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.

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.

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 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.

What do surgical oncology staff nurses know about colorectal cancer ostomy care?

BACKGROUND: For most patients diagnosed with colorectal cancer, dealing with the adjustment and rehabilitation after treatment can be overwhelming. There is a significant need for expert educational and counseling support, especially for the patient with a new ostomy. This pilot study describes acute care oncology staff nurses' knowledge about and attitudes toward providing direct ostomy care support and education. This study is part of a larger project assessing gaps in education and services in support of patients with colorectal cancer. METHODS: The Survey on Ostomy Care questionnaire designed to assess nurses' knowledge about and attitudes toward ostomy care was administered to oncology staff nurses at a comprehensive cancer center. RESULTS: Only 30% of staff nurses surveyed strongly agreed or agreed with the statement, "I care for ostomy patients often enough to keep up my skills in ostomy care." Maintaining staff nurses' ability to teach and demonstrate to patients complex care such as ostomy care depends on the ability to practice both education and hands-on skills. Staff nurses identify that lack of opportunity to care for the new ostomy patient influences their ability to maintain skill expertise. CONCLUSION: The results show the need to explore the provision of ongoing staff education for low-volume patient populations using creative teaching strategies, such as clinical simulation and short videos.

Overcoming challenges: life with an ostomy.

BACKGROUND: Studies have demonstrated decreased health-related quality of life in patients with stomas. METHODS: Using US Department of Veterans Affairs electronic medical records, veterans with stomas were surveyed using the City of Hope Quality of Life-Ostomy questionnaire. Focus groups were conducted segregated by type of stoma (ileostomy vs colostomy) and quality-of-life score (high vs low). Qualitative analysis was performed on the basis of the City of Hope Quality of Life for Ostomates format of health-related quality of life (physical, psychological, social, and spiritual). The findings of the colostomy focus groups are reported. RESULTS: Two new domains emerged: colostomy specific and health care specific. The most common domains discussed were colostomy specific, psychological, and social. The most frequently discussed colostomy-specific theme was effective and ineffective solutions to colostomy care. Family and spousal relationships were the main theme from the psychological category. The predominant social issue was sexual relationships. CONCLUSIONS: Awareness of patients' social, psychological, and medical status allows surgeons to identify those likely to have problems and devote resources to those veterans.

Going with the flow: quality-of-life outcomes of cancer survivors with urinary diversion.

PURPOSE: The purpose of this descriptive study was to describe health-related quality of life (HRQOL) concerns among cancer patients with continent urinary diversion (UD) and incontinent UD. SUBJECTS AND SETTINGS: Study participants were accrued from members of the California United Ostomy Association and 2 cancer centers in Southern California. INSTRUMENT: The City of Hope HRQOL-Ostomy Questionnaire (COHHRQOL-O) is a modified HRQOL measurement tool based on the original work done over a number of years by Grant and colleagues. METHODS: The COHHRQOL-O was mailed to 2,890 individuals. Of the 1,600 returns, there were 307 responses from patients with UD, indicating that they had a UD and a diagnosis that clearly indicated cancer. RESULTS: The majority of respondents were diagnosed with bladder cancer, and the average time since surgery was 9.5 years. While most patients reported being sexually active prior to UD, less than 27% resumed sexual activity after surgery. More than 75% of patients also reported difficulty in adjusting to their UD, with the majority reporting difficulty with urine leakage. Those who were incontinent reported a range of bothersome issues, such as skin problems around the UD, difficulties in managing UD care, fear of recurrence, financial worries, family distress, and uncertainty about the future. CONCLUSIONS: The results of this study add to our understanding of how patients adjust to a UD and what problems and issues can occur, even years after the initial surgery. Mastering UD care is best done under the guidance of a WOC nurse, and access to WOC nurse is essential when problems occur.

Promotion of urinary continence worldwide.

Millions of individuals around the world suffer from urinary incontinence. This article discusses worldwide urinary incontinence, and the use of information and communication technology to facilitate global nursing collaboration.

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.

Cutaneous T-cell lymphoma.

OBJECTIVE: To review recent information on the epidemiology, etiology, clinical presentation, staging, treatment approaches, and nursing management of CTCL. DATA SOURCES: Research and review articles and textbooks. CONCLUSION: Identifying the etiology and finding a cure for cutaneous T-cell lymphoma is promising as our knowledge and understanding of the T-cell biology evolves, creating more options for innovative therapies or treatment modalities. IMPLICATIONS FOR NURSING PRACTICE: It is essential for the oncology nurse to understand the disease process, treatment modalities, and side effect profiles to provide astute nursing assessment, establishment of treatment goals, management of cutaneous symptoms, treatment of side effects, and pain control while preventing infection and providing psychological/social support throughout the course of the disease.

"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.

Biological advances for new treatment approaches.

OBJECTIVES: To review malignant cell characteristics, which serve as the basis for the development of molecular, targeted cancer therapies. To provide an introduction and overview of new targeted agents, including monoclonal antibodies, enzyme inhibitors, antiangiogenic agents, gene therapy, and vaccines. DATA SOURCES: Published scientific papers, review articles, and book chapters. CONCLUSION: Through new understandings and theories of how cancer cells survive, thrive, and metastasize, researchers have created new targeted therapies for cancer treatment to minimize the harmful systemic effects of traditional therapy. IMPLICATIONS FOR NURSING PRACTICE: As with any new therapeutic modality, scientific rationale and mechanism of action must be appreciated by health care staff to build a solid foundation for patient education and to provide astute management of acute and latent effects.