ABSTRACT
BACKGROUND: A growing need exists to ensure safe and skilled oncology nursing care for an increasing number of patients enrolled in phases 1 and 1/2 clinical trials and to provide detailed adherence to protocol administration. This can be best accomplished in a dedicated area for patients in early phase clinical trials. OBJECTIVES: Nursing standards and practice within a newly established translational research unit at an academic medical center were developed. METHODS: A portion of an existing outpatient infusion room composed of 13 beds and a sub-waiting room with 2 chairs was designated for placement of patients enrolled in early phase clinical trials. The functional and safety requirements needed to successfully care for these patients while meeting the demands of the trial protocol drove the creation of this dedicated unit. FINDINGS: Development of dedicated space provided opportunities to define the role of the nurse and hardwire patient and staff safety practices that assisted in reducing study deviations.
Subject(s)
Clinical Trials as Topic/standards , Guideline Adherence , Oncology Nursing/standards , Patient Participation , Treatment Adherence and Compliance , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Translational Research, BiomedicalABSTRACT
Administration of chemotherapy agents can give rise to many safety issues. Extravasation of a vesicant agent causes tissue blistering and necrosis. This complication of chemotherapy administration causes additional pain and suffering in patients who are already suffering with a diagnosis of cancer. Nurses hold key responsibilities for educating patients about administration issues and following practice standards to minimize the risk of extravasation. Defining a path of shared responsibilities among team members is a critical step in assuring the safe administration of drugs classified as vesicants. This article describes a clinical practice change that is used at a large midwestern academic medical cancer center. This practice and policy change has resulted in a 90% reduction in the administration of vesicant agents peripherally, with no occurrence of extravasations in the first 6 months of implementation.
Subject(s)
Antineoplastic Agents/administration & dosage , Extravasation of Diagnostic and Therapeutic Materials/prevention & control , Catheterization, Peripheral/methods , Humans , Inservice Training/methods , Neoplasms/drug therapy , Neoplasms/nursing , Patient Care Team/standards , Patient Education as TopicABSTRACT
Participation in the ONS Foundation-supported Breast Cancer Care Quality Measures Set pilot study defined areas of need for compliance with proposed standards. Key outcomes were the revision of nursing assessment and documentation tools. Subsequent to those efforts, a walking track was made available for patients within the clinical cancer center. The track serves as an exercise resource for patients and family members to use while waiting for and after appointments. The planning involved multiple disciplines, and criteria established by the multidisciplinary team defined what group of patients should be advised of or encouraged to use the walking track without provider consultation. The scheduled nurse-patient education appointment prior to start of chemotherapy provides the venue for the discussion. The goal is to assist patients in staying active during and after treatment.
Subject(s)
Breast Neoplasms/physiopathology , Fatigue/therapy , Walking , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Fatigue/chemically induced , Humans , Nurse-Patient Relations , Patient Education as Topic/methods , WisconsinABSTRACT
Administration of chemotherapy agents can give rise to many safety issues. Extravasation of a vesicant agent causes tissue blistering and necrosis. This complication of chemotherapy administration causes additional pain and suffering in patients who are already suffering with a diagnosis of cancer. Nurses hold key responsibilities for educating patients about administration issues and following practice standards to minimize the risk of extravasation. Defining a path of shared responsibilities among team members is a critical step in assuring the safe administration of drugs classified as vesicants. This article describes a clinical practice change that is used at a large midwestern academic medical cancer center. This practice and policy change has resulted in a 90% reduction in the administration of vesicant agents peripherally, with no occurrence of extravasations in the first 6 months of implementation.
Subject(s)
Antineoplastic Agents/administration & dosage , Extravasation of Diagnostic and Therapeutic Materials/prevention & control , Humans , Inservice Training , Neoplasms/drug therapy , Neoplasms/nursing , Risk Reduction BehaviorABSTRACT
PURPOSE/OBJECTIVES: To examine patient preferences for content and methods of delivering treatment plans, educational information, and survivorship care plans. RESEARCH APPROACH: Thematic analysis of four tape-recorded focus groups of cancer survivors. SETTING: An outpatient clinical cancer center in an academic medical center in the midwestern United States. PARTICIPANTS: 40 cancer survivors who had completed initial treatment. Participants were grouped by disease site: (a) prostate, genitourinary, and skin; (b) breast and gynecologic; (c) gastrointestinal, sarcoma, and head and neck; and (d) brain, pancreas, and lung. METHODOLOGIC APPROACH: An exploratory, descriptive approach with in-depth focus group thematic and comparative analysis methodology. The data are grouped into four major, interconnected themes. MAIN RESEARCH VARIABLES: Survivors' personal experiences with receiving cancer treatment. FINDINGS: Four categories were agreed on using thematic analysis: educational information, treatment plan, survivorship care plan, and patient support. Themes were identified within each category. CONCLUSIONS: The number of cancer survivors continues to grow each year. Approaching each survivor with individualized educational information, an initial treatment plan, a survivorship care plan, and emotional support is imperative. Oncology nurses must assess cancer survivors for their unique needs and intervene accordingly. INTERPRETATION: Because oncology nurses assess and recognize the learning needs of each patient, they are best positioned to develop teaching content, strategies, and timing of interventions. The importance of written educational materials cannot be negated. Oncology nurses also are well positioned to provide a proactive role in the development and delivery of treatment and survivorship plans of care.
Subject(s)
Neoplasms/nursing , Neoplasms/psychology , Oncology Nursing/methods , Patient Education as Topic/methods , Patient Preference/psychology , Social Support , Adult , Aged , Female , Focus Groups , Humans , Male , Middle Aged , Neoplasms/therapy , Nurse-Patient Relations , Outpatients/psychology , Patient Care Planning , Survivors/psychologyABSTRACT
The Resource Center of the American Alliance of Cancer Pain Initiatives provided templates, faculty, and ongoing consultation to assist seven state pain initiatives to implement programs to improve pain management practices. A total of 113 health care organizations participated. Each organization committed to support a team of two to three staff through a 10-month pain quality improvement process, which included a site visit, two educational conferences, pre- and postprogram analyses of the organizational structures in place to support pain assessment and management, quality improvement work plan development, and patient survey data collection. Postprogram results showed statistically significant increases in the presence of structural elements that are critical to effective pain management, as well as statistically significant, though modest, decreases in the percentage of patients who reported pain of any severity, and specifically moderate to severe pain, in the previous 24 hours. The largest changes occurred in long-term care facilities. Nevertheless, the percentage of patients in moderate to severe pain remained unacceptably high.
Subject(s)
Delivery of Health Care , Pain Management , Patient Care Team/organization & administration , Home Care Services , Hospitalization , Humans , Long-Term Care , Pain Measurement , Program Evaluation , United StatesABSTRACT
Cancer pain management is a crucial aspect of patients' quality of life. During the course of the disease, patients with cancer may develop difficult pain management problems that do not respond to interventions that use the basic principles of pain management. Ongoing assessment, multiple approaches, and excellent communication among all care management team members are critical. Pain management goals must be continually evaluated, reestablished if necessary, and negotiated by patients and the team. Difficult pain management cases demand the involvement of all team members, especially patients, to assist in determining acceptable approaches. Nurses must recognize the challenge, advocate for better management, and provide ongoing assessment. Ultimately, pain management outcomes are determined by nursing advocacy. Through nurse leadership, suffering is minimized and quality of life is improved for this patient population.
Subject(s)
Analgesics, Opioid/therapeutic use , Methadone/therapeutic use , Neoplasms/complications , Oncology Nursing/organization & administration , Pain/drug therapy , Patient Care Team/organization & administration , Administration, Oral , Aged , Communication , Drug Monitoring , Female , Humans , Interprofessional Relations , Middle Aged , Nurse's Role , Nursing Assessment , Pain/diagnosis , Pain/etiology , Pain/psychology , Pain Measurement , Patient Care Planning , Patient Education as Topic , Patient Participation , Quality of Life , Therapeutic Equivalency , Treatment FailureSubject(s)
Breast Neoplasms/nursing , Breast Neoplasms/psychology , Communication , Nurse's Role , Nurse-Patient Relations , Palliative Care/psychology , Activities of Daily Living , Adaptation, Psychological , Advance Care Planning/organization & administration , Aged , Attitude to Death , Breast Neoplasms/diagnosis , Family/psychology , Female , Humans , Nursing Assessment , Patient Care Planning , Physician-Nurse Relations , Physician-Patient Relations , Truth DisclosureSubject(s)
Critical Pathways , Death , Geriatric Assessment , Aged , Humans , Life Expectancy , Nursing Assessment , Patient Care TeamSubject(s)
Communication , Nurse's Role , Pain Measurement/nursing , Pain/drug therapy , Patient Care Team , Female , Humans , Internet , Pain/classification , Severity of Illness IndexABSTRACT
Many people with dementia are unable to clearly or consistently verbalize pain symptoms. The Assessment of Discomfort in Dementia (ADD) Protocol is a systematic tool that can be used by nurses to make a differential assessment and treatment plan for both physical pain and affective discomfort experienced by people with dementia. This ADD Protocol is based on the assumption that behaviors associated with dementia are symptoms of unmet physiologic and/or nonphysiologic needs. Steps of the process include a physical assessment, a review of the patient's history, an assessment of affective needs including environmental stress and sensoristasis, and the administration of analgesics. The ADD Protocol is unique in that it uses "as needed" analgesics as a part of the assessment process. The dualistic perspective, in which physical and affective needs are considered in tandem, is an essential and innovative feature of the ADD Protocol.
