RESUMO
Most nurses agree that incorporating evidence into practice is necessary to provide quality care, but barriers such as time, resources, and knowledge often interfere with the actual implementation of practice change. Published practice guidelines are one source to direct practice; this article focuses on the use of the National Comprehensive Cancer Network's Clinical Practice Guidelines for Oncology: Distress Management, which articulate standards and demonstrate assessment for psychosocial distress. Planning for the implementation of the guidelines in a feasibility pilot in a busy radiation oncology clinic is described. Results indicate that adding a distress assessment using the distress thermometer and problem checklist did not present substantial burden to nurses in the clinic or overwhelm the mental health, pastoral care, or oncology social work referral sources with more patients. Understanding distress scores and problems identified by patients helped the nurses direct education interventions and referrals appropriately; improved patient satisfaction scores reflected this.
Assuntos
Medicina Baseada em Evidências/organização & administração , Avaliação em Enfermagem/organização & administração , Pesquisa em Avaliação de Enfermagem/organização & administração , Enfermagem Oncológica/organização & administração , Guias de Prática Clínica como Assunto , Estresse Psicológico/diagnóstico , Adulto , Atitude do Pessoal de Saúde , Estudos de Viabilidade , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Neoplasias/complicações , Neoplasias/psicologia , Papel do Profissional de Enfermagem , Inovação Organizacional , Educação de Pacientes como Assunto , Satisfação do Paciente , Projetos Piloto , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Radioterapia (Especialidade)/organização & administração , Encaminhamento e Consulta/organização & administração , Índice de Gravidade de Doença , Estresse Psicológico/etiologia , Estresse Psicológico/enfermagemRESUMO
PURPOSE/OBJECTIVES: To identify the ways oncology nurses in one state advocate for patients, as well as the resources they use to do so. DESIGN: Descriptive, cross-sectional survey. SETTING: North Carolina. SAMPLE: 141 RNs in North Carolina who were members of the Oncology Nursing Society (ONS). METHODS: Subjects completed a two-page, self-administered questionnaire comprised of fixed-choice and open-ended questions. MAIN RESEARCH VARIABLES: Demographics, frequency of advocating for patient services, and awareness of ONS resources. FINDINGS: Nurses in North Carolina advocate for patients in a variety of ways. A need exists to develop ongoing methods to keep nurses up to date on advocacy issues, as well as to establish mentoring opportunities for them. Nurses believe that they are most challenged in addressing patients' financial and insurance concerns. CONCLUSIONS: Oncology nurses frequently advocate for patients' needs. The findings provide direction for future initiatives to educate nurses about their role in patient advocacy and available resources. IMPLICATIONS FOR NURSING: Ongoing education and research are needed to enhance the role of oncology nurses as patient advocates.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Neoplasias/enfermagem , Defesa do Paciente , Apoio Social , Adulto , Idoso , Estudos Transversais , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , North CarolinaRESUMO
Hematopoietic stem cell transplantation (HSCT) is being used increasingly in the treatment of malignant and nonmalignant diseases. The treatment modality has been proven effective but is not without risks. Studies consistently have identified the need for advanced supportive care (e.g., multiple organ dysfunction, vasopressor use, mechanical ventilation) as a negative prognostic indicator in patients who have received HSCT. Among patients who have received HSCT, 15%-40% require critical care monitoring or advanced support. Nurses on intensive care units can positively impact outcomes for transplant recipients when they possess the specialized skills to recognize and promptly intervene when transplant-related complications arise. This article will provide a basic overview of the HSCT process and outline the complications that may necessitate transfer to a higher level of care for specialized skills and equipment in the intensive care setting.
Assuntos
Cuidados Críticos/métodos , Transplante de Células-Tronco Hematopoéticas/enfermagem , Papel do Profissional de Enfermagem , Enfermagem Oncológica/métodos , Competência Clínica , Diagnóstico Precoce , Doença Enxerto-Hospedeiro/etiologia , Doença Enxerto-Hospedeiro/prevenção & controle , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Hepatopatia Veno-Oclusiva/etiologia , Hepatopatia Veno-Oclusiva/prevenção & controle , Humanos , Terapia de Imunossupressão/efeitos adversos , Terapia de Imunossupressão/enfermagem , Controle de Infecções , Pneumopatias/etiologia , Pneumopatias/prevenção & controle , Monitorização Fisiológica/enfermagem , Avaliação em Enfermagem , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Fatores de Risco , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/enfermagem , Resultado do TratamentoRESUMO
OBJECTIVES: To discuss the role of the radiation oncology nurse as changes in technology and treatment impact care delivery. DATA SOURCES: Published articles and texts, professional organizations, and the authors' experience. CONCLUSION: Patients receiving cancer treatment today face a myriad of treatment options that can be delivered over days, weeks, and months. As treatments become more complex and standard chemotherapy regimens are combined with new agents and targeted agents, radiation oncology nurses need to have the knowledge and skills to accurately assess and intervene. The radiation oncology nurse is the cornerstone of patient advocacy, care, and education. IMPLICATIONS FOR NURSING PRACTICE: Changes in treatment and technology continue to drive cancer care. Radiation oncology nurses need to collaborate with colleagues and incorporate evidence into practice.
Assuntos
Neoplasias , Papel do Profissional de Enfermagem , Enfermagem Oncológica/organização & administração , Radioterapia (Especialidade)/organização & administração , Radioterapia/enfermagem , Competência Clínica , Comunicação , Comportamento Cooperativo , Medicina Baseada em Evidências , Previsões , Humanos , Serviços de Informação , Relações Interprofissionais , Modelos de Enfermagem , Neoplasias/enfermagem , Neoplasias/radioterapia , Enfermeiros Clínicos/educação , Enfermeiros Clínicos/organização & administração , Enfermeiros Clínicos/psicologia , Papel do Profissional de Enfermagem/psicologia , Relações Enfermeiro-Paciente , Avaliação em Enfermagem , Pesquisa em Avaliação de Enfermagem , Informática em Enfermagem , Enfermagem Oncológica/educação , Inovação Organizacional , Defesa do Paciente , Educação de Pacientes como Assunto , Enfermagem Primária/organização & administração , Radioterapia (Especialidade)/educaçãoRESUMO
Patients with head and neck cancer often present with locally advanced disease at the time of diagnosis. Treatment plans include aggressive radiation therapy, often with concurrent chemotherapy. This treatment causes significant toxicity resulting from normal tissue damage. Currently, no consensus or evidence-based practice guidelines exist regarding which type of oral care products are best to use. Nurses in one radiation oncology department initiated a performance improvement project to develop oral care guidelines and an educational-tool for patients.
