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.

Retrospective study of multidisciplinary rounding on a thoracic surgical oncology unit

Multidisciplinary rounding (MDR) reduces medical errors and improves the quality of care for hospitalized patients. The purpose of this study was to evaluate hospital length of stay, patient satisfaction, admission to a skilled care facility, and the use of home health care or hospice in patients who received MDR compared to those who did not. This retrospective study included the records of 3,077 thoracic surgical patients with cancer who were admitted to a midwestern National Cancer Institute-designated comprehensive cancer center from January 1, 2006, through July 1, 2011. Overall mean length of stay was 5.3 days in the MDR group compared to 6.5 days in the no MDR group. The MDR group also had significantly shorter mean length of stay compared to the no MDR group among patients who were discharged home from the hospital, admitted to hospice following a hospital discharge, discharged to a skilled care facility, or admitted to home healthcare services. No significant differences in satisfaction scores were reported in patients who received MDR compared to those who did not. MDR is an important aspect of inpatient oncology care, and staff should be identified to participate who have expertise relevant to patients' needs.

Avoiding failure to rescue situations: a simulation exercise for oncology nurses

This project aimed to improve RNs' recognition of and appropriate responses to failure to rescue situations on a surgical oncology unit. Simulation exercises played a key role in identifying areas of strength, opportunities for improvement, and development of a personalized education plan. In addition, the exercises improved RNs' clinical confidence.

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.