Oncologic Surgical Care Using an Enhanced Recovery Approach.

Enhanced recovery programs are multimodal, evidence-based perioperative programs designed to improve a patient's functional recovery after surgery. Enhanced recovery programs promote standardized, multidisciplinary care throughout the perioperative course to improve patient outcomes, rather than focusing on surgical technique. It is important for nurses working in acute and critical care to be aware of the paradigm shift created by the trend toward the enhanced recovery approach. By learning more about facets of the approach, the nurse will be better prepared to adopt whatever aspects of enhanced recovery their institution implements for the surgical oncology population. An overview is provided of the potential components of enhanced recovery.

The Development of an Oncology Clinical Nurse Specialist Fellowship Program.

New graduate clinical nurse specialists (CNSs) face many challenges when starting their new role. To address this, a CNS fellowship program was developed to mentor new CNSs during their first year of practice. This CNS fellowship program would provide opportunities to increase skills related to each of the CNS spheres of influence, including nursing practice, patient care, and systems and organization. Experienced CNSs mentored CNS fellows and identified learning opportunities. The fellows completed an online self-assessment based on the National Association of Clinical Nurse Specialists CNS Competency Checklist during week one of orientation and again at months 3, 6, 9, and 12. The CNS fellows completed and presented three projects designed to explore the spheres of the CNS role, along with a formal onboarding. The results of the fellowship depicted significant competency development within all three CNS spheres at program completion. The CNS fellowship program provided structure and guidance to the newly graduated CNSs and clearly transitioned staff nurses to advanced practice nurses. The fellowship has demonstrated a positive effect on both the new CNSs and the organization in which it was developed.

Pain intensity and pain management of hospitalized patients with cancer: an opportunity for improvement

About 73% of patients diagnosed with cancer report poor pain management. The purpose of this study was to evaluate pain intensity and the extent to which pain was controlled, and based on the findings, to pose options for improving pain management for hospitalized patients with cancer.

From unit based to population focused: transforming the role of oncology clinical nurse specialists.

PURPOSE/OBJECTIVES: The aim of this study was to describe how the clinical nurse specialist (CNS) role can be positioned to proactively plan and facilitate evidenced-based best practices in collaboration with a transdisciplinary, population-focused team that manages the patient across the cancer care continuum. This model capitalizes on the spheres of CNS practice (patient, nurse, and organization) through the functional roles of the CNS (clinical expert, researcher, educator, and consultant) to maximize quality care. BACKGROUND/RATIONALE: The CNS practice in a Midwest comprehensive cancer center has been unit based, focused on nursing staff education, skills, and competencies. Practice varied based on the needs of the unit. With the aging population, rapid growth in research accrual, increasing referrals, and expansion of facilities and programs, a reexamination of CNS practice was undertaken. DESCRIPTION OF THE PROJECT/INNOVATION: Nursing administration and CNSs evaluated the efficacy of transitioning to a population-focused model. Some responsibilities transitioned to other roles, the reporting structure was changed, and the role was realigned to a specific disease focus that encompassed care across the entire cancer continuum. OUTCOME: There was significant improvement in the areas of physician collaboration, autonomy, administrative support, teamwork, and contribution to the mission of the cancer program. INTERPRETATION/CONCLUSION: In this model, CNSs proactively plan and facilitate evidenced-based best practices in collaboration with a transdisciplinary team that manages the patient from diagnosis through the cancer trajectory, maximizing quality care and nursing-sensitive patient outcomes. IMPLICATIONS: Healthcare organizations need to examine various roles for opportunities to focus on incorporating evidenced-based practices that will result in improved patient care and satisfaction.