Oncology Nursing During a Pandemic: Critical Reflections in the Context of COVID-19.

OBJECTIVES: To provide a critical reflection of COVID-19 in the context of oncology nursing and provide recommendations for caring for people affected by cancer during this pandemic. DATA SOURCES: Electronic databases, including CINAHL, MEDLINE, PsychINFO, Scopus, professional web sites, and grey literature were searched using Google Scholar. CONCLUSION: Nurses are key stakeholders in developing and implementing policies regarding standards of care during the COVID-19 pandemic. This pandemic poses several challenges for oncology services. Oncology nurses are providing a pivotal role in the care and management of the novel COVID-19 in the year landmarked as the International Year of the Nurse. IMPLICATIONS FOR NURSING PRACTICE: It is too early to tell what shape this pandemic will take and its impact on oncology care. However, several important clinical considerations have been discussed to inform oncology nursing care and practice.

A Clinical Practice Perspective on Publishing in Oncology Nursing.

OBJECTIVE: To describe how clinical problems and observations can generate ideas for writing for publication. DATA SOURCES: Journal articles, publishers' information for authors, online publishing resources, personal experience. CONCLUSION: Ideas for publishable manuscripts can be generated from clinical practice dilemmas, patient or nursing outcome data, and reading professional materials or attendance at professional meetings. Publishing opportunities for novice writers include case reports, letters to editors, abstracts for professional conferences, and articles in a variety of newsletters and journals. IMPLICATIONS FOR NURSING PRACTICE: Nurses working in clinical practice settings have a wealth of opportunities for identifying topics suitable for publication.

Use of the modified early warning score and serum lactate to prevent cardiopulmonary arrest in hematology-oncology patients: a quality improvement study.

This process improvement project aimed to improve the early identification of clinically deteriorating hematology-oncology patients in order to prevent the development of critical illness and to facilitate timely intensive care unit (ICU) transfers. Using failure modes and effects analysis, a protocol employing the Modified Early Warning Score and serum lactate level was implemented to identify deteriorating patients who required the attention of the rapid response team. Control charts revealed a significant decrease in codes and preventable codes, while ICU transfers remained stable. A retrospective analysis to control for age, sex, race, severity of illness, and do not resuscitate status was performed, yielding a codes odds ratio of 0.51 (95% confidence interval = 0.31-0.85) and a preventable codes odds ratio of 0.25 (95% confidence interval = 0.07-0.82). At the study team's institution, implementation of this protocol reduced codes and preventable codes without an associated increase in ICU transfers.

Questioning the role of a neutropenic diet following hematopoetic stem cell transplantation.

The use of a neutropenic diet (ND) after hematopoietic stem cell transplantation (HSCT) was instituted more than 30 years ago as a means of preventing infection from organisms colonizing the gastrointestinal tract. Evidence supporting this practice is lacking, however, and the actual efficacy of the ND remains unknown. Institutional policy at Northwestern Memorial Hospital discontinued the use of ND in 2006. We conducted a retrospective study of 726 consecutive HSCT recipients, 363 who received an ND and 363 who received a general hospital diet, to determine the incidence of microbiologically confirmed infections during and after transplantation. Our findings indicate a higher rate of infections in the HSCT recipients who received an ND.

Symptom management issues in oncology nursing.

Symptoms experienced by patients with cancer can occur as a direct effect of the disease process and be related to side effects of treatment. Many patients with cancer also are older in age and have comorbidities, such as diabetes and heart disease. Comorbid conditions also produce disease and treatment-related symptoms that may have an independent or compounding effect on cancer-related symptoms.

Hypersensitivity reactions to biological drugs.

OBJECTIVES: To review the current evidence regarding hypersensitivity reactions related to the administration of biological drugs in the management of cancer, and to provide the nurse with appropriate interventions related to the management of hypersensitivity reactions. DATA SOURCES: Review articles and research studies from the medical and nursing literature. CONCLUSION: Current evidence is available regarding the types of reactions that are associated with the administration of biological drugs in the management of cancer. Medical and nursing studies that review the most effective management of hypersensitivity reactions related to the administration of biological drugs. A review of "best practice" is offered in this article regarding the management of hypersensitivity reactions related to the administration of biological drugs. IMPLICATIONS FOR NURSING PRACTICE: Nurses play a key role in the early identification of hypersensitivity reactions. Management of hypersensitivity reactions must be rapid for optimal patient outcomes.

Nursing considerations of bevacizumab use in multiple tumor types.

PURPOSE/OBJECTIVES: To update information concerning the antiangiogenic agent bevacizumab, discuss side effects, and provide information on nursing management of the side effects. DATA SOURCES: Published articles, abstracts, and research data. DATA SYNTHESIS: In clinical trials, the addition of bevacizumab to standard chemotherapy increased survival in patients with metastatic colorectal cancer and advanced non-small cell lung cancer and increased progression-free survival in patients with metastatic breast cancer. Bevacizumab also is being evaluated in combination with other targeted agents in various tumor types. Commonly reported side effects associated with bevacizumab include hypertension, proteinuria, and minor bleeding. CONCLUSIONS: The value of bevacizumab in treating metastatic colorectal cancer has long been established. Clinical trial data have demonstrated the benefit of using bevacizumab in combination with standard chemotherapy in the treatment of non-small cell lung cancer and metastatic breast cancer. Because of bevacizumab's expanding role in cancer treatment, nurses need to know how to use it, be aware of possible side effects, and anticipate interventions. IMPLICATIONS FOR NURSING: Nurses play an important role in the identification and management of adverse events associated with bevacizumab.

Putting evidence into practice: prevention of infection.

The prevention of infection is an important outcome to measure in patients with cancer because infectious complications are a significant cause of morbidity and mortality. Nurses play a vital role in the prevention of infection in patients with cancer through nursing practice, research, and patient education. However, many common nursing interventions to prevent infection are based on tradition or expert opinion and have not been subjected to scientific examination. The 2005 Oncology Nursing Society Prevention of Infection Outcomes Intervention Project Team reviewed, critiqued, and summarized the research evidence for nursing interventions to prevent infections in patients with cancer. Pharmacologic and nonpharmacologic interventions were included because many advanced practice nurses prescribe medications. This article is an evidence-based review of nursing interventions to prevent infection in patients with cancer.

Nursing-sensitive patient outcomes: the development of the Putting Evidence into Practice resources for nursing practice.

The Oncology Nursing Society (ONS) has worked diligently to improve the care of patients with cancer and their families. A recent project that demonstrates this commitment toquality care is the development of nursing-sensitive patient outcomes resources. ONS has teamed researchers, advanced practice nurses, and staff nurses to develop Putting Evidence Into Practice resources that provide guidance for nursing interventions based on the evidence. The ability to provide evidence for nursing interventions is critical to all aspects of patient care, including patient teaching, development of patient care policies and procedures, and provision of direct patient care.

Chemotherapy-induced hypersensitivity reactions.

PURPOSE/OBJECTIVES: To assist clinical nurses in understanding the complex nature of chemotherapy-induced hypersensitivity reactions as well as effectively preventing or managing these reactions. DATA SOURCES: Published articles and abstracts, pertinent book chapters, computerized databases. DATA SYNTHESIS: Most available chemotherapy drugs can cause hypersensitivity reactions, but certain drug groups frequently are associated with these reactions (e.g., asparaginases, taxanes, platinum compounds, epipodophyllotoxins). Preventing hypersensitivity reactions is the primary goal; however, understanding the principles of managing these reactions is critical because hypersensitivity reactions can occur despite using appropriate prevention strategies. CONCLUSIONS: Chemotherapy-induced hypersensitivity reactions are potentially life-threatening. Nurses working with chemotherapy drugs must understand which drugs are associated with a high risk of causing hypersensitivity reactions and must be prepared to attempt to prevent or manage reactions. IMPLICATIONS FOR NURSING: The potentially life-threatening nature of hypersensitivity reactions to chemotherapy requires that nurses have a plan to manage them. This may include a written policy on staff education and training, appropriate equipment, and medications.

Use of the Pleurx Pleural Catheter for the management of malignant pleural effusions.

Many patients with cancer, especially those with lung and breast cancer, experience malignant pleural effusions. Several treatment options exist, and most require hospitalization. The Pleurx Pleural Catheter (Denver Biomedical, Golden, CO) is a new treatment option that allows patients to be treated on an outpatient basis for weeks or months. With a catheter in place, pleural effusions can be drained intermittently at home by trained family members or caregivers. Nurses play a critical role in educating patients about the use of the Pleurx catheter, as well as teaching patients and family members how to drain the catheter. The purpose of this article is to familiarize nurses with the proper care of Pleurx catheters and provide a basis for patient education.

Management of tumor lysis syndrome: prevention and treatment.

OBJECTIVES: To provide a review of the preventive and treatment strategies for tumor lysis syndrome (TLS). DATA SOURCES: Primary and tertiary literature and clinical experience. CONCLUSIONS: The oncology nurse can optimize outcomes in the patient at risk for TLS through a variety of prevention and treatment interventions: (1) aggressive patient monitoring for early identification and treatment; (2) minimize risk factors via thorough medication and nutritional histories, and assurance of proper prophylactic regimens; (3) assessment of optimal routes of drug delivery to assure medication bioavailability; and (4) reinforcement of the above with comprehensive patient education. IMPLICATIONS FOR NURSING PRACTICE: Awareness and effective use of prophylactic and treatment regimens related to TLS will positively impact patient outcomes. The oncology nurse is at the front line to identify issues related to effective management of TLS.