Critical Event Debriefing: Impacts on Clinical Practice and Implications for Oncology Nurses.

BACKGROUND: The complexity of caring for patients with cancer has a direct impact on oncology nurses. When a patient with cancer experiences a critical health event, oncology nurses may have concerns about their ability to provide high-quality care for patients in the current healthcare environment. These concerns can negatively affect nurses' emotional well-being and lead to compassion fatigue and burnout. OBJECTIVES: This article aims to examine critical event debriefing and identify ways oncology nurses can implement a critical event debriefing framework into their clinical practice. METHODS: A literature search was conducted in CINAHL® and PubMed® databases for articles related to critical event debriefing and compassion fatigue and burnout among oncology nurses. A case study demonstrates the use of critical event debriefing on an oncology unit. FINDINGS: Critical event debriefing frameworks can enhance teamwork, help initiate process improvements, and offer psychological support to improve emotional well-being. Additional research is needed about the use of critical event debriefing as a solution to compassion fatigue and burnout among oncology nurses.

Care Coordination: Overcoming Barriers to Improve Outcomes for Patients With Hematologic Malignancies in Rural Settings.

BACKGROUND: Most patients with cancer experience financial, emotional, and logistical barriers to care that significantly affect their adherence to and successful completion of treatment. However, patients with hematologic malignancies, particularly those who live in rural settings, must also contend with additional challenges. OBJECTIVES: This article aims to synthesize the literature about barriers to timely access to care and to coordination of this care for patients with hematologic malignancies, particularly those in rural settings, as well as identify strategies to improve cancer care delivery for those patients. METHODS: A search of the literature from 2008-2018 pertaining to rural health disparities for patients with hematologic malignancies, along with ways to overcome these disparities, was conducted. FINDINGS: Patients with hematologic malignancies, particularly those who reside in rural settings, face complex barriers to care. These barriers cause emotional and physical distress. A team approach to care coordination that is focused on eliminating these barriers and improving outcomes is needed.

Bridging the healthcare divide with patient navigation: development of a research program to address disparities.

Americans who live in poverty as well as certain ethnic and racial groups have higher cancer death rates than other populations. Patient navigators have been identified as an important weapon against these disparities. Navigators can address insurance, financial, and logistical issues (e.g., transportation, appointment scheduling, child or elder care). They can provide understandable health education that may lessen fears of cancer diagnosis and treatment. This article describes the development and implementation of a multisite patient navigator program involving five cancer institutions in Western Pennsylvania. Navigator programs have great potential to enhance cancer care by reaching underserved populations and opening the door for future research.

Facilitating program and NCLEX-RN success in a generic BSN program.

This article focuses on a study of predictors of program and NCLEX-RN success and withdrawal in a generic BSN program at the University of Hawaii at Manoa School of Nursing. Data were collected over a 5-year period after a new curriculum was implemented. High program (95.09%) and NCLEX-RN (97.25%) success were achieved. Of the 11 who did not meet the definition of program success, 100% completed the program by another two to three semesters and 90.91% passed the NCLEX-RN as first-time takers. The program withdrawal rate was 20%. It is very important to use measures to promote program completion and NCLEX passing for both the normally progressing and at-risk student to meet the demands of the nursing shortage.

Medullary thyroid cancer and the impact of genetic testing.

Medullary thyroid cancer (MTC) consists of a rare, undifferentiated tumor and often is described as having a chronic and indolent disease process. Approximately 5%-10% of all thyroid malignancies are MTC, and about 25% of patients diagnosed with the disease have a genetic form that was inherited through a mutation of the RET proto-oncogene. The mutation is expressed by an autosomal dominant allele and, if inherited, has almost a 100% chance of developing into a malignancy. Detection of the germline mutation identifies individuals at risk and enables prophylactic treatment for the prevention of MTC. As a result, patients and family members commonly undergo genetic testing during the diagnostic phase and experience certain psychosocial stressors. The purpose of this article is to provide an overview of MTC and its symptoms, treatment, prognosis, and genetics. The psychosocial effects of genetic testing on the quality of life of patients with MTC also will be described. By learning more about the pathophysiology and psychosocial stressors, nurses can facilitate proper counseling and increase the likelihood of positive outcomes for their patients.

Role of Gabapentin in Managing Mucositis Pain in Patients Undergoing Radiation Therapy to the Head and Neck.

BACKGROUND: Oral mucositis (OM) is a painful and debilitating side effect that affects 80%-100% of patients undergoing radiation therapy for head and neck cancer. This dose-limiting side effect may potentially lead to pain, dehydration, malnutrition, infection, and treatment breaks. Treatment breaks can lead to decreased disease control and suboptimal patient outcomes. No primary prevention exists for OM, and management is focused on pain control. Compelling evidence exists that OM pain has somatic and neuropathic components. OBJECTIVES: This article reviews the existing literature on the use of gabapentin (Neurontin®) as a co-analgesic in treating the neuropathic pain in OM. METHODS: A literature search was performed using CINAHL® and PubMed with the search terms gabapentin and oral mucositis. The selected articles were briefly screened for relevance, and three were included in this review. FINDINGS: No systematic reviews exist on the role of gabapentin for neuropathic pain in radiation-induced OM. Two retrospective studies concluded that gabapentin reduced escalation of opioid doses and unplanned treatment breaks. One retrospective study demonstrated favorable swallowing outcomes. Pain and OM are nursing-sensitive outcomes that can be significantly affected by evidence-based nursing interventions.

Legislative advocacy skills for baccalaureate nursing students.

One of the most effective ways for nurses to demonstrate professionalism is to be involved in public policy, advocating for issues of public interest that contribute to healthcare improvements. Faculty designed a program to provide nursing students an opportunity to develop legislative advocacy skills by serving as legislative interns. The authors describe the process by which the project was implemented.

Human papillomavirus and cervical cancer: not just a sexually transmitted disease.

The human papillomavirus (HPV) is the cause of virtually all cancers of the cervix, the fourth most common cancer in women in the United States. HPV is sexually transmitted, and the lifetime risk of contracting the virus is estimated to be 75%-90%. New methods of detecting HPV infection and cellular changes (dysplasia) caused by HPV can greatly reduce the mortality associated with this virus. More than 100 types of HPV exist and may be classified as low-, intermediate-, or high-risk in terms of causing cancer. The virus can cause genital warts, subclinical dysplasia, and cancer. Nurses play an important role in educating patients regarding HPV and preventive measures as well as in screening and treatment. Most women diagnosed with HPV need emotional support and factual information provided in a supportive, nonjudgmental manner. Nurses can meet this challenge and make a difference in reducing the incidence and mortality of cervical cancer.

Cross-cultural comparison of workplace stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses in Japan, Thailand, South Korea and the USA (Hawaii).

In an attempt to cross-culturally compare factors that may contribute to the nursing shortage within countries that have produced a limited number of research findings on role stress in nurses, this research examined work stressors, ways of coping and demographic characteristics as predictors of physical and mental health among hospital nurses from Japan, South Korea, Thailand and the USA (Hawaii). Subjects (n = 1554 hospital-based nurses) were administered four self-report questionnaires: Demographic Questionnaire, "Nursing Stress Scale", "Ways of Coping Questionnaire" and "SF-36 Health Survey". Findings suggested that nurses indicated similar workplace stressors, ways of coping, and levels of physical and mental health. While subjects, across countries, demonstrated a variety of predictors of physical and mental health, several predictors were found to be the same. Cross-culturally the role of nurses may vary; however, certain factors are predictive of the status of hospital nurses' physical health and mental health.

Oncology nurses ... who are we?

Oncology nursing has matured into a well-established specialty in nursing. The scope of practice for the oncology nurse is broad and spans the continuum of cancer care. Oncology nurses have important roles in all aspects of cancer care. The ONS is the largest organization of oncology professionals in the United States with a membership of about 30,000 and has contributed to the development of oncology nursing through its many educational programs, support of research, opportunities for networking, establishment of certification examinations, and development of an active foundation.

Cervical cancer beliefs and pap test screening practices among Chinese American immigrants.

PURPOSE/OBJECTIVES: To examine beliefs and Pap test utilization among Chinese American women, the largest Asian female population in the United States. RESEARCH APPROACH: Cross-sectional descriptive, correlational study. SETTING: Metropolitan areas of Portland, OR. PARTICIPANTS: 100 foreign-born Chinese women aged 40 years and older. METHODOLOGIC APPROACH: Three questionnaires were modified, translated, combined, and pretested. Participants completed the self-administered questionnaire in a group setting. MAIN RESEARCH VARIABLES: Utilization of Pap test screening, health beliefs, and cultural and sociodemographic variables. FINDINGS: Sixty-eight percent reported having a Pap test within the prior three years (adherence), and 84% reported ever having a Pap test. The odds of Pap test use and adherence decreased with increasing age. Women with insurance or a regular healthcare provider had better odds of Pap test use and adherence. Older age, older age when a participant moved to the United States, and increased modesty were negatively associated with ever having had a Pap test. CONCLUSIONS: Age and cultural beliefs influence Pap test use and adherence. The strength of provider recommendation and healthcare access as predictors suggest areas for interventions designed to increase screening for cervical cancer. INTERPRETATION: Nurses play a vital role in preventive health care, especially with the growing number of advanced practice nurses delivering primary care. Primary healthcare providers should be reminded of their influential role in increasing adherence to cancer screening. Further health policy action is necessary to extend screening coverage to those who do not have adequate health insurance.