The Emergence of a Sustainable Tobacco Treatment Program across the Cancer Care Continuum: A Systems Approach for Implementation at the University of California Davis Comprehensive Cancer Center.

Tobacco treatment is increasingly recognized as important to cancer care, but few cancer centers have implemented sustainable tobacco treatment programs. The University of California Davis Comprehensive Cancer Center (UCD CCC) was funded to integrate tobacco treatment into cancer care. Lessons learned from the UCD CCC are illustrated across a systems framework with the Cancer Care Continuum and by applying constructs from the Consolidated Framework for Implementation Research. Findings demonstrate different motivational drivers for the cancer center and the broader health system. Implementation readiness across the domains of the Cancer Care Continuum with clinical entities was more mature in the Prevention domain, but Screening, Diagnosis, Treatment, and Survivorship domains demonstrated less implementation readiness despite leadership engagement. Over a two-year implementation process, the UCD CCC focused on enhancing information and knowledge sharing within the treatment domain with the support of the cancer committee infrastructure, while identifying available resources and adapting workflows for various cancer care service lines. The UCD CCC findings, while it may not be generalizable to all cancer centers, demonstrate the application of conceptual frameworks to accelerate implementation for a sustainable tobacco treatment program. Key common elements that may be shared across oncology settings include a state quitline for an adaptable intervention, cancer committees for outer/inner setting infrastructure, tobacco quality metrics for data reporting, and non-physician staff for integrated services.

Nurse perspectives regarding the meaningfulness of oncology nursing practice.

BACKGROUND: Recruiting, retaining, and training oncology nurses is challenging given the stress levels associated with a field with constantly evolving treatments and a need for expertise in death and dying. OBJECTIVES: This research was conducted to assess what is unique about oncology nursing, to identify what motivates oncology nurses to continue working in the specialty, and to determine what sustains them in daily practice. METHODS: A phenomenologic approach was used to analyze data. FINDINGS: Nurses identified three main themes: the importance of vulnerability and thankfulness in patients, the feeling of spirituality associated with oncology practice, and the value of being in the moment and recognizing priorities as meaningful aspects of oncology nursing.

Building a caring client relationship and creating a quilt. A parallel and metaphorical process.

The process of designing a quilt became a metaphor of developing a caring relationship for a nursing student as she came to understand caring theory and its application to practice. A clinical experience combined with reflective journaling and aesthetic expression in the form of a quilt gave the student a way of understanding and concretizing a relationship. With quilts representing comfort, warmth, and expression, the student saw a parallel with the nursing profession with its essence in caring. Houses are the main visual element in the quilt because house or home is important to the human spirit and was a key issue in this caring relationship. The 10 houses illustrate Jean Watson's carative factors and the role Watson's theoretical perspective played in the caring relationship. The human-like figures, the caring spirits, represent the nursing profession, and the colored squares symbolize the energy of caring.