue distress. In contrast, higher pretreatment levels of global symptom distress and mood disturbance were associated with an earlier onset, longer duration, and greater severity of fatigue distress. CONCLUSION: The fatigue experience in patients undergoing radiation therapy is highly individualized. Variations in the health states of patients as well as the area of the body being treated can influence fatigue onset, duration, and distress. IMPLICATIONS FOR NURSING: Pretreatment screening for fatigue and its correlates is needed to identify patients at risk for an earlier onset, longer duration, and more distressing levels of fatigue.