Role of advanced nurse practitioners in the care pathway for children diagnosed with leukemia.

PURPOSE: The development of advanced nursing practices (ANP) can meet challenges presented by evolving needs of health care. We aimed at describing the approach taken to implement ANP in a pediatric oncology-hematology unit. METHOD: The Participatory, Evidence-informed, Patient-centered Process for Advanced practice was considered as a conceptual framework for the development, implementation and evaluation of the nursing role. Successive steps were taken for identifying patients and family needs, defining the health care priorities, and establishing a new health care model. RESULTS: The seven steps of the PEPPA framework were carried out over a year and contributed to the identification of the tasks and the role of the advanced nurse practitioner in the patient care pathway. The implementation of ANP was gradually achieved with the development of new evidenced-based health care procedures. The subsequent approval of a contract specification for advanced nurse practitioners facilitated the onset of a specific consultation, which facilitated a holistic approach. CONCLUSION: The impact of the implementation can be appreciated at different levels: i) the patient and his or her family, with improvement of communication and continuity of care; ii) the interdisciplinary team, with development of a dynamic and greater motivation of the health care providers; and iii) the profession, with a greater recognition of the competencies and conceptualization of the new role. An assessment of the process, the structure and the results should be carried out to validate the role of the advanced nurse practitioner throughout the long journey of a child with leukemia.

Effects of Slow-Stroke Back Massage on Symptom Cluster in Adult Patients With Acute Leukemia: Supportive Care in Cancer Nursing.

BACKGROUND: Patients with acute leukemia usually experience pain, fatigue, and sleep disorders, which affect their quality of life. Massage therapy, as a nondrug approach, can be useful in controlling such problems. However, very few studies have been conducted on the effects of massage therapy on the complications of leukemia. OBJECTIVE: The aim of this study was to examine the effects of slow-stroke back massage (SSBM) on the symptom cluster in acute leukemia adult patients undergoing chemotherapy. METHODS: In this randomized controlled trial, 60 patients with acute leukemia were allocated randomly to either the intervention or control group. The intervention group received SSBM 3 times a week (every other day for 10 minutes) for 4 weeks. The pain, fatigue, and sleep disorder intensities were measured using the numeric rating scale. The sleep quality was measured using the Pittsburgh Sleep Quality Index. Statistical tests of χ, t test, and the repeated-measure analysis of variance were used for data analysis. RESULTS: Results showed that the SSBM intervention significantly reduced the progressive sleep disorder, pain, fatigue, and improved sleep quality over time. CONCLUSIONS: Slow-stroke back massage, as a simple, noninvasive, and cost-effective approach, along with routine nursing care, can be used to improve the symptom cluster of pain, fatigue, and sleep disorders in leukemia patients. IMPLICATIONS FOR PRACTICE: Oncology nurses can increase their knowledge regarding this symptom cluster and work to diminish the cluster components by using SSBM in adult leukemia patients.

THE MANY FACES OF CARING IN NURSING.

Nonverbal communication is essential with children. Nurses are challenged when answers to assessment questions include shoulder shrugs and descriptions of 'ouchies' and pain all over that feels 'bad.' Pediatric nursing requires creativity and eliciting expression of emotions nonverbally. One way our patients express themselves is through art therapy. The art therapist on our unit uses masks with children who choose not to express themselves with words. I chose to create a mask as sculpture to nonverbally share my values, feelings, and compassion, just like my pediatric patients. As I worked with the mask, many faces of nursing emerged.

Models of survivorship care provision in adult patients with haematological cancer: an integrative literature review.

PURPOSE: Increasing numbers of haematology cancer survivors warrants identification of the most effective model of survivorship care to survivors from a diverse range of haematological cancers with aggressive treatment regimens. This review aimed to identify models of survivorship care to support the needs of haematology cancer survivors. METHOD: An integrative literature review method utilised a search of electronic databases (CINAHL, Medline, PsycInfo, PubMed, EMBASE, PsycArticles, and Cochrane Library) for eligible articles (up to July 2014). Articles were included if they proposed or reported the use of a model of care for haematology cancer survivors. RESULTS: Fourteen articles were included in this review. Eight articles proposed and described models of care, and six reported the use of a range of survivorship models of care in haematology cancer survivors. No randomised controlled trials or literature reviews were found to have been undertaken specifically with this cohort of cancer survivors. There was variation in the models described and who provided the survivorship care. CONCLUSION: Due to the lack of studies evaluating the effectiveness of models of care, it is difficult to determine the best model of care for haematology cancer survivors. Many different models of care are being put into practice before robust research is conducted. Therefore, well-designed high-quality pragmatic randomised controlled trials are required to inform clinical practice.

A mother's perspective: the power of holistic care for the terminally ill child.

This is the account of a mother who lived through the 5-year experience of watching her child fight and finally succumb to a genetic disorder. Lessons about caring practices and insights into the needs of patients and families are emphasized.

[Reclaiming the body through touch-relaxation massage]. / Se réapproprier son corps grâce au toucher-massage.

More than just a simple technique, touch-relaxation massage in the protected haematology unit of Nantes general hospital has become a real personalised act of care, in what are often difficult conditions of hospitalisation. It forms part of the global support of patients suffering from leukaemia.

Psychoneuroimmunology and innovative behavioral interventions in patients with leukemia.

PURPOSE/OBJECTIVES: To review current research examining the effects of behavioral interventions on reducing symptom distress and improving quality of life in patients with cancer and to explore the application of behavioral interventions to patients with leukemia who are immunosuppressed by the disease or its treatment. DATA SOURCES: Published books, journal articles, and personal experiences. DATA SYNTHESIS: Interventions such as relaxation training, guided imagery, attentional/cognitive distraction, and therapeutic touch have been found to reduce pain, anxiety, and chemotherapy-related side effects, to elicit the relaxation response, and to improve several aspects of immune function in patients with cancer. CONCLUSIONS: A multicomponent, long-term program of behavioral interventions may provide the greatest and most lasting benefit, but it may be very challenging to implement. However, simple relaxation techniques are not difficult to learn, are not particularly time-consuming or costly to practice, and can be used anywhere. IMPLICATIONS FOR NURSING PRACTICE: Nurses in virtually any setting easily can incorporate behavioral modalities into their practices and help patients with leukemia to reduce their physiologic arousal and symptom distress. Nursing research examining the effects of behavioral interventions on immunocompetence and cancer pain in patients with leukemia is needed.