Building Resilience in New Graduate RNs: Lessons Learned.

BACKGROUND: Transitioning into oncology practice can be challenging for new graduate RNs. High patient acuity, a steep learning curve, psychosocial challenges, and frequent patient deaths can be overwhelming. OBJECTIVES: The purpose of this program was to provide resilience training for new graduate oncology nurses as part of an existing nurse residency program. Building resilience among oncology nurses was a primary goal during the COVID-19 pandemic and continues to be an important goal. METHODS: Resilience training in this program consisted of didactic lectures, personalized goal setting, one-on-one mentoring, and a follow-up support group. Various measurement scales were used at baseline, 6 months, and 12 months to assess resilience, professional quality of life, and new graduate experience measures, including communication and organizational skills. FINDINGS: Resilience significantly declined from baseline to six months; professional quality of life and new graduate experience measures also worsened. Some improvements in organizational skills and communication emerged at 12 months. Results indicate an ongoing need to consider extending nurse residency programs, resilience training, and support beyond the traditional one-year period.

Transitions of Care: A Hematopoietic Stem Cell Transplantation Nursing Education Project Across the Trajectory.

BACKGROUND: Hematopoietic stem cell transplantation (HCT) is a complicated treatment modality used to address hematologic malignancies and other disorders. The complex care of patients undergoing HCT places them at high risk for poor outcomes during times of transition. Education is a critical component of preparing patients and caregivers to move through the many phases of the HCT treatment trajectory (i.e., preadmission, preparative regimens, inpatient admission, discharge, outpatient management, survivorship). OBJECTIVES: The purpose of this article is to provide a useful systematic approach to the standardization of patient teaching methods across various professional nursing roles in the HCT trajectory (i.e., nurse coordinator, midlevel staff, case manager, inpatient nurse, day hospital nurse) in an effort to improve outcomes related to patient transitions. METHODS: A performance improvement project based on physician and health services researcher Avedis Donabedian's conceptual framework was implemented at a National Cancer Institute-designated comprehensive cancer center in the western United States, with the intention of enhancing nurses' knowledge and standardizing the education of patients undergoing HCT and their caregivers from pretransplantation to survivorship. FINDINGS: Donabedian's framework was a helpful model in enacting changes focused on transitions in care for the population of patients undergoing transplantation. For this population, implementing and sustaining coordinated care across multiple nursing roles in a treatment trajectory is complex. However, early possible indicators of success (e.g., decreased length of stay, lower readmission rates) were promising outcomes.

Feasibility of a palliative care intervention for cancer patients in Phase I clinical trials.

BACKGROUND: Cancer patients with advanced disease who have exhausted most treatment options are often offered participation in Phase I clinical trials. To date, studies that assess the benefits of palliative care provided concurrently in Phase I clinical trial settings are lacking. The overall purpose of this study was to test the feasibility of a palliative care intervention administered concurrently to cancer patients receiving treatment in a Phase I clinical trial. METHODS: Cancer patients enrolling in a Phase I clinical trial were invited to participate in this study. Patients completed baseline questionnaires prior to treatment initiation that assessed quality of life (QOL), symptom distress, psychological distress, and satisfaction with care. Patients then received the palliative care intervention (PCI), which consisted of comprehensive QOL assessment, care planning for the patient during an interdisciplinary team meeting, and two patient education sessions. Patients were surveyed again at 1 and 2 months following treatment initiation. RESULTS: A total of 14 patients were accrued to the pilot over a 3-month time period, representing 70% of eligible patients. Patient retention was high at 1 month (75%), and had declined at 2 months (50%). Patient outcome measure scores, including symptom distress, psychological distress, and satisfaction with care, were relatively stable over time, except for overall QOL, which declined over time. CONCLUSIONS: Concurrent palliative care is feasible for cancer patients treated in Phase I clinical trial settings. A large, multisite randomized controlled trial based on this pilot will be launched to test the efficacy of the intervention in this understudied cancer population.

What do I say? Suicide assessment and management.

The risk of suicide in the cancer population is real, and it requires nurses to be able to assess and manage such risk competently. This article supports the idea that oncology nurses need to be comfortable with identifying, assessing, and appropriately triaging depressed and possibly suicidal patients with cancer to appropriate specialists, given the increased risk of suicidal ideation and completion in the cancer population. The goal of this article is to help oncology nurses identify the specific risk factors for suicide in their patients with cancer, feel confident and prepared with an accurate assessment, and provide the necessary interventions.

Discharge needs of allogeneic transplantation recipients.

Hematopoietic cell transplantation (HCT) recipients are one of the most complex patient populations to teach at the time of discharge. The purpose of this article is to discuss the qualitative themes that emerged at the time of discharge for 141 transplantation recipients who were enrolled in an advanced practice nurse (APN) intervention study. The APN intervention consisted of six teaching sessions, and the qualitative data for this article involved the first session at the time of discharge. Content analysis was conducted on the patient-initiated narrative content and structured into three groups: content scheduled to be covered at Session 1, content scheduled to be covered at a later session, and content that was not part of the scripted intervention. All topics were organized into the quality-of-life framework (physical, psychological, social, and spiritual or survivorship). Most of the patient-initiated topics, which were not part of the scripted intervention, were psychosocial in nature. Nurses need to be aware of the complex teaching needs that encompass not only physical issues but also psychosocial issues at discharge. That teaching awareness needs to be coupled with flexibility, competence, and comfort with challenging psychosocial issues.

Functional status and health-related quality of life among allogeneic transplant patients at hospital discharge: a comparison of sociodemographic, disease, and treatment characteristics.

PURPOSE: The purpose of this paper is to report the findings of a study of hematopoietic cell transplant patients, describing the needs of allogeneic transplant patients at the time of discharge in regard to their functional status, quality of life (QOL), and caregiver information and comparing these needs across a number of sociodemographic, disease, and treatment characteristics. The findings of this study are part of a larger mixed-methods study, representing one data time point of the larger study. METHODS: This paper will discuss the baseline data collected at the time of discharge for 282 allogeneic transplant patients, which include sociodemographic data combined with disease, treatment, functional status, and QOL data to present a comprehensive portrait of the transplant patient at discharge. RESULTS: Mean age was 48 years, males represented 52%, and 22% of the patients were Hispanic. The majority of the patients had acute leukemia (55%), were diagnosed within the last 3 years, and had matched unrelated (52%) transplants. The time from transplant to discharge averaged 30 days. Mean scores for QOL (scale = 1-10, with 10 = best QOL) included a low score of 5.7 for both psychological and social well-being, 6.3 for overall QOL, and 7.1 for both physical and spiritual well-being. Males had significantly higher QOL than females, as did non-Hispanics. Patients with Hodgkin's disease had significantly lower overall QOL scores. CONCLUSIONS: Our results highlight the physical, psychological, social, and spiritual challenges which present for patients and their caregivers at the time of hospital discharge following allogeneic transplant.

Challenges and strategies for recruitment and retention of vulnerable research participants: promoting the benefits of participation.

The purpose of this article was to describe recruitment and retention of vulnerable hematopoietic cell transplant patients participating in a longitudinal intervention study. Utilizing Swanson's theory of caring model, nurse researchers facilitated patients' visualization of how study participation could enable them to share their experience and further clinical insights.

Psychosocial care for adolescent and young adult hematopoietic cell transplant patients.

Psychological issues following hematopoietic cell transplantation (HCT) are unfortunately common. Literature specific to the transplant experience for the needs of adolescents and young adults (AYA) is lacking. The purpose of this article is to (1) describe the allogeneic transplant experience for AYA transplant patients during the first year following transplantation including demographic and treatment characteristics, (2) present AYA data obtained during and following a six-part posttransplant discharge study, (3) illustrate typical AYA experiences using case studies, and (4) propose AYA intervention strategies within Erickson's stages of psychosocial development. A quality of life model provided the research conceptual framework, and the content analysis framework for the qualitative research. Themes that emerged within each domain were the following: sexuality/fertility, fatigue, depression/poor coping/habits,adherence issues, use of technology, dependency issues, changes in roles/relationships, issues with school/education, financial issues, family problems/issues, miscellaneous, religion/spirituality, fear of future, uncertainty, life, death, more life appreciation. These data guide us for providing targeted interventions for the needs of this AYA population. This paper has presented literature and developmental theory, qualitative and qualitative data from an intervention study, and clinical cases in order to propose a developmental treatment model for AYA transplant patients. A coordinated and multidisciplinary approach is needed for the HCT patient who is an AYA.

Creating a palliative educational session for hematopoietic stem cell transplantation recipients at relapse.

Relapse after hematopoietic stem cell transplantation (HSCT) is a stressful event for patients and families, but provides an opportunity for education and psychosocial support. Little available research satisfies the needs of transplantation recipients at this critical time in the cancer trajectory. This article will apply the End-of-Life Nursing Education Consortium content principles to tailor an education session in an advanced practice nursing research intervention after a relapse from HSCT. The components were a specific session devoted to relapse, family-focused education and assessment, and bereavement follow-up. The details of the three steps are discussed with application to four case studies, which describe the variety of scenarios that can occur and illustrate how a standard approach should be tailored for each situation. In addition, the actual teaching tools and forms used for the intervention are included.

Informal caregiving in Hematopoietic Blood and Marrow Transplant patients.

PURPOSE: Hematopoietic cell transplant patients are among the most vulnerable and acutely ill cancer populations (Bevans et al., 2008). The responsibility of caring for the daily physical and psychosocial needs of these patients after transplant is placed mostly on family caregivers (Williams, 2007). The purpose of this descriptive correlational research study was to describe caregiving experiences of 56 caregivers of HCT patients 3-12 months following transplant. METHODS & SAMPLE: Patients and caregivers were recruited from two west coast regional transplant programs in the United States. Variables studied were: relationship quality, rewards of caregiving, predictability, role strain, patient function, caregiving activities, and caregiver quality of life (QOL). KEY RESULTS: Results indicated that all areas of role strain are significantly negatively correlated with caregiver's QOL. Predictability was negatively associated with problem solving and emotional strain indicating that as the level of predictability of the situation decreases, caregiver strain and problem solving increase. Predictability was positively correlated to caregiver QOL indicating that as the situation is more predictable caregiver QOL increases. Emotional strain, problem-solving strain, and usual care strain were significantly positively related, indicating that emotional strain and problem-solving strain increased together. As usual care strain increased, so did problem-solving strain and emotional strain. CONCLUSIONS: Suggestions for interventions include assessing and responding to caregiver issues such as emotional strain, problem-solving strain, usual care strain, unpredictability, and QOL. Examples of caregiver-focused interventions include providing timely appropriate information about these caregiver concerns including elements that make the caregiving situation predictable, and incorporating best practices for preventing and minimizing caregiver emotional strain.

Informal caregivers of hematopoietic cell transplant patients: a review and recommendations for interventions and research.

BACKGROUND: Informal caregivers (ICs) for medically fragile hematopoietic cell transplantation (HCT) patients are a vital unrecognized population supporting the transplant patient along the illness continuum. The long transplant recovery period shifts a greater burden of care to the patient's IC. Assessment of HCT caregivers' quality of life (QOL) and health status is critical to implementation of timely intervention and support. METHODS: A literature search using several search strategies covering 1980 to 2010 identified studies on ICs of HCT patients. These studies were summarized within the caregiver concepts of QOL, role, and resources. Findings of this review were used to create recommended interventions and identify implications for further research. RESULTS: Although limited, research on ICs of hematopoietic call transplant patients provides beginning evidence for clinical interventions to support this caregiver population. Interventions created focus on education, psychosocial support, and self-care. CONCLUSIONS: Although limited randomized trials of interventions have been reported, descriptive studies provide evidence for creating intervention content that addresses the needs of ICs of HCT patients. Testing of these interventions and additional areas of research are identified. IMPLICATIONS FOR PRACTICE: Beginning descriptive evidence provides the basis for interventions for ICs of HCT patients. These interventions support caregiver QOL and role implementation, depending on individual caregivers' resources and needs. Further evaluation and clinical research are needed.

Psychological issues of stem cell transplant.

OBJECTIVES: To address the psychological impact of transplant on quality of life, including physical, psychological, social, and spiritual, for the patient and caregiver, and to discuss the nurse's "emotional labor of caring" and "compassion fatigue" for such an intense vulnerable population. DATA SOURCES: Psychological transplant studies, peer review journals, and textbooks. CONCLUSION: The psychological impact after the experience of transplant can leave an indelible impression on the patient, caregiver, and nurse. IMPLICATIONS FOR NURSING PRACTICE: Suggestions are made for assessment and management of various potential psychological issues for the three mentioned populations. With these issues being better understood, nurses can actively lessen psychological morbidity.

Advanced practice nurses core competencies: a framework for developing and testing an advanced practice nurse discharge intervention.

The purpose of this paper was to describe evidenced-based interventions as implemented by advanced practice nurses (APNs) conducting intervention research with a vulnerable population of blood and marrow transplant patients. In addition, each of the 6 core competencies of the APN role identified by Hamric are outlined and applied using a patient case study. These competencies are the following: direct clinical practice, expert coaching and advice, consultation, research skills, clinical and professional leadership, collaboration, and ethical decision making. This article chronicles a typical patient's journey through a post-hospital discharge nursing research study involving APNs as "intervention nurses" and discusses the various aspects of the APN core competencies throughout the process.

Discharge and unscheduled readmissions of adult patients undergoing hematopoietic stem cell transplantation: implications for developing nursing interventions.

PURPOSE/OBJECTIVES: To describe discharge and unscheduled readmission patterns of adult patients undergoing hematopoietic stem cell transplantation (HSCT). To identify implications for nursing practice from survey results and the literature that may improve patient outcomes during and following initial hospital discharge. DESIGN: Retrospective chart review and literature review. SETTING: National Cancer Institute-designated Comprehensive Cancer Center. SAMPLE: 100 adult patients undergoing HSCT in the first six months of 2000. METHODS: Investigator-created retrospective chart-review tool collected data in three areas: demographic, clinical, and readmissions in the first six months after discharge. MAIN RESEARCH VARIABLES: Demographic variables: gender, marital status, age, and diagnosis; clinical variables: remission status at transplant, type of transplant, presence of comorbid or concurrent conditions, number of infections, number of catheter-related infections, number of bacteremic episodes, and psychosocial support; readmission variables: reason for admission, discharge or death data, number of days of each admission, and length of time between discharge to the next admission. FINDINGS: Fifty-one percent had at least one unscheduled readmission, and 80% developed an infection after HSCT. Further analysis comparing autologous to allogeneic transplant recipients indicated that the allogeneic group had a higher number of readmissions, unscheduled readmissions, and infections. Patients who reported an infection within a month prior to HSCT had a 50% mortality rate after transplantation. CONCLUSIONS: Findings indicate that allogeneic transplant recipients are a more vulnerable population in regard to infections and readmissions. Developing and testing nursing interventions surrounding the discharge period are needed next steps in improving care. IMPLICATIONS FOR NURSING: Knowledge of trends in this vulnerable population will guide nursing to plan targeted interventions.

"Research to practice": a practical program to enhance the use of evidence-based practice at the unit level.

PURPOSE/OBJECTIVES: To assist clinical nurses in translating research into clinical practice. DATA SOURCES: City of Hope Quality-of-Life (QOL) Model to guide presentations and discussion, research utilization theories, and evidence-based practice literature. DATA SYNTHESIS: Based on percentage of individual participant involvement, the four domains of QOL, and a knowledge survey. OUTCOMES: Attendance, discussion, QOL domain ranking, satisfaction, and pre- and postknowledge scores. Attendance averaged 13 individuals; average discussion participation was 54%. The psychological QOL domain was most important (58%), and discussion averaged a score of 3 (1 = slow to 5 = lively). A one-point increase (scale 1-5) measured a change in knowledge. CONCLUSIONS: The challenge for nursing assessment is to fully address patient issues in the psychological domain. IMPLICATIONS FOR NURSING: A practical program can be formulated to bring evidence-based practice to the clinical setting.

Support for evidence-based practice.

OBJECTIVES: To discuss examples of the process for evidence-based practice (EBP) and suggest helpful mechanisms for its support. DATA SOURCES: Published review and research articles, textbooks, guidelines, and web sites. CONCLUSIONS: Evidence-based practice requires a step by step process. Obtaining resources for EBP is essential to identifying and implementing and/or sustaining clinical care based on the best evidence available. IMPLICATIONS FOR NURSING PRACTICE: Finding resources to conduct EBP activities is one of the more challenging aspects of this approach to maintaining and improving quality of clinical care. However, nurses have found creative ways to obtain needed resources to implement EBP.