Exploration of System Chief Nurse Executive's Leadership Practices to Support, Mentor, Develop, and Retain Nurse Leaders.

In 2019, the National Academy of Science identified clinician burnout as a growing public health concern. The COVID-19 pandemic has only compounded this crisis and transformed it into an escalating fracture within the US health care system. Concurrently evolving with this emergency is a rise in the number of nurses who intend to leave the profession. Frontline nurse leaders are the lynchpin in ensuring health care systems function. These leaders have accountability over patient care and clinician well-being. Focused efforts must address clinician burnout. However, without addressing the well-being of frontline nurse leaders, the fault line in our health care system becomes a vast chasm. Recently, published literature began to emerge describing and addressing frontline clinician burnout. Unfortunately, only a few, if any, address issues related to leaders. The aim of this qualitative case study research was to explore and discover general themes in system chief nurse executive leadership practices that support, mentor, develop, and retain nurse leaders as a basis for future research. Three major themes were identified for future study and exploration: enhancing leadership development programs; improving leader work environments; and focusing on leader well-being and support. Further research is needed to evaluate the effectiveness of these themes.

Increased Intracranial Pressure: The Use of an Individualized Ladder Approach.

OBJECTIVE: This paper provides a review of current knowledge on intracranial pressure (ICP) dynamics, assessment, and diagnostic considerations, and presents a ladder approach to the management of the neuro-oncological emergency increased ICP. DATA SOURCE: Review of recent literature from PubMed. CONCLUSION: Increased ICP can rapidly escalate into a catastrophic event. Prompt initiation of an individualized ladder approach to clinical management enabled by early recognition of symptoms and application of diagnostic tools have been shown to improve outcomes in patients suffering from this neuro-oncological emergency. IMPLICATIONS FOR NURSING PRACTICE: The care of cancer patients with increased ICP can be very challenging. When increased ICP in patients with cancer is evident or strongly suspected, nurses need to initiate a prompt and effective care plan that includes intensive monitoring of symptoms and continuous assessment of the patient's neurological condition that will guide diagnostic and treatment decisions. Nurses must continue to recognize the importance of utilizing best available evidence to support a collaborative interdisciplinary clinical plan of care.

Filipino nurses in the United States.

Demographic profile and job satisfaction.

Neurological improvement of perineural and leptomeningeal spread of squamous cell carcinoma treated with intrathecal chemotherapy and systemic EGFR inhibition.

Squamous cell carcinoma (SCC) is a common cancer of the skin. Risk factors include fair skin, excessive sun and ultraviolet light exposure, and history of xeroderma pigmentosa. Perineural invasion (PNI), an uncommon manifestation of SCC, involves microscopic tumor cells invading various layers of the nerve sheath. It is associated with a poorer prognosis. Standard treatment for PNI includes radiation therapy. Here, we describe a case an older gentleman with a history of SCC with PNI successfully treated with erlotinib and intrathecal chemotherapy.

The Hidden Morbidity of Cancer: Burden in Caregivers of Patients with Brain Metastases.

Caregiving is a highly individualized experience. Although numerous articles have been published on caregiver burden from a variety of diagnoses and conditions, this article presents the unique features of caregiving in patients with brain metastases. Improved long-term survival, concerns about disease recurrence or progression, the cancer experience (initial diagnosis, treatment, survivorship, recurrence, progression, and end of life), and the increasing complexity of cancer treatments add to the demands placed on the caregivers of patients with brain metastases. Health care professionals must identify caregiver burden and administer the appropriate interventions, which must be as unique and individualized as the caregivers' experiences.

Cognitive dysfunction in patients with brain metastases: influences on caregiver resilience and coping.

PURPOSE: Neurologic deficits that may be manifested as cognitive impairment contribute to the challenges faced by caregivers of patients with brain metastases. To better address their needs, we examined how caregivers respond to these challenges and explore the relationship between the patient's cognitive impairment and caregiver resilience and coping. METHODS: We conducted a descriptive, cross-sectional study using self-reported data from 56 caregivers of patients with brain metastases. Study participants from a comprehensive cancer center were asked to complete a series of instruments that measured their perception of the patient's cognitive dysfunction (revised memory and behavior problems checklist, RMBC), their own personal resilience (Resilience Scale, RS), and their utilization of a broad range of coping responses (COPE inventory and Emotional-Approach Coping scale). RESULTS: Caregivers reported that memory-related problems occurred more frequently in the patients they cared for compared to depression and disruptive behavior (mean scores 3.52 vs 2.34 vs. 1.32, respectively). Coping strategies most frequently used by caregivers were acceptance (3.28), planning (3.08), and positive reinterpretation and growth (2.95). Most caregivers scored moderate to high on the RS (77%). The coping strategy acceptance correlated significantly with the memory and disruptive behavior subscales of the RMBC. CONCLUSIONS: Given the protective effect of problem-focused coping and the high rate of caregivers utilizing less effective coping strategies in instances of worsening cognitive dysfunction, healthcare professionals need to systematically assess the coping strategies of caregivers and deliver a more personalized approach to enhance effective coping among caregivers of patients with brain metastases.

Voices of Oncology Nursing Society members matter in advocacy and decisions related to U.S. Health Policy

The Oncology Nursing Society (ONS), a member of the Nursing Organizations Alliance, invests in advocating for health and public policy decisions by sending members to the Nurse in Washington Internship (NIWI) program annually. NIWI provides a forum to educate nurses on the legislative process, giving attendees a better understanding of political, legislative, and regulatory issues facing nurses. The 2014 ONS delegation participated in training and lobbying focused on federal funding issues, nursing education, workforce oversight, and funding for nursing research. The three-day program ended with a Capitol Hill visit where nurses met with their respective legislators or their staff, using skills learned at NIWI briefings to influence policy for nurses and the patients they serve. Critical health and public policy decisions affecting nurses, their practice, and their patients require participation in and understanding of the legislative process. This article provides a glimpse into the three-day experience of the delegates attending the 2014 NIWI.

Novel approaches to treating leptomeningeal metastases.

Leptomeningeal metastasis is a devastating complication of the central nervous system in patients with late-stage solid or hematological cancers. Leptomeningeal metastasis results from the multifocal seeding of the leptomeninges by malignant cancer cells. Although central nervous system metastasis usually presents in patients with widely disseminated and progressive late-stage cancer, malignant cells may spread to the cerebrospinal fluid during earlier disease stages in particularly aggressive cancers. Treatment of leptomeningeal metastasis is largely palliative but will often provide stabilization and protection from further neurological deterioration and improve quality of life. There is a need to raise awareness of the impact of leptomeningeal metastases on cancer patients and its known and putative biological basis. Novel diagnostic approaches include identification of biomarkers that may stratify the risk for developing leptomeningeal metastasis. Current therapies can be used more effectively while waiting for advanced treatments to be developed.