Homecare Encounters: An Organizational Response to Innovative Care for Patients Undergoing Hematopoietic Stem Cell Transplantation During COVID-19.

BACKGROUND: Healthcare delivery has been significantly changed because of the COVID-19 pandemic. Patients undergoing hematopoietic stem cell transplantation (HSCT) are vulnerable to infections because of their immunocompromised status. The risk of nosocomial infection may be reduced by providing care to patients at home. OBJECTIVES: This article describes one cancer center's approach for delivering safe patient care through homecare encounters, the benefits of home care for HSCT, and future directions. METHODS: Patients received detailed information on home encounters. Advanced practice providers visited patients daily and then returned to the clinic to formulate a plan of care with the interprofessional care team. Transplantation RNs visited patients on the same day to provide the prescribed care. FINDINGS: Based on evaluations from 32 patients and 12 providers, the results indicated that home care was safe, feasible, and beneficial for patient care post-HSCT during the COVID-19 pandemic.

Pain Management Revisited.

Now that the SARS-CoV-2 virus and its variants have altered clinical oncology practice as we know it, let's return to a familiar focus from the Core Curriculum for Oncology Nursing-pain management. Much has happened during the past two years that influences the effective management of pain in patients with cancer-not the least of which is a clinical environment that has been changed by the COVID-19 pandemic.

Ambulatory Oncology: Infrastructure Development in Response to the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic generated challenges to the delivery of safe, efficient, and high-quality cancer care. In ambulatory oncology, where most cancer care is delivered, these challenges required the rapid development of infrastructure. OBJECTIVES: This article describes challenges to the design and implementation of ambulatory oncology infrastructures that support clinical oncology care during a pandemic. METHODS: This article reviews clinical experiences in interprofessional, multicenter, academic, and community settings during the COVID-19 pandemic. Cohesive and efficient services, collaborative processes, and workflows; patient triage and symptom management; technology and equipment; and communication strategies are discussed. National ambulatory care guidelines and practice recommendations are included as applicable and available. FINDINGS: Continued treatment delivery and support for patients with cancer, as well as infrastructure to minimize viral exposure to patients and oncology healthcare workers, are essential when caring for this high-risk population.

Care Delivery and Treatment Decision Making: Bioethical and Nursing Considerations During and After the COVID-19 Pandemic.

BACKGROUND: The disruption in the supply chain of resources and interruptions in cancer treatments caused by the pandemic presented tremendous challenges to the healthcare system. OBJECTIVES: This article describes the National Academy of Medicine-defined states of medical and nursing care delivery for which local plans should be drawn and the shifting and evolving systems framework that can guide decisions to optimize the crisis standards of care. METHODS: A case study is presented to describe the process of shifting the state of medical and nursing care delivery and bioethical nursing considerations during the pandemic and beyond. FINDINGS: An evolving and shifting systems framework for crises rooted in deontology, principlism, and the ethics of care model provide meaningful guidance for establishing priorities for patient care.

Telehealth in Palliative Care: Communication Strategies From the COVID-19 Pandemic.

Palliative care was once believed to be too high-touch to be delivered via telehealth. However, numerous studies have demonstrated the positive effects of palliative care delivered through telehealth. Because the COVID-19 pandemic has quickly shifted how health care is delivered to patients with cancer, particularly because of their immunocompromised status and the risks associated with unnecessary exposures in the clinic, previous lessons from palliative care research studies can be used to inform practice. This article presents a case study that illustrates evidence and best practices for continuing to deliver palliative care via telehealth after COVID-19 restrictions are lifted.

Care and Coping During COVID-19: Practice Changes and Innovations in the Oncology Setting.

BACKGROUND: The COVID-19 pandemic has required healthcare systems to transform the delivery of care. Although the core principles of care for patients with cancer have not changed, this pandemic has led to heightened awareness concerning the fragility of patients with cancer and how healthcare systems can protect them. OBJECTIVES: The aims were to identify and implement inpatient and ambulatory care clinical practice changes during the COVID-19 pandemic, based on defining moments and coping strategies from clinical oncology nurses, advanced practice RNs, nurse leaders, and researchers. METHODS: This article presents a Lean Six Sigma framework, accompanied by numerous rapid cycle tests of change. FINDINGS: The COVID-19 pandemic required clinical healthcare providers at the authors' institution to focus on seven priority areas. Nurses tested and implemented practice changes.

COVID-19 Pandemic: What Have We Learned?

This issue of the Clinical Journal of Oncology Nursing presents foundational content about clinical oncology care in the environment of a virulent pandemic, particularly the COVID-19 pandemic, which continues to overwhelm global health and healthcare delivery systems.