Engaging Nurse Residents Through Poetry.

Oncology nurse residents write legacy letters to future cohorts in the 11th month as a reflection on their transition year, focusing on lessons learned and advice gleaned. This article explores poetry as an alternative to leg.

The Clinical Nurse Specialist: Maximizing Return on Investment.

The United States health care system is facing an unprecedented nursing shortage, increasing complexity of care, and fewer experienced nurse mentors. These factors contribute to a cycle of burnout, turnover, decreased quality and safety, and a worsening financial bottom line. Improving these contributing factors depends on our ability to mitigate the structural causes of burnout and turnover. The clinical nurse specialist role is essential to improving the work environment, advancing evidence-based nursing practice, reducing turnover, and stabilizing the bottom line.

Bettering Sleep Hygiene to Decrease Delirium and Improve Patient Satisfaction on an Inpatient Oncology Unit.

Poor sleep during hospitalization can negatively affect patient health, well-being, and satisfaction. This nurse-led quality improvement project aimed to promote quality sleep on an inpatient telemetry medical-surgical onco.

Defining and Addressing Research Priorities in Cancer Cachexia through Transdisciplinary Collaboration.

For many patients, the cancer continuum includes a syndrome known as cancer-associated cachexia (CAC), which encompasses the unintended loss of body weight and muscle mass, and is often associated with fat loss, decreased appetite, lower tolerance and poorer response to treatment, poor quality of life, and reduced survival. Unfortunately, there are no effective therapeutic interventions to completely reverse cancer cachexia and no FDA-approved pharmacologic agents; hence, new approaches are urgently needed. In May of 2022, researchers and clinicians from Moffitt Cancer Center held an inaugural retreat on CAC that aimed to review the state of the science, identify knowledge gaps and research priorities, and foster transdisciplinary collaborative research projects. This review summarizes research priorities that emerged from the retreat, examples of ongoing collaborations, and opportunities to move science forward. The highest priorities identified include the need to (1) evaluate patient-reported outcome (PRO) measures obtained in clinical practice and assess their use in improving CAC-related outcomes; (2) identify biomarkers (imaging, molecular, and/or behavioral) and novel analytic approaches to accurately predict the early onset of CAC and its progression; and (3) develop and test interventions (pharmacologic, nutritional, exercise-based, and through mathematical modeling) to prevent CAC progression and improve associated symptoms and outcomes.

Reduction of Chemotherapy-Induced Nausea and Vomiting: A Pilot Study of Essential Oils in the Autologous Blood and Marrow Transplantation Population.

BACKGROUND: Chemotherapy-induced nausea and vomiting (CINV) places a burden on patients receiving blood and marrow transplantation. The effects of complementary aromatherapy on CINV are documented, but more information is needed to implement practice changes. OBJECTIVES: The purpose of this pilot study was to evaluate whether pure peppermint or ginger essential oil reduced the severity of CINV. METHODS: A controlled randomized pilot study was conducted using peppermint oil, ginger oil, and control (canola oil) groups. Nurses applied the assigned oil every four hours. Outcome and patient feedback data were collected. FINDINGS: Twenty patients experienced a level 2 or greater nausea event. Patients in the peppermint oil group were the least likely to experience a nausea event, followed by the ginger oil and control groups. Five patients experienced level 2 vomiting; these events did not differ between groups.

Prevalence of baseline hypocalcemia and symptomatic hypocalcemia during leukapheresis.

Symptoms of hypocalcemia are reported in up to 50% of patients undergoing leukapheresis procedures. There is no set standard of practice for administering calcium supplementation in the prevention or treatment of hypocalcemia symptoms. The goal of this descriptive, retrospective study was to determine the prevalence of baseline hypocalcemia and symptomatic hypocalcemia during leukapheresis with acid citrate dextrose solution A and to identify patient characteristics associated with symptomatic hypocalcemia. Three percent of patients were found to have hypocalcemia before leukapheresis with 35% experiencing hypocalcemia symptoms during leukapheresis. Older age, higher albumin levels, and longer procedure time were associated with increased risk of hypocalcemia symptoms.

Personal protective equipment for antineoplastic safety.

ABSTRACT: Nurses must protect themselves while handling hazardous drugs or contaminated items. Wearing personal protective equipment (PPE) will reduce contact and prevent any acute or chronic adverse reactions that may occur from unintentional exposure. This article reviews PPE for antineoplastic safety and evidence-based guidelines for their use.

Legacy Letters Written by Oncology Nurse Residents: Post Hoc Poetic Inquiry.

BACKGROUND: A qualitative analysis of Legacy Letters written by oncology nurse residents to future nurse residents on what they wish they knew and what they learned at the end of their 1-year residency program showed four themes. This article presents a poetic inquiry of select themes/subthemes, providing a new perspective on the findings. METHOD: Post hoc poetic inquiry of select subthemes/themes from a previously conducted qualitative nursing research study on nurse residents' Legacy Letters was conducted using a collective participant voice approach. RESULTS: Three poems were created. A sample quote by an oncology nurse resident and an explanation of the relationship of the poem to the Legacy Letters are provided. CONCLUSION: These poems represent a larger theme of resilience. Learning from mistakes, dealing with emotions, and providing self-care embody the experience and adaptation of the oncology nurse residents to this year of transition from graduation to professional practice. [J Contin Educ Nurs. 2023;54(3):117-120.].

Psychological Impact of COVID-19 on Oncology Patients: Perceptions of Oncology Health Care Providers.

The COVID-19 pandemic profoundly impacted psychological well-being worldwide. Oncology health care professionals' (OHCPs') perceptions of psychological effects of COVID-19 among people in active cancer treatment were explored. Semi-structured interviews with a purposive sample of OHCPs actively providing care were conducted. Interviews were audio-recorded, transcribed, and coded using Atlas.ti v8 and thematic analysis. In total, 30 OHCPs participated. Most were registered nurses (70%), worked in outpatient setting (56.7%) and were in their current position 1-5 years (53.3%). Overarching themes are as follows: (a) cancer treatment disrupted due to patients' fear of exposure to COVID-19; (b) social distancing restrictions caused discontinued social support and supportive services that exacerbated psychological distress; (c) pandemic-related stressors led to overwhelmed coping skills; and (d) OHCPs played a vital role in providing emotional support and connecting patients with family/friends through technology. Behavioral health interventions should focus within the "new world of COVID-19" of reduced face-to-face support and increased online support for patients.

Nurse Residents' Legacy Letters: A Qualitative Analysis.

It is important for graduate nurses to reflect on their time in residency programs. Legacy letters, written by oncology nurse residents to future residents, reflect on "what I wish I knew" and "what I learned." A retrospective, qualitative thematic analysis of 30 letters at a National Cancer Institute-designated comprehensive cancer center in the southeastern United States was conducted. Four themes arose. Understanding these experiences can provide insight to nurse residents and guide improvements for the residency program.

"What Matters Most" to Older Adults With Cancer: Advance Care Planning.

Approximately 1 in 3 adults have some type of advance directive. Advance care planning (ACP) is associated with greater use of supportive care services and decreased patient and family stress. Despite this, organizations continue to have difficulty in implementing effective programs for increasing ACP. Increasing knowledge and comfort of the health care team with end-of-life discussions and ACP is essential. Educational efforts should focus on decreasing known barriers to ACP discussions such as discomfort, unclear role, lack of experience, and limited education. Role playing and case discussions taught by geriatric resources nurses can help increase staff knowledge and comfort regarding ACP. Role playing allows staff to think about their own mortality and what will happen in various situations if ACP is not complete. Team members find that once they have completed their own ACP, they are more comfortable discussing ACP with patients and caregivers. Nurses should collaborate with social workers and chaplains for ACP education and discussing what matters most to them. Patients are encouraged to make sure that they provide advance directives to their health care providers. This article shares an interprofessional team approach to improving processes for ACP as a component of "what matters most" to older adults with cancer.

Quality of Life of Older Adults With Complicated Grief: A Mixed Methods Exploration.

The current mixed methods study investigated what changes in quality of life (QOL) mean to older adults with complicated grief treated with Accelerated Resolution Therapy (ART) post-hospice services. An informational matrix, which included select patient characteristics (e.g., number of comorbidities, single versus multiple deaths, relationship role), four identified qualitative themes, end of study QOL scores measured by the Centers for Disease Control and Prevention Health-Related QOL Healthy Days Module, and changes in scores from baseline to end of study, was created to analyze the data. Results showed that although a history of multiple deaths may contribute to greater improvements in QOL with therapy, having at least one comorbidity resulted in a richer description and endorsement of QOL in response to treatment. This is the first longitudinal, randomized controlled trial using a mixed methods approach to examine QOL of hospice family caregivers with complicated grief who are receiving ART. This study identifies potential links of QOL and caregiver characteristics, providing nurses with foundational knowledge for assessment, care, and further research on the experiences of complicated grief. [Journal of Gerontological Nursing, 48(5), 19-26.].

Adapting Research to a Global Pandemic: A Fully Remote Actigraphy and Ecological Momentary Assessment Study.

BACKGROUND: Mandated social distancing practices and quarantines in response to COVID-19 have resulted in challenges for research on healthcare workers, such as hospital nurses. It remains unknown whether nursing studies utilizing complex methodology like sleep actigraphy and ecological momentary assessment (EMA) can be conducted remotely without compromising data quality. OBJECTIVES: We aimed to (a) disseminate our remote study protocol for sleep actigraphy and EMA data from hospital nurses during COVID-19, (b) assess feasibility and acceptability of this approach for studies on hospital nurses, and (c) examine the reliability and ecological validity of sleep characteristics measured across 14 days. METHODS: Using an online platform, we provided 86 outpatient nurses from a cancer hospital with detailed video/text instructions regarding the study and facilitated virtual study onboarding meetings. Feasibility was assessed by comparing adherence rates to a similar in-person study of nurses from the same hospital; acceptability was evaluated through content analysis of qualitative study feedback. Multilevel modeling was conducted to assess changes in sleep characteristics as a function of study day and daily stressful experiences. RESULTS: Adherence to EMA (91.8%) and actigraphy (97.9%) was high. EMA adherence was higher than the in-person study of inpatient day-shift nurses from the same hospital. Content analyses revealed primarily positive feedback, with 51.2% reporting "easy, clear, simple onboarding" and 16.3% reporting the website was "helpful." Six participants provided only negative feedback. Sleep characteristics did not change as a function of study day except for self-reported quality, which increased slightly during Week 1 and regressed toward baseline after that. A higher incidence of stressor days or higher stressor severity followed nights with shorter-than-usual time in bed or poorer-than-usual sleep quality, supporting the ecological validity for these methods of assessing sleep in nurses. DISCUSSION: Findings suggest that a fully remote study protocol for EMA and actigraphy studies in nursing yields robust feasibility, acceptability, reliability, and validity. Given the busy schedules of nurses, the convenience of this approach may be preferable to traditional in-person data collection. Lessons learned from COVID-19 may apply to improving nursing research postpandemic.

Impact of COVID-19 on Oncology Healthcare Providers: The Resilience of a Profession.

BACKGROUND: The novel coronavirus (COVID-19) has plagued countries worldwide. This pandemic has greatly affected healthcare delivery and those providing care to vulnerable, immunocompromised patients undergoing cancer treatment, who are at a higher risk for poorer outcomes related to COVID-19. OBJECTIVE: The aim of this study was to explore the impact of COVID-19 on oncology healthcare professionals (OHCPs). METHODS: An exploratory study design was employed using semistructured interviews. A thematic analysis was completed using Atlas.ti software. RESULTS: Of 30 OHCP participants, most were female (90%), registered nurses (70%), and bachelor's prepared (66%). The following themes emerged: (1) pandemic-related restrictions and stress on personal lives impacted the ability of OHCPs to rejuvenate and reenergize for work; (2) fear of exposure and transmission and concern for high-risk status for contracting COVID-19; (3) limited resources and inconsistent communication about organizational policies caused additional stress, affecting OHCP trust and confidence in the system; (4) concern for the mental health of fellow OCHPs; (5) adaptation and resilience were required amidst shifting workloads, workflow, and new restrictions; and (6) importance of self-care to reduce personal/professional stressors. CONCLUSIONS: Oncology healthcare professionals continue to face challenges of COVID-19 on their personal and professional lives yet have shown resilience during these unprecedented times. IMPLICATIONS FOR PRACTICE: Oncology healthcare professionals need to advocate for appropriate personal protective equipment and reliable mental health support services through employers. They should be engaged in COVID-19 task forces to ensure their challenges are heard and needs are addressed to provide quality oncology care.

Quality of life of older adults with complicated grief: A thematic analysis.

Approximately 15% of the general population has complicated grief (CG). Understanding how older adults with CG describe their quality of life (QOL) is crucial to healthcare workers especially in hospice and mental health settings. Four themes for QOL emerged from the thematic analysis of semi-structured interviews. From highest to lowest endorsement, they were Mental Function (sub-themes: mental health, joy, and happiness), Self-management (sub-themes: self-efficacy and self-agency), Social Support, and Physical Function. This study provides new information related to the relationships between CG and QOL among older adults. Multidimensional aspects of QOL can provide insight into delivering individualized patient- and family-centered care.

A Longitudinal Examination of Quality of Life of Older Adults with Complicated Grief Receiving Accelerated Resolution Therapy.

Objective: To examine the effect of Accelerated Resolution Therapy (ART) on the quality of life (QOL) of older adults with complicated grief (CG) over time. Design: Subanalysis of a randomized controlled trial. Setting/Subject: Older adult, former caregivers were recruited from a large hospice in the southeastern United States to be treated with ART for CG. Measurement: The CDC Health-Related Quality of Life (HRQOL) Healthy Days Module was administered pre-, post-, and eight weeks after therapy. Results: The subsample consisted of 27 older adults. A multilevel model indicated a statistically significant, negative difference of 8.21 (improvement) in QOL scores for each period of data collection (ß = -8.21, t = 4.02, p < 0.001). Both the intervention (11%, p = 0.013) and time (7.8%, growth curve p = 0.014) contributed significantly. Conclusion: There was a significant large effect of ART on CG. This study supports concurrent improved patient-related outcome-QOL.

The Use of Telehealth to Provide Continuity of Cancer Care during the COVID-19 Pandemic: Advantages, Disparities, and Implications to Promote Health Equity.

Perceptions of oncology health care providers use of telehealth to provide care to patients during the COVID-19 pandemic were explored. A qualitative study using semi-structured interviews and purposive sampling (N = 30) was conducted. Four themes emerged: 1) telehealth provided continuity of cancer care and used to decrease the risk of COVID-19 exposure; 2) advantages brought about convenience and inclusion of family caregivers; 3) telehealth revealed geographic, aging, and racial/ethnic disparities and digital illiteracy; and 4) rapid implementation was challenging. Telehealth provides a number of opportunities to support care for vulnerable cancer patients during this health crisis; however, disparities must be addressed.