Evaluation of Online Learning Modules for Improving Physical Activity Counseling Skills, Practices, and Knowledge of Oncology Nurses.

PURPOSE/OBJECTIVES: To examine the effectiveness of online learning modules for improving physical activity counseling practices among oncology nurses. 
. DESIGN: Randomized, controlled trial.
. SETTING: Online.
. SAMPLE: 54 oncology nurses.
. METHODS: Oncology nurses were randomly assigned to the learning modules group or control group. The learning modules group completed six online learning modules and quizzes focused on physical activity for cancer survivors, general physical activity principles, and motivational interviewing.
. MAIN RESEARCH VARIABLES: Percentage of cancer survivors counseled, self-efficacy for physical activity counseling, knowledge of physical activity, and perceived barriers and benefits of physical activity counseling.
. FINDINGS: Analyses of covariance revealed no significant difference between the learning modules and control groups in the percentage of cancer survivors that oncology nurses counseled. Significant differences were found in self-efficacy for physical activity counseling and perceived barriers to physical activity counseling at postintervention. 
. CONCLUSIONS: The online learning intervention tested in this study improved some parameters of physical activity counseling but did not increase the percentage of cancer survivors that oncology nurses counseled. Additional pilot work is needed to refine the intervention.
. IMPLICATIONS FOR NURSING: This study suggests the potential utility of an evidence-based online learning strategy for oncology nurses that includes information on physical activity and its benefits in cancer survivorship. The findings offer a framework on how to implement physical activity counseling skills in oncology nursing practice.

Taking action: An exploration of the actions of exemplary oncology nurses when there is a sense of hopelessness and futility perceived by registered nurses at diagnosis, during treatment, and in palliative situations.

"There is nothing more that can be done" is a phrase that may occasionally cross the minds of oncology nurses. This paper reports on the actions of exemplary oncology nurses who were faced with such situations where their colleagues gave up or turned away. The research question, "What actions do exemplary clinical oncology nurses (RNs) undertake in patient-care situations where further nursing interventions seem futile?" prefaced data collection via a secure website where 14 Canadian clinical oncology registered nurses (RNs) provided narratives documenting their actions. Thematic analysis utilized QRS NVivo 10 software and hand coding. Four themes were generated from data analysis: advocacy, not giving up, genuine presence, and moral courage. Implications for practice and future research are provided.

Fibrocytes in the fibrotic lung: altered phenotype detected by flow cytometry.

Fibrocytes are bone marrow hematopoietic-derived cells that also express a mesenchymal cell marker (commonly collagen I) and participate in fibrotic diseases of multiple organs. Given their origin, they or their precursors must be circulating cells before recruitment into target tissues. While most previous studies focused on circulating fibrocytes, here we focus on the fibrocyte phenotype in fibrotic tissue. The study's relevance to human disease is heightened by use of a model in which bleomycin is delivered systemically, recapitulating several features of human scleroderma including multi-organ fibrosis not observed when bleomycin is delivered directly into the lungs. Using flow cytometry, we find in the fibrotic lung a large population of CD45(high) fibrocytes (called Region I) rarely found in vehicle-treated control mice. A second population of CD45+ fibrocytes (called Region II) is observed in both control and fibrotic lung. The level of CD45 in circulating fibrocytes is far lower than in either Region I or II lung fibrocytes. The chemokine receptors CXCR4 and CCR5 are expressed at higher levels in Region I than in Region II and are present at very low levels in all other lung cells including CD45+/collagen I- leucocytes. The collagen chaperone HSP47 is present at similar high levels in both Regions I and II, but at a higher level in fibrotic lung than in control lung. There is also a major population of HSP47(high)/CD45- cells in fibrotic lung not present in control lung. CD44 is present at higher levels in Region I than in Region II and at much lower levels in all other cells including CD45+/collagen I- leucocytes. When lung fibrosis is inhibited by restoring caveolin-1 activity using a caveolin-1 scaffolding domain peptide (CSD), a strong correlation is observed between fibrocyte number and fibrosis score. In summary, the distinctive phenotype of fibrotic lung fibrocytes suggests that fibrocyte differentiation occurs primarily within the target organ.

An exploration of the experience of compassion fatigue in clinical oncology nurses.

Compassion fatigue (CF) is "debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others" (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers' stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided.

Why exemplary oncology nurses seem to avoid compassion fatigue.

The goal of this phenomenological study was to explore what within the lived experiences of exemplary oncology nurses facilitates the avoidance of compassion fatigue. A purposive sample of seven oncology nurses (RNs) who were identified by their colleagues as exemplary caregivers was recruited. Data were collected through semi-structured conversations that were subsequently transcribed. Transcripts were analyzed for recurring themes using three points of reference: recurrence of ideas, repetition of ideas, and forcefulness with which ideas were expressed (Owen, 1984). Findings focus on three themes: moments of connection, making moments matter, and energizing moments. Discussion highlights practical implications for clinical nurses, nurse educators, and health care administrators.

Touched by a nurse: the imprint of exemplary oncology nursing care.

This paper examines the relationship between exemplary oncology nursing practice and professional fulfillment. What inspires nurses to choose oncology and, subsequently, what gives them impetus to continue in this field? To answer this question, oncology nurses were invited to recall moments in their careers when they were satisfied that they had chosen the "right" career. Data, in narrative form, were collected through an online research technique. Submissions were analysed using three approaches, narrative analysis (Priest, Roberts, & Woods, 2003), poetic interpretation (van Manen, 1990) and photovoice (Woolrych, 2004). Findings reveal that oncology nurses who provide excellent care, and make strong connections with their patients, are also usually very satisfied with their careers. Specifically, nurses provide exemplary care and report attaining professional fulfillment when they achieve connection with those in their care by affirming value and sharing humour. Second, caregivers feel they are making a difference when they "see patients through" the care trajectory. Nurses accomplish this in part by helping people live on, individualizing care, enabling hope, and helping individuals find meaning. It is anticipated that this paper will reawaken memories of similar experiences in caregivers, thus enhancing confidence, self-esteem and energy and reminding nurses that they do unquestionably leave an imprint.

Exemplary care of the palliative patient: the journey shared.

Critical care involves caring for complex and acute needs of patients with life-threatening conditions. Despite skilful interventions, there are times when the care needed by patients and their families is primarily palliative. In this article, the author focuses on examples of ways nurses can make the palliative care they provide exemplary. Based on findings of a research study of outstanding palliative care nurses, the researcher describes the possible effect providing excellent palliative care may have on both the patient and the caregiver. Critical care nurses are often called to stand in the shadow of grief that accompanies death. Yet in doing so, these caregivers can be molded into more caring and compassionate people, and more exemplary nurses. Nurses in critical care are challenged daily to meet the multiple needs of patients and their families. Though state of the art technology, medications and advanced skills may save many lives, there are times when the care that is required is palliative. It is in these instances that a nurse 's strength and courage may be tested. By taking up this challenge, and sharing the final journey with patients, a nurse may learn many lessons. In part, caregivers may come to see that sometimes death is neither an enemy, nor a failure. Rather, sometimes death can lead to a more joyous embracing of life. Sometimes death is the only way that suffering can be erased. This article includes a description of key ways critical care nurses may address the needs of patients who are palliative. Specifically, the themes of helping people live on, individualizing care, defending human dignity, sensitive listening, sharing hope, and keeping the promise to never abandon are described. These themes all fall under the overarching theme of simple gestures, which is also described in this report.