2004 Congress Abstracts

151
TOOLS FOR INCREASING EASE AND COMPLIANCE IN PATIENT EDUCATION AND TEACHING (DOCUMENTATION MADE EASY FOR NURSES). Buenagracia Delacruz, RN, BSN, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Nurses face the same challenges related to time, staffing, and money, regardless of the size or location of the healthcare facility. On the hematology service areas at the University of Texas M.D. Anderson Cancer Center (UTMDACC), we are continually seeking to overcome some of the barriers to documentation of patient teachings in order to communicate patient’s knowledge and meet JCAHO standards.
With the development of internal monthly chart audits in each department, assessment and evaluation of nursing/allied health teaching compliance is accomplished in real time. Within the unit council structure, quality improvement (QI) members are responsible for identifying deficits in practice on the specific unit. Chart audits by members initially revealed that there was less than 60% compliance with documentation in areas of pain, food, and drug interactions, and discharge teaching. The institutional goal for this was set at greater than 90%. To achieve this goal, council members decided to develop new tools that were brief, user friendly, and accessible to the staff. Ready-to-use preprinted teaching labels that the nurses could attach to the IPTR (interdisciplinary teaching record) were created. The labels included a checklist of all possible interventions applicable to the educational need and allowed nurses to individualize the plan by checking only those interventions appropriate to the patient. In collaboration with the unit-based educational council, individual nursing teaching packets and a storyboard with example of appropriate and inappropriate documentation were presented to the nursing staff.
Recent audits have indicated a current compliance rate of over 90% that was achieved over a period of only eight months.
The quality council members are also responsible to ensure that tools are being kept up to date and supplies are available for nurses to use. Recent audits have indicated a current compliance rate of over 90% that was achieved over a period of only eight months. As our institution is moving toward a computerized medical record, these tools/labels will become the template for teaching documentation.

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TUMOR MARKERS: ARE YOU CONFIDENT ENOUGH TO DISCUSS THEM WITH YOUR PATIENTS. Deanna Yamamoto, RN, MS, CS, ANP, and Pamela Viale, RN, MS, CS, ANP, OCN^®, Santa Clara Valley Medical Center, San Jose, CA.

Oncology nurse/patient encounters may include discussion of pertinent tumor markers. Often patients ask nurses about markers and what they mean regarding specific prognosis and treatment.
Oncology nurses are the harbingers of knowledge and information for patients with cancer as well as the general public. Every practicing oncology nurse, whether they are in academia or at the bedside, should be knowledgeable about the use of tumor markers. The purpose of this paper is to review the most common tumor markers used in oncology today and identify the less common tumor markers and what roles they may play in the future.
Tumor marker development is in its infancy compared to other diagnostic and prognostic tools, and we are at the threshold of witnessing a revolution in clinical practice. Tumor markers are important tools in the management of cancer, helping to screen and diagnose cancer, monitor treatment, and assist in determining recurrence. The first modern tumor marker used to detect cancer was human chorionic gonadotropin (HCG), followed in 1965 by the development of carcinoembryonic antigen (CEA). Currently there are almost a dozen tumor markers being used in the oncology arena with a dozen more tumor markers in development for clinical use. The relevancy of tumor marker use will be reviewed along with their use in various cancers including colon, breast, and ovarian cancer. Oncology nurses should be made aware that only one tumor marker, prostate-specific antigen (PSA), has been approved as a screening tool, although lay literature may propose otherwise.
Over the last several decades, the number of tumor markers has grown tremendously, and oncology nurses must now be as informed about tumor markers as they are with chemotherapy.
With these tools, nurses can more confidently answer the patient’s question, “What does my tumor marker number mean?”

153
THE NURSE’S ROLE IN ENSURING CORRECT PATIENT EDUCATION FOR PATIENTS BEING DISCHARGED WITH A PLEUREX CATHETER. Maureen Jingeleski, RN, BSN, and Keri Wagner, RN, OCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Patient education has become an essential part of shifting the responsibility of the management of the catheter from the inpatient healthcare provider to the patient at home. Patients are being instructed by the nursing staff at a comprehensive cancer center to use a clean technique to change the bottle and the dressing. However, the patient instruction booklet and video supplied by the company demonstrates sterile technique. As a result, once at home, patients found that the information they had concerning the care of the catheter was conflicting with what they were taught causing confusion and anxiety.
Providing the patient with understandable teaching and educational material facilitates proper care and use of the pleurex catheter. This, in turn, can decrease length of stay, readmissions, and complications as well as increase patient’s feeling of independence and overall quality of life.
The authors contacted the institution’s patient education department and Denver Biomedical regarding the patient teaching material and developed institution specific patient education material, which has since been submitted to the institution’s patient education department. In addition, revisions have been sent to Denver Biomedical regarding the patient teaching material.
Denver Biomedical has agreed that revisions are necessary and are changing both the printed material and video. The institution continues to use the pleurex catheter and the nurses teach according to the revised patient education material.
Pleural effusions are a common late-stage complication of lung cancer that now can be managed at home. Traditionally, pleural effusions meant an inpatient admission with a chest tube placed and a procedure such as pleurodesis done. This is a long, painful process with a high incidence of recurrence. Currently, patients at a NCI designated comprehensive cancer center are sent home with a Denver Pleurex catheter, a closed drainage system, consisting of a soft fenestrated catheter with a one-way valve, in place. This system allows for intermittent self-drainage of the effusion. This eliminates the need for admission, reduces incidence of recurrence, and is easily cared for at home by the patient.

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A QUALITY IMPROVEMENT PROJECT TO ENHANCE UNDERSTANDING AND COMPLIANCE WITH HEMATOLOGY/ONCOLOGY DISCHARGE INSTRUCTIONS. Joni Chilson, RN, BSN, OCN^®, Vivian Grubbs, RN, BSN, OCN^®, and Karen Thongsavath, RN, OCN^®, Wake Forest University Baptist Medical Center, Winston Salem, NC.

Oncology nurses wrote detailed instructions. Our multidisciplinary team identified that our patients did not always understand or comply with their discharge instructions. Our outpatient clinic staff had noticed an increase in the volume of phone calls from recently discharged patients with questions pertaining to their medication regimen or discharge instructions. The concern was brought to the attention of our multidisciplinary team and an action plan was formulated.
We did a quality improvement monitor to determine if there was a problem. A survey was conducted on patients and revealed that patients could not remember what instructions they had received. They had several questions and concerns about their medications. The hematology/oncology multidisciplinary team, consisting of inpatient and outpatient nurses, pharmacy, physician, case management, and clinical nurse specialists, met with our oncology unit based shared governance to determine how we could improve compliance with discharge instructions.
The unit based shared governance team incorporated the concerns of the multidisciplinary team and patient survey to develop specific patient instructions for hematology/oncology. The new instructions were detailed and provided specific information on infection and bleeding precautions, mouth care, symptom management, lifestyle considerations, and medications. These written instructions are followed up with a phone call within one week of discharge to ensure understanding of instructions.
The results of our follow-up phone calls indicate that patients often refer to the discharge instructions as a reference when they have questions or concerns. The number of unnecessary phone calls to the clinic has decreased. This project has also demonstrated the benefit of a follow-up phone call for our oncology patients to ensure understanding with their discharge instructions.

155
MY STORY: A DIARY FOR PEOPLE WITH CANCER. Leah Mraz, MSN, RN, C, OCN^®, The Cancer Institute of New Jersey, New Brunswick, NJ, and Ellyn Matthews, RN, PhD, AOCN^®, University of Colorado Health Science Center, Aurora, CO.

My Story: A Diary for People With Cancer, was developed by two nurse clinicians as a way to positively affect peoples health, leading to acceptance, positive interpretation, and growth.
The purpose of the diary was to assist patients/families in tracking information about their care and communicating their needs to healthcare providers. Once diagnosed with cancer, an overwhelming volume of diagnostic information accumulates. Evidence suggests that organizing information, particularly when first diagnosed, promotes a sense of order and control at a very vulnerable period. The diary may be especially beneficial for anxious, control-seeking patients.
Development of the diary began with the formation of a committee. A literature review identified the need for a cancer patient diary. Industry benchmarking revealed that diaries on the market were not conducive to journaling and had little room to track care. In addition, many included vast amounts of education material, making it confusing if the book was to be read and written in. The diary provides an outline of important healthcare information with six main sections: (1) Personal, (2) Insurance, (3) Treatment, (4) Progress, (5) Personal Notes and Thoughts, and (6) Evaluation. The section topics were based on clinical observations. Patient/family input was sought throughout development. The loose-leaf binder format is easy to use, allowing customization to meet the needs of individual patients. Section contents may be added or deleted as needed. Funding was secured, a marketing plan was developed, and a process for distribution was implemented.
After two months, patients are asked to complete a written evaluation of the diary. Results have been favorable and modifications are being considered based on comments and suggestions of patients/families. Expected outcomes of using the diary include improved communication with the healthcare team, enhanced organization of healthcare materials, and superior efficiency in the teaching process.
Oncology nurses should consider developing such a diary, which assists with satisfaction of care and a better quality of life for individuals with cancer.

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CULTURAL DIVERSITY AND COPING WITH CANCER EDUCATION. Robin Herman, RN, MN, OCN^®, LAC/USC Medical Center, Los Angeles, CA.

Nursing organized and implemented a vital educational program together with a multidisciplinary team comprised of dietary, social service, and spiritual leaders to meet the educational needs of our patients with cancer.
The Los Angeles USC Medical Center is one of the largest cancer centers in the world and possesses one of the most culturally diverse populations. In 2002, there were 1,262 patients with newly diagnosed cancer at this facility and approximately 56 languages spoken among this population with an average reading level of sixth grade. These patients with cancer must learn to navigate this huge healthcare system while facing uncomfortable treatments, pain, side effects, and psychosocial issues. In response to these concerns, a multi-disciplinary healthcare team convened to address specific educational needs. Our purpose was to implement a program that would provide education and psychosocial support for our patients with cancer and family members utilizing the “I Can Cope” program model.
Our team chose the topics of symptom management, nutrition, pain, psychosocial issues, and spiritual issues to be presented. Each topic was developed into a one-hour program presented at a sixth grade reading level in English and Spanish in a format of lecture followed by open-forum discussion. Initially each topic was provided once per month at a central location. Specific educational materials were provided to each patient’s specific topic.
The program started in June 2001 with topics being presented in a single location. Within 12 months, patient demand was so high that two additional locations within the medical center were added and topic frequency was increased to two times per month for the nutrition, pain, and symptom management presentations. Since January 2003, these topics have been presented three times per month at three patient care locations. Symptom management is the most popular and well-attended program with the patients’ main concerns focusing around neutropenia, anemia, and fatigue. English and Spanish booklets entitled “Neutrophil: Your One-In-A-Million Bodyguard,” sponsored by Amgen were useful in enforcing course content. Because the program content targets critical patient care needs at a level the patient can understand, the program continues to expand.
We are now looking at expanding the program into other languages, specifically Korean, Chinese, Armenian, and Russian. The use of this modified program has created an excellent educational outlet for our culturally diverse patient population.

157
MEETING THE “AFTER HOURS” ACUTE CARE NEEDS OF AMBULATORY CARE ONCOLOGY PATIENTS. Leslie Smith, RN, BSN, Nebraska Medical Center, Omaha, NE.

Providing optimum after-hours services to patients with cancer with urgent problems requiring prompt attention challenges healthcare centers to address the unique needs of these individuals. Specialized oncology nurses have the critical skills necessary for triaging and providing the interventions required.
The trend of delivering oncology services outside the traditional hospital setting has resulted in increasing numbers of individuals with acute care needs during non-traditional outpatient hours of care. Consequently, many of these immune compromised patients have to seek care in emergency rooms that are overcrowded with sick and potentially contagious people. Our medical center has developed an approach to meet the unique needs of this population by providing 24-hour access to the outpatient center.
After regular clinic hours, patients are instructed to call their physician with problems that need immediate attention such as fever, pain, problems controlling nausea, and management of other symptoms. The physician informs the nurse that the patient is coming to the treatment room and provides the appropriate orders. Oncology nurses use finely tuned expert assessment skills and triage the patients. This includes determining the need to be seen by the physician, providing direct interventions, and preparing the patient for dismissal. Often, the treatment needed is administered and the patient returns home. However, if the patient requires admission, treatments can be started and the patient transferred to the hospital in a seamless manner.
Patients are taken care of in a timely and competent manner when they are treated in a specialized area such as the oncology treatment room, and often avoid hospitalization. Patients indicate they like this system because they are familiar with the nurses and surroundings. They are confident the nurses know them and work as a team with the doctors to treat their problems.
Patients get competent, specialized care at one place day or night in an ambulatory setting using the skills of oncology nurses and an organized team approach with the physicians. This model could be used by oncology nurses in other centers desiring to better meet the needs of their acutely ill oncology population.

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NURSE NAVIGATOR: A NEW ROLE FOR THE ADVANCED PRACTICE NURSE. Brandy Payne, RN, MSN, Michele Stephens, RN, MSN, APRN, BC, AOCN^®, and Norma Sheridan Leos, RN, MSN, AOCN^®, CPHQ, Curtis and Elizabeth Anderson Cancer Institute, Savannah, GA.

Multi-modality treatment for cancer has now become the standard of care for many cancer types. Although multi-modality treatment has improved survival for many diseases, it can result in more side effects. Multi-modality treatment calls for coordination of complex treatment schedules.
A seamless approach to educating the patient and communication between the multidisciplinary treatment team is essential for patients undergoing multi-modality treatment. Because of the complexity of this type of care, the nurse navigator role was devised. The nurse navigator functions as a clinician, educator, researcher, counselor, healthcare liaison, consultant, and patient advocate.
This poster will describe the creative approach used by two advanced practice nurses (APNs) to devise, implement, and evaluate the role of nurse navigator. Detail will be provided so that other organizations may implement similar roles at their institutions.
The APNs were able to erase traditional boundaries that can occur. They were able to: (1) devise a process for comprehensive education to meet the unique learning needs of patients with newly-diagnosed cancer, (2) promote a better understanding of the patient care experience, and (3) reinforce communication between the subspecialties that care for the patient undergoing multi-modality treatment.
When patients receive accurate information, they can make healthcare decisions in a more effective manner. Coordination of care by the nurse navigator leads to a shorter length of hospital stay, and the patient can become an active participant in the care planning process.

159
THE CREATION OF A NURSE PRACTITIONER ROLE AS A MEDICAL CONSULTANT IN AN ONCOLOGY SETTING. Sally Pham, MSN, RN, FNP(c), University of Texas M.D. Anderson Cancer Center, Houston, TX.

Patients who are hospitalized in an oncology setting have multiple needs and require timely medical management. At the University of Texas M.D. Anderson Cancer Center, the oncologists focus on treating the patients’ cancer and consult with internal medicine specialists to manage other medical problems such as diabetes and hypertension. As the number of consultations increased, nurse practitioners were assigned to cover inpatient to assist the oncologists in managing non-cancer-related medical issues, including uncontrolled diabetes, hypertension, and preoperative evaluation.
To study the process of consultation and identify the type of medical problems requiring primary care specialists, nurse practitioners maintained a log of consults from oncologists.
After the six-month pilot period, the internal medicine nurse practitioners and doctors evaluated the results. The three most common reasons for consultation were hypertension requiring multiple medications to control, diabetes needing insulin, and new-onset hyponatremia. Literature review revealed effective strategies in performing medical consultation. These findings were incorporated in developing the role of the nurse practitioner. In conjunction with internal medicine specialists directly involved in the consultation process, guidelines and protocols were created for nurse practitioners. Through these guidelines, nurse practitioners perform the initial patient history and physical examination, formulate the rationale for the differential diagnosis, order appropriate tests, and recommend medical plans to oncologists. Oncologists then review nurse practitioners’ recommendations and issue appropriate orders for patients. Patients requiring care outside the scope of the nurse practitioner’s practice are triaged to internal medicine specialists.
Nurse practitioners, as consultants, are considered to be a valuable asset to the healthcare team, as verbalized by physicians and patients.
The role of nurse practitioners is constantly changing to meet healthcare needs. Initially, the field of nurse practitioners was created in response to the pressing need for health care in medically underserved areas. Roles of nurse practitioners have evolved to become more specialized. At the University of Texas M.D. Anderson Cancer Center, nurse practitioners have developed into successful consultants. Consequently, we recommend the implementation of nurse practitioners as medical consultants to similar settings.

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THE ROLE OF THE CANCER SUPPORT NURSE IN AN AUSTRALIAN HOSPITAL. Tracey Mander, BN, ONC, MHA, and Elizabeth Stickland, BN, ONC, MHA, Austin Health, Melbourne.

The purpose of this paper is to describe the model of the cancer support nurse (CSN) role implemented at Austin Health, Melbourne, Victoria. There is increasing recognition by healthcare professionals of the supportive and complex needs of individuals with cancer. Nursing’s contribution in addressing these needs has been acknowledged as critical. Studies of the breast care nurse (BCN), in particular, have provided level one and two evidence that the BCN can contribute to improved patient outcomes (1, 2). Psychosocial clinical practice guidelines recommend the presence of the specialist BCN as they reduce psychological morbidity and improve wellbeing (3). Using the principles of these guidelines, this role was established to address needs of patients with newly diagnosed cancer of any type.
Prior to the CSN role, patients undergoing surgery for cancer were not able to have their support and information needs met. Staff lacked specific oncology knowledge and were unable to reassure them, or provide them with information regarding cancer support resources.
As a result of the CSN role, there have been a number of positive interventions which include the facilitating multidisciplinary communication, identifying the information and support needs of patients and their families/caretakers, breaking bad news, and educating patients, families, and nursing and medical staff.
Referrals to the CSN service are collected and reported upon yearly. There has been a steady increase in the number of referrals to the CSN service since its inception. A survey of the CSN service is in progress at present to evaluate consumer views and to provide information for future service planning.
The CSN provides a vital service in nononcology units. The role enables provision expert resources, support, and development opportunities to staff involved in the care of patients with cancer. Specific needs of patients with newly diagnosed cancer, their families, and caregivers are identified and addressed.
References: McArdle, J.M.C., George, W.D., McArdle, C.S., Smith, D.C., Moodie, A.R., Hughson, A.V.M., Murray, G.D. (1996). Psychological support for patients undergoing breast cancer surgery: A randomized study. British Medical Journal, 312(7034), 813–816.
Watson, M., Denton, S., Baum et al., (1988). Counseling breast cancer patients: A specialist nurse service. Counseling Psychology Quarterly, 1(1), 25–34.
National Health and Medical Research Council (1999). Psychosocial Clinical Practice Guidelines. Canberra: AGPS.

161
COLLABORATION BETWEEN HEAD AND NECK MULTI-CLINIC AND RADIATION-BASED NURSING PRACTICE. Robin Delaney, RN, BS, OCN^®, and Patricia Powell, AS, RN, Massachusetts General Hospital, Boston, MA.

Treatment for patients with head and neck cancers include the combined modalities of surgery, chemotherapy, and radiation. The radiation and hematology oncology nurses at the MGH cancer center have newly joined together in collaboration to provide a consistent plan of care.
The purpose was to improve communication among the nursing staff for head and neck patients. The continuity of care between surgery, chemotherapy, and radiation for these complex patients was often inadequate or inconsistent.
Nursing developed an intake assessment with further assessment by chemotherapy and radiation nursing. Working collaboratively with interventional radiology nursing and a task force, a G-tube pathway was developed. Patient education materials on the side effects and medication were developed. A weekly head and neck clinical discussion conference where all patients are presented and staff are updated on their care was ongoing. Disciplines that attend are homecare liasion, dietary, social service, speech pathology, research, and nursing staff involved in all aspects of the patient’s care along with residents and physicians. Telephone and e-mails between nursing helped resolve patient problems as they arose.
The overall care was less fragmented as the nursing staff came together in this collaborative environment. Discussions led to targeting patients most at risk for significant weight loss and resulted in an improved pathway for G-tube placement. Side effects from treatment are also managed in a timely and more efficient manner improving the quality of patient care.
Head and neck patients require extensive and early symptom management throughout the course of their disease. This requires care that encompasses the specialty of oncology nursing.

162
BIOPSYCHOSOCIAL IMPACT OF PARENTAL CANCER ON SCHOOLAGERS. Ying-hwa Su, PhD(c), MS, RN, and Nancy Ryan Wenger, PhD, RN, CPNP, Ohio State University, Columbus, OH.

Cancer is the second leading cause of death in the United States. In 1998, approximately 128,089 children had a parent diagnosed with cancer. Parental cancer may be a pervasive stressful event for children, but the impact on children is largely unrecognized. Most research on children’s adjustment to parental cancer lacks a theoretical basis and appropriate comparison groups. How children cope with parental cancer and the effectiveness of their coping strategies is unknown. Other variables that may mediate or moderate children’s responses are rarely analyzed. Differences between children’s and parents’ perceptions of this phenomenon need to be examined as well.
The purpose is to characterize the stress-coping process of children ages 7–12 who have a parent with cancer. Findings will be compared to similar measures from previous research on children who have encountered stressful events other than parental cancer.
This study is based on an integration of Lazarus’s cognitive appraisal theory of stress and coping, cognitive developmental theory, social/emotional developmental theory, and physiologic stress response theory.
Power analysis indicates that a sample of 37 children is needed for this descriptive, cross-sectional design. Children will be recruited from a university support group, an oncology clinic, and the general clinical research center. Instruments completed by parents include a demographic data form, the Child Behavior Checklist/4–18, and the Family Peer Relationship Questionnaire. Children will complete the Family Peer Relationship Questionnaire, Feel Bad Scale (concurrent stressors), Schoolagers’ Coping Strategies Inventory, Children’s Stress Symptom Scale, and a human figure drawing. Also, a morning salivary sample will be analyzed for cortisol levels. The reliability and validity of all instruments used in this study are well established.
Analysis will include descriptive statistics, Pearson’s Meta and canonical correlations to examine relationships, MANOVA for mediator and moderator analysis, and t-tests to compare groups.
Findings will increase our understanding of this pervasive stressor in some children’s lives and will help to identify healthcare outcomes that are amenable to nursing interventions.

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THE PROMOTION OF PSYCHOSOCIAL WELL-BEING IN ONCOLOGY PATIENTS THROUGH AN INTERDISCIPLINARY APPROACH. Jackie Medland, RN MS, Jane Hawksley, RN, MS, Ralph Schwab, LCSW, Elaine Miller, LCSW, Nancy Nainis, MA, LCPC, and Mara Levine, MOTR, Northwestern Memorial Hospital, Chicago, IL.

Our hematology-oncology unit needed to improve performance in the management of psychosocial and spiritual issues. Based on the findings of patient satisfaction surveys, patients felt that staff’s attention to psychosocial and spiritual issues was lacking (70th percentile, Press Ganey).
An interdisciplinary team (IDT) conducted a psychosocial environmental assessment revealing that, while staffing was adequate and psychosocial services were in place, the emotional toll on the nursing staff was high and interdisciplinary team function was suboptimal. The IDT hypothesized that providers lacked the necessary skills and resources to address the complex psychosocial and spiritual issues presented on the unit. Anecdotally, patients told us that they believed that these issues were “not the care team’s job,” given the other demands of patient care.
We planned to measure the level of distress in our population of patients with cancer using the distress thermometer, however, patients did not relate to the word “distress” without significant interpretation by the healthcare provider and responded better to inquiries about levels of “stress” (on a 1–10 scale). A treatment algorithm was designed, featuring a range of interventions such as education regarding available resources, incorporation of volunteers into the healthcare plan, professional referrals or comprehensive assessment, and care planning by a licensed clinical counselor. Scores of = 4 set the algorithm in motion. The IDT also developed a comprehensive assessment tool that evaluates the patient’s, the family’s, and the IDT’s goals for care. To improve the staff’s comfort and competency in dealing with the psychosocial aspects of care, we initiated brief lunchtime case conferences to discuss current patients with a focus on improving listening skills and increasing utilization of existing resources. At weekly interdisciplinary treatment rounds, nurses included information on patient and family levels of stress.
The staff now focuses more effectively on the psychosocial dimensions of patient care as evidenced by improvement in the patient satisfaction index related to psychosocial issues (84th percentile) and a decrease in the number of psychiatric consults.
The IDT improved the staff’s acumen at providing psychosocial care on our hematology-oncology unit through focused strategies that enhanced their ability to address these complex issues.

164
UNDERSTANDING THE FAMILY EXPERIENCE OF NEUTROPENIA: ARTISTIC EXPRESSION OF RESEARCH FINDINGS. Patricia Earle, PhD, RN, Norma Krumwiede, EdD, Sonja Meiers, PhD, Mary Bliesmer, DNSc, Sandra Eggenberger, PhD(c), and Shirley Murray, MS, LISW, Minnesota State University, Mankato, Mankato, MN.

Topic: “Hope” by Esmail Mostaghimi is a representation of the research study entitled “Understanding the Family Experience of Neutropenia.” The role of symptom management is central to oncology nursing. This artistic expression addresses the impact of chemotherapy-induced neutropenia on the family.
The purpose of the painting was to showcase the research in an innovative and meaningful way to assist with the dissemination of the study’s findings. Utilization of research findings is often minimal. The conceptualization of this project was to disseminate research findings in the form of a painting.
“Hope,” an original piece of art, is a 30” x 40” acrylic painting and is an aesthetic interpretation of data obtained from rural families experiencing neutropenia as a result of cancer therapy. The painting expresses the whole of this challenging situation and is informed by the artist and researchers who conducted a qualitative inquiry entitled “Understanding the Family Experience of Neutropenia.”
The family is together on one long couch. The storm portrayed outside represents the turbulent times caused by neutropenia. However, slivers of light continue to stream in and the storm does not destroy the family’s hope. The shattered glass in the window represents treatment interruption and the grandfather clock depicts time standing still while waiting for neutropenia to resolve. In the center of the painting, the family member with cancer is confined to a separate square on the couch, and is dressed in white symbolizing innocence and neediness. Nonspecific faces represent differing family experiences, diverse family types, and changing family roles and relationships. Various out-of-perspective features such as the twisted legs and thin, elongated arms represent pain and yearning throughout the cancer experience.
The use of an artistic display to bring the research alive is the goal of the researchers. The painting is extremely moving to nurses who have seen the image. This scholarly work is significant because it enriches the nurses’ understanding of the neutropenic experience of the family unit. Nursing approaches created from this perspective will embrace the humanity of health care, support the building of diverse relationships, and honor the family as a significant partner in care.

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ARTS IN MEDICINE: PROVIDING AN EXPRESSIVE OUTLET FOR STRESS REDUCTION. Linda Rice, RN OCN^®, and Frances Falk, MFA, MEd, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL.

In our world of oncology nursing, everybody appears busy. Patients are busy getting treated, families are busy with patients, and staff members are busy meeting their needs on the journey through each cancer experience. Some stress is managed while other stress is not.
Familiar stress management might include counseling or medication. Less familiar management for stress includes art, music, storytelling, and poetry. The focus of offering art experiences in medicine is based on the concept of process, not product. For this reason, an Arts in Medicine Program was developed at our NCI-comprehensive cancer center. Art experience in is not necessary for participation.
The focus of this abstract is to explain how introducing art into the medical surrounding can offer patients, visitors, and staff a creative outlet for expression and a channel for stress reduction.
Staff artists and volunteers coordinate the creative selections available. An art cart stocked with drawing, painting, and sculpting supplies offers art experiences to patients and visitors. The art cart is taken to different waiting areas or patient rooms when a private referral is made. An open studio is held in patient lounges or larger waiting areas where people can create together on large-scale projects such as our 22’ x 24’ labyrinth or on individual artwork. A poets’ circle, playback theatre, and storytelling is also available. Musician staff and volunteers also use their talents to ease the hospital atmosphere with music in lobbies, waiting areas, busy inpatient units, or even at the bedside. Scheduled sessions are posted in the main lobbies. Nursing activities are accompanied by stress reducing art projects designed upon request for meetings or mandatory programs such as origami and watercolor projects.
As each individual makes “art,” time stands still allowing for reduction of anxiety and worry. Meetings become less stressful and more relaxed. Communication is often enhanced. Individual responses vary but are consistently positive.
Patients, visitors, and staff have channeled stress with arts in medicine. The “art” workshops developed are not only pleasant distractions, they are creative outlets brought right to us on our busy healing journey.

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NURSES’ PERCEIVED BARRIERS TO THE PROVISION OF SPIRITUAL CARE AND THEIR COPING MECHANISM. Tan Hwee Hoon, Advanced Diploma in Oncology Nursing, Lang Siew Ping, BSN, Advanced Diploma in Oncology Nursing, and Ang Emily, MN, The Cancer Institute at National University Hospital, Singapore.

Studies have shown that more than one third (40%) of nurses expressed that providing spiritual needs to the patients and their family as being the least effective in the hematology/oncology wards (Lee, 2003). It was suggested the provision of such care was hindered by wide and different definitions of spirituality, and lack of staff, time, and resources. In achieving holistic nursing care, nurses need to overcome all the possible obstacles and have excellent knowledge and skills to provide not only physical, mental, and social care, but also spiritual care, as well, in order to improve patient quality of life.
The purposes of this study were to identify nurses’ perceived barriers in the provision of spiritual care and explore their coping mechanisms.
This qualitative, phenomenology study sample consisted of 11 registered nurses who had been working in a hematology-oncology setting for one month to 10 years. Written questionnaires were used to assess nurses’ perceived barriers in the provision of spiritual care and their coping mechanism when they faced difficulties of providing spiritual care. Verbal consent was obtained from the nurses prior to the study, and confidentiality and anonymity was assured.
The data were transcribed and subjected to content analysis, and categories were developed and described. The final themes that emerged from the study were subjected to peer reviews to ensure reliability and validity of findings.
The results suggested that the majority of the nurses listed lack of rapport with patients and not knowing how to approach patients as the most difficult reason they faced in recognizing and meeting patients’ spiritual needs, followed by differences in religious and cultural background. In coping with the difficulties experienced, the majority of the nurses coped by finding time to interact with patients in the midst of heavy workload to established rapport, and seeking help from fellow colleagues and other resources. The study concluded that there is a great need to empower nurses with adequate knowledge and skills in meeting patients’ spiritual needs despite religious and cultural differences. This will then release the nurses from the fear of offending patients as they provide spiritual care to patients in the pursuit of holistic nursing.

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RESPECTING SPIRITUAL BELIEFS: MANAGING A JEHOVAH’S WITNESS PATIENT WITHOUT BLOOD PRODUCT SUPPORT. Suzanne Carroll, RN, MS, OCN^®, AOCN^®, Wake Forest University Baptist Medical Center Comprehensive Cancer Center, Winston Salem, NC.

Research suggests there is an increased sense of spirituality among patients with cancer. Spirituality refers to the dimension of being human that motivates self-transcendence. Spirituality assists patients to make sense of their universe. Religiosity is an extension of spirituality. Religion, through rituals, observances, and sacred practices serves to represent and express ones spirituality. Oncology nurses facilitate patient spirituality.
A religious practice followed by Jehovah’s Witnesses includes the refusal of blood products. Jehovah’s Witnesses believe that all hope of eternal life will be forfeited if transfusion is accepted. Instead of transfusions, Jehovah’s Witnesses promote blood conservation and transfusion alternatives. Recently, many medicolegal and ethical issues arose when we treated a Jehovah’s Witness patient with induction chemotherapy for acute lymphocytic leukemia (ALL). The purpose of this poster is to describe this patient care experience with an emphasis on the spiritual issues encountered.
As blood counts fell to dangerously low levels, oncology nurses needed to utilize clinical interventions that were respectful and sensitive to the religious beliefs of the patient. Nursing interventions were aimed at minimizing blood loss by consolidating blood draws and using the least amount of blood; administering long acting agents such as Neulasta, Aranesp, and Neumega instead of shorter acting agents; controlling symptoms to prevent nausea/vomiting/constipation, all of which could initiate a bleeding episode and loss of blood; providing nutritional support and administering vitamin supplements; and optimizing oxygen delivery and reducing oxygen consumption. An advanced directive was reviewed and communicated among nursing and medical staff to ensure that blood products would not be administered in the event of a bleeding episode, adverse reaction, or medical emergency.
Treating this patient without the use of blood products was a departure from the norm and created some tense and anxious moments among the nursing staff. This departure, however, also allowed for some creative nursing interventions and demonstrated that patients can be treated successfully without the use of supportive blood products.
This patient care scenario exemplified the importance of recognizing and respecting patients’ spiritual beliefs and will serve as an example for other patients with unique spiritual needs.

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MULTIDISCIPLINARY CLINICAL INITIATIVES TO DECREASE THE RISK OF ETHICAL DILEMMAS. Joyce L. Neumann, RN, MS, AOCN^®, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Oncology healthcare providers are confronted by a number of clinical situations that may challenge their technical skills and intellect as well as their beliefs, values, and principles. Having a professional responsibility to advocate for patients, practitioners may have to come to terms with competing ethical principles presented by differences in resources allocation, religious beliefs, and societal mores. Oncology care is unique in that patients present with a life-threatening illness if untreated. In addition, many of the interventions for control or cure tend to be very aggressive and can greatly affect the individual’s quality of life. The uncertainty related to the treatment options and outcomes may also lead to difficulty in decision making and potential ethical dilemmas.
The purpose of this poster or presentation will be to identify clinical initiatives, which have been successful in preventing or resolving ethical dilemmas challenging the patient/family and the healthcare team. These ethical issues include level of appropriate care, informed consent, do not resuscitate orders, and discontinuation of medically inappropriate care.
Clinical initiatives that are currently being utilized include ethics rounds, informal ethics consult, advanced directives taskforce, care conferences, self-care and caregiver agreements, and creation of a compliance algorithm/pathway.
Results of a nurse survey examining the impact of ethics rounds will be presented, as well as information about institutional ethics consults. Copies of self-care and caregiver agreements and educational material about advanced directives for high-risk patients will be provided.
Incorporating relevant clinical initiatives will assist in preventing or resolving potential ethical issues.

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CREATION, IMPLEMENTATION, AND EVALUATION OF AN ESOPHAGECTOMY SUPPORT GROUP: PROVIDING CONTINUITY OF CARE IN THE OUTPATIENT SETTING. Donna Edmondson, RN, C, BSN, OCN^®, Diane Tunney RN, OCN^®, and Linda Schiech, RN, MSN, AOCN^®, Fox Chase Cancer Center, Philadelphia, PA.

Patients with a diagnosis of esophageal cancer are faced with many life-altering adjustments. Oncology nursing research supports a positive correlation between participation in cancer support groups and patient outcomes. Support groups help to alleviate feelings of isolation, fear, and depression as members of the group share common problems and learn to overcome them together.
An assessment determined that only one support group existed in the tri-state area of the northeast for this patient population. With an average of thirty esophagectomies performed annually at this comprehensive cancer center, the interdisciplinary team felt it was imperative to design a support group model for these vulnerable patients. Oncology nurses were in a pivotal role to promote holistic care by advocating for the development of this program. Collaboration with a case manager, social worker, clinical nurse specialist, thoracic surgeon, and patients was critical to successful implementation.
The surgeons encourage support group participation during initial patient encounters pre-surgery. Early group involvement has the potential to decrease pre-treatment anxiety by offering support and an enhanced knowledge base of disease and treatment. Patients often feel at ease when they meet someone who has a similar experience. The objective of the group is to offer patient and family support throughout the treatment continuum. Informational discussions on disease process and treatment regimens promote coping strategies for commonly shared symptoms (swallowing difficulty, reflux, weight loss/gain, depression) and provide an open forum for exchange of feelings and concerns. A convenient meeting place and time was located and occasional speakers are coordinated. A social worker and registered nurse facilitate the group.
An individual patient questionnaire is being developed and will be sent to the members biannually to evaluate the effectiveness of the program. To date, patient feedback has been overwhelmingly positive.
A support group offers, to many, the courage to continue their treatment. Patients learn not only to survive, but also to live each day to the fullest as they travel the road to recovery in unity.

170
NATIONAL CONSENSUS PROJECT FOR QUALITY PALLIATIVE CARE—PALLIATIVE CARE STANDARDS. Constance Dahlin, APRN, BC, PCM, Massachusetts General Hospital, Boston, MA.

Each year 555,500 people die of cancer.
1. According to the Institute of Medicine (IOM) Improving Palliative Care for Cancer, most patients with cancer will die from the disease and will have poor quality of life.
2. Nurses can affect the dying process with good standards of palliative care. In 1975, only about 1,000 Americans received hospice care, but in 2001, this increased to 775,000 people. Only 20% of all terminally ill patients die with hospice. The report, Means to a Better End: A Report on Dying in America Today, revealed that many Americans don’t have access to good end-of-life care, let alone, hospice care.
3. Research conducted during the past decade has shown that Americans with serious advanced illnesses want to be free from pain and other burdensome symptoms, maintain a sense of control, have their dignity respected, avoid being a burden to their families, and not experience futile care.
The Institute of Medicine called for “best practices to dictate the standard of care.” To remedy this situation and improve delivery of palliative care in the United States, Voluntary Consensus Standards for Palliative Care were developed by the National Consensus Project for Quality Palliative Care (NCP) and will be released in January 2004. The NCP was formed in December 2001 by a group of peer-nominated leaders in end-of-life care who met in New York in response to a call to develop nationally accepted definitions of the essential elements and best practices of palliative care.
These standards describe the scope and characteristics of both specialist and primary palliative practice settings, with the hoped outcome of formal recognition, stable reimbursement structure, and accreditation initiatives by JCAHO. This poster will review the seven domains of care and their application to oncology nurses in any setting.
The guiding principles of the standards are access to care and quality improvement, relief of suffering, comprehensive assessment, patient- and family-centered care, comprehensive interdisciplinary holistic care, and strong communication skills. As many patients will need such care, the oncology nurse plays a critical role in identifying appropriate patients for palliative care and participating in the provision of care. These standards will help oncology nurses deliver care across the cancer continuum.

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USE OF ALGORITHMS IN PALLIATIVE CARE. Karen Overmeyer, MS, APRN, BC, Jill Laird, MN, APRN, and Patrick Coyne, MSN, APRN, BC, Virginia Commonwealth University Health System, Richmond, VA.

The Thomas Palliative Care Unit is an 11-bed inpatient unit dedicated to the management of patients with symptomatology related to disease progression and end-of-life care. The unit opened in May 2000 with a nursing staff from a wide variety of specialized backgrounds. Algorithms for symptom management were developed to meet the following goals: (1) To provide the grounds for consistency in clinical assessment and treatment for a diverse staff from very different backgrounds, (2) To increase the autonomy of the palliative care nurses to initiate appropriate intervention any time during a 24-hour period, (3) To decrease the amount of time between symptom development and the start of active treatment, and (4) To utilize the most effective treatments based on research and/or review of the current literature.
The physicians and nursing staff chose symptom management algorithms versus standing orders because algorithms visually depict systematic evaluations aimed at identifying patients who stand to benefit (or not benefit) from a particular range of management strategies. Algorithms are “decision trees” consisting of boxes containing questions, counseling, testing and treatment suggestions, and decision options. Validity for the counseling and decision boxes is based on data from systematic literature reviews. Annotated text with literature citations accompanies the symptom management recommendations where feasible. The algorithms were developed by interdisciplinary team collaboration. This process involved identifying the most common symptoms of advancing disease and end of life according to palliative care literature. Twenty-two symptoms became algorithm constructs. Each provides for clinical flexibility allowing for evaluation of effectiveness at different levels.
Using evidence-based clinical algorithms in palliative care has proven to be a valuable method for initiating proactive interventions to alleviate and control symptoms that adversely affect patient quality of life. These decision trees have led to improved consistency in treatment of symptoms and the opportunity for continuing outcomes evaluation and research. Additionally, algorithms also appear to offer cost savings.
Future studies include a cost-benefit analysis and further clinical research to address the dearth of literature for selected symptom algorithms and the problems of incomplete databases.

172
THE KEYS TO CREATIVE CARING. Melissa Lehan Mackin, RN, BSN, OCN^®, Sharon Baumler, RN, MSN, CORLN, Barb Bezoni, RN, BSN, and Dawn Keiffer, RN, BSN, University of Iowa Hospitals and Clinics, Iowa City, IA.

Nursing in the inpatient acute care setting is plagued by staffing shortages and the race to match increasing physiological needs with technical skills. Despite these challenges, the nurses on an inpatient cancer unit in the Holden Comprehensive Cancer Center at the University of Iowa have infused creativity in their approach to continue and preserve holistic care.
The first key in promoting this creative care is to identify the need to connect with the patients and their families. This connection is crucial to becoming aware of needs beyond the physical realm. Reducing fear and anxiety and advocating quality to life needs to be an important part of the care plan. Another key is knowledge of the pool of resources and how to draw upon this wealth.
One example of creative caring involved taking a patient, who had been hospitalized for several months, to a football game to see his daughter in the marching band. This effort required the support of multiple disciplines to provide the care he needed during this outing. Another example included the planning and support of a birthday party for a patient with her twin brother at the end of life. For another, it was as simple as one staff member bringing in an actual mini-snowman for a patient who was restricted indoors for months due to his prolonged illness.
The results of these efforts have increased overall patient satisfaction and largely affected staff satisfaction. Utilizing special talents and skills allow staff to find internal rewards for the work they do.
Creating a work environment that encourages and supports creative caring allows staff to contribute holistically to patient care, allows the use of talents not otherwise employed in the physiological need driven model of care delivery, and has the ultimate outcome of increased satisfaction for all involved.

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STAFF SATISFACTION AND RETENTION IN THE PALLIATIVE CARE SETTING. Jill Laird, MN, APRN, Patrick Coyne, MSN, APRN, BC, and Karen Overmeyer, MS, APRN, BC, Virginia Commonwealth University Health System, Richmond, VA.

In the current healthcare environment, the retention of RN staff is paramount to the fiscal survival of a unit, department, or institution. Job dissatisfaction leads to turnover, which is expensive. Staff satisfaction and retention is critical.
The literature reports that RNs leave nursing because of staffing issues, patient acuity, physical and emotional stress, perceptions of little respect, lack of autonomy, and lack of support. In contrast, RNs report increased job satisfaction when they are able to make a difference, have professional autonomy, feel a sense of community, and receive recognition for their work. Creative scheduling, part-time options, continuing education, and providing continuity of care are also valued.
At the Thomas Palliative Care Unit, we support nursing with (1) close-knit, supportive staff, (2) autonomy in practice with algorithms for symptoms management, (3) collaborative relationship with attending physicians, (4) annual retreats for planning, review, and team-building, (5) self-scheduling with four-, eight-, and 12-hour shift options, (6) hourly, part-time, and full-time employment opportunities, (7) continuity of care, (8) a unit manager who shares in direct patient care activities, (9) interdisciplinary support staff, (10) career advancement, (11) national certification, and (12) continuing education.
The Thomas Palliative Care Unit is an 11-bed inpatient unit at Virginia Commonwealth University Health System, which opened in May 2000. The unit is dedicated to the management of patients with symptomatology related to disease progression and end of life care. There are currently 12 RNs filling 9.8 FTEs. The last RN hired began 18 months ago. Ten RNs from VCUHS are on a waiting list to work on the palliative care unit.
Providing palliative care for symptom management related to disease progression at the end of life is the right thing to do. We have demonstrated that a palliative care unit can offer high staff satisfaction and low turnover. The unit, department, and institution benefit from a reduction in costs for training, education, and recruitment of RN staff.

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CUMULATIVE GRIEF: A PROGRAM TO RECOGNIZE AND SUPPORT STAFF RESPONSES TO PATIENTS’ DEATHS. Elizabeth Johnson, MSN, AOCN^®, RN, Esther O. Dette, AD, RN, Carol Ghiloni, MSN, RN, Michael McElhinny, MD, and Lisa Sohl, MSN, OCN^®, RN, Massachusetts General Hospital, Boston, MA.

A significant part of the oncology nursing experience is the close relationship that develops between staff and patients. When a patient dies, loss of that relationship can be as poignant for the staff as it is for family. A bereavement program dedicated to staff promotes healthy resolutions to their grieving for patients.
To promote healthy grieving among nurses and professional care providers, a program for staff bereavement was implemented on the acute care inpatient oncology/bone marrow transplant unit of a major teaching hospital.
The major components of the program are

• Annual service for multidisciplinary staff from the inpatient oncology unit to celebrate the memory of deceased patients for whom they cared during the previous year. A highlight of the service is a time for spontaneous sharing by staff from all levels and all disciplines.
• Monthly bereavement rounds led by the oncology chaplain to discuss anticipated as well as actual deaths.
• Enrollment of selected staff in the hospital’s clinical pastoral education program, an intensive 170-hour interdisciplinary course conducted over five months focused on spirituality in patient care delivery.
• Spontaneous group debriefings led by senior staff, the oncology chaplain, and a representative from the employee assistance program when a death provokes particularly intense feelings.
• Opportunities for staff to consult one-on-one with the oncology chaplain or the unit-based psychiatric clinical nurse specialist regarding a patient death.

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TEACHING END-OF-LIFE NURSING CARE TO UNDERGRADUATE STUDENTS. Patricia Rushton, RN, BSN, MSN, PhD, AOCN^®, ANP, Brigham Young University College of Nursing, Provo, UT.

Nurses care for individuals and families from birth until death. Birth is a joyous time. Nurses are glad to care for the newborn and its family. When it’s time to leave life, nurses can be uncomfortable providing appropriate care for the dying patient and their family. The discomfort is due to poor knowledge about the death process and methods of care to alleviate suffering during the dying period. This knowledge has expanded recently. Because nurses are frequently the healthcare providers present with spouses, parents, friends, neighbors, and church members dealing with those who are dying, learning to do it well is important.
The purpose of an end-of-life course is to educate nursing students in principles and practice of providing care to the terminally ill, the involved family, and significant others. The course is based on Ferrell’s theoretical framework, which discusses the physical, psychological, social, and spiritual dimensions of quality of life. The framework includes patients, family caregivers, and nurses and spans the continuum of life.
The course’s goals are to help students understand and apply principles of end-of-life care and demonstrate the ability to teach individuals, families, and significant others to assist them in successfully coping with end-of-life experiences. The interventions used include weekly lectures from the End-Of-Life Nursing Education Consortium Training Program. Nursing, popular literature, and movies are used to help students see the application of principles of end-of-life care. Students spend time each week in inpatient and outpatient clinical situations working with nurses who provide end-of-life care.
Achievement of course goals are evaluated on written student work completed on home visits to dying patients or their families, class presentations on movies demonstrating end-of-life situations, and on case studies requiring that the student apply principles of end-of-life care. Student course evaluations demonstrate students felt they learned the principles of end-of-life care and are able and desire to apply them in their clinical practice.
Preparing students to provide better care to the terminally ill will produce graduate nurses better prepared to render care to the terminally ill.

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END-OF-LIFE CARE PROGRAM: SUPPORT FOR PATIENTS, FAMILIES, AND CAREGIVERS. Frank Brown, RN, BSN, OCN^®, and Beth Lenegan, PhD, Roswell Park Cancer Institute, Buffalo, NY.

Providing end-of-life care presents a great challenge to many oncology nurses. Health- care professionals must cope with, and help the patient/family unit cope with many complex situations when dealing with serious illness, dying, loss, and bereavement. Caregivers may feel overwhelmed or inadequate to provide the supportive measures, counseling, or to anticipate other less obvious needs.
During the past few years, a great emphasis and accompanying training has been placed on physical pain and symptom management. While psychological and spiritual care needs are often noted, the practitioner is rarely provided with adequate skills to address these needs; and even if the skills are inherent, time to employ them is still an issue.
At Roswell Park Cancer Institute, a multidisciplinary team was assembled to review current practice and the needs of patients and their families. Families who had experienced loss of loved ones at the institute were surveyed following the semi-annual remembrance service to identify what could have been done better during their experience.
The poster will demonstrate the End-of-Life Taskforce’s approach to a process that is begun at the time of terminal diagnosis, accelerates as death becomes imminent, and continues for families after the patient dies. Included in the process are scheduled guest lectures, prepared educational materials, staff debriefings, bereavement support groups, and community education for volunteers. The process seeks to aid staff by supplying resources for patient/family interaction, supporting the staff during particularly emotional periods, and providing other professionals to complement the nursing staff.
This new program has successfully increased satisfaction scores and, again this year, is nominated for the Circle of Life award. The institute provides patients, families, staff, and the community with a model program that is comprehensive and progressive as it meets the many needs experienced during the end of life.

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END-OF-LIFE PREPARATION: EDUCATION OF PATIENTS AND FAMILIES. Jane Caplinger, RN, BSN, MSA, OCN^®, William Beaumont Hospital, Royal Oak, MI.

Nurses play a significant role in providing support and education to dying oncology patients and their families.
Death still occurs mostly in hospitals. According to the National Center for Health Statistics, there were 2,417,798 deaths in the United States in 2001. Of those deaths, 553,251 were from cancer. According to hospitals statistics, 31% of all deaths in our institution occur on the oncology unit. Oncology nursing staff identified that patients and their families had a knowledge deficit regarding end-of-life care. They usually had similar questions and concerns about death, families wanted to participate in their loved one’s care, but didn’t know how, and they had difficulty remembering what they were told verbally. The purpose of this pamphlet was to reinforce verbal education, provide support, and educate the patient and families about the signs and symptoms of approaching death, offer suggestions on what families can do to help the patients, give guidance on what to say, and answer commonly asked questions.
There was no comprehensive, readable patient/family education material available at our institution to meet this need. A pamphlet on end-of-life care was created by an interdisciplinary team comprised of physicians, nurses, social workers, and pastoral care staff.
This pamphlet will be used by nurses to teach oncology patients and their families following the discussion of a patient’s terminal diagnosis. A comparison study will be done to evaluate the effectiveness of the teaching tool. A test will be administered to the experimental group before and after verbal instruction and the pamphlet use. The control group will be tested before and after verbal instruction only.
When patient care focus changes from cure to comfort, the patients and their families need education on end-of-life care. This pamphlet will be used by nurses to teach end-of-life care to oncology patients and their families following the discussion of a patient’s terminal diagnosis.

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BEREAVED FAMILY CAREGIVERS’ DESCRIPTIONS OF SLEEP CHANGES DURING AND AFTER CARE GIVING. Corinne Grimes, PhD, RN, Patricia Carter, PhD, RN, CNS, and Martita Lopez, PhD, The University of Texas at Austin, Austin, TX.

The findings from this project will support a funding application to be submitted to the National Institutes of Health to conduct a longitudinal study of sleep pattern changes in bereaved family caregivers and to explore the impact these sleep patterns have on caregiver emotional and physiological health over time. Family caregivers rely on their oncology nurses even after the death of their family member. This study may provide insight into the affect sleep has on the caregiver’s bereavement process that oncology nurses can use in their practice.
Family caregivers of persons with terminal illnesses experience severe levels of stress while providing care and after the death of the patient. Research has shown caregivers’ sleep quality diminishes greatly as a result of providing care to a terminally ill family member. Additionally, research with bereaved caregivers has shown that caregivers continue to experience varying levels of stress that can affect their lives for up to two years after the death of the patient. What is not known is how bereaved caregivers’ sleep is affected and how changes in sleep quality affect the caregiver’s experiences during the first year after the death of the patient. This project proposed to explore sleep changes in bereaved caregivers from the caregiver’s point of view.
A phenomenological frame of reference was used for this study.
This project proposed to explore sleep changes in bereaved caregivers from the caregiver’s point-of-view. Caregiver’s sleep is measured objectively with the Pittsburgh Sleep Quality Index. Additionally, caregivers were asked to provide narrative descriptions of how their sleep patterns changed during and after care giving, and how these changes may have affected their quality of life, daily functioning, physiological health, and bereavement process.
Content analysis will be used to explore caregiver narratives for themes that describe their experiences during and after care giving. Descriptive statistics will be used to explore quantitative sleep (PSQI) and depression (CESD) measures. A comparison of quantitative and qualitative self-reports will be conducted for sleep and depression measures.
This project is in process. Anticipated findings will support further research to describe bereaved caregiver sleep and depression patterns over time and how the caregiver sleep quality may affect physical and emotional health as well as movement through the bereavement process.

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UNLICENSED ASSISTIVE PERSONNEL: MEETING PATIENT CARE NEEDS AND INCREASING PATIENT SATISFACTION IN AN ERA OF BUDGET CUTS. Tricia Cox, MS, RN, ANP-BC, OCN^®, and Patrice Steininger, RN, OCN^®, John Randolph Medical Center, Hopewell, VA.

Delivering quality health care to oncology patients in an environment of budget cuts and increased patient loads can be daunting. Reductions in staffing can negatively affect patient satisfaction and decrease employee morale.
To describe a creative approach for meeting patient care needs, improving staff productivity, and increasing patient satisfaction on an inpatient oncology unit using unlicensed assistive personnel (UAP).
A task force, consisting of the nurse manager, director of nursing, RNs, and UAPs, was formed to review staffing needs, assess patient care issues, and plan ways to promote patient and staff satisfaction. The task force reviewed nursing and non-nursing tasks, modified training methods, created competency validation tools, and developed a tiered system for UAPs with pay increases for increased responsibilities. Next, a staff retreat was held to introduce the program and foster the team building necessary to implement the changes. New roles and tasks were introduced and RNs and UAPs provided input with regard to the program and competency requirements. Retreat participants decided to introduce one task at a time (e.g., indwelling urinary catheter removal) to UAPs. An RN would supervise and evaluate each competency before moving to the next. Educational materials were developed using the Oncology Nursing Society position paper for the use of assistive personnel. Classes were held and skills stations provided hands-on training. Daily appraisals by staff helped monitor the progress of the initiative and allowed prompt adjustments.
UAPs reported increased job satisfaction, RNs reported increased satisfaction with UAP performance, and patient satisfaction improved as measured by the Gallup survey. RNs and UAPs working together to implement the new program fostered teamwork. RN supervision of UAP training helped build trust and foster positive working relationships. Discussions between RNs and UAPs promoted communication and facilitated successful program changes. As a result, UAPs reported increased job satisfaction, RNs reported increased satisfaction with UAP performance, and patient satisfaction improved as measured by the Gallup survey. This program suggests that UAPs can positively affect patient satisfaction, enjoy increased job satisfaction, and improve job performance if provided with proper training, supervision, and evaluation.

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DEVELOPMENT AND IMPLEMENTATION OF AN ONCOLOGY NURSE RECOGNITION DAY AT A LARGE COMPREHENSIVE CANCER CENTER. Sherry Emigh, RN, BSN, OCN^®, Amy Barnett, RN, BSN, Mary Scherbring, MS, RN, OCN^®, Donna Schumacher, MS, RN, Shelley Reidt, RN, BSN, and Kari Anderson, RN, BSN, OCN^®, Mayo Clinic, Rochester, MN.

Recent focus on recruitment and retention of qualified nurses and the intense demands placed on oncology nurses highlight the need to provide recognition for their efforts. Additionally, providing patient care at a large comprehensive cancer center requires a multitude of integrated departments connected in purpose, but commonly separated by distance.
The nursing education committee of the hospital hematology, oncology, and blood and marrow transplant units consists of four representative inpatient nurses from the various specialties, two nurse educators, and one nurse manager. The committee oversees education to orientees and experienced nurses.
Recognizing the effort required to prepare oncology nurses and the importance of retaining them, in 2001, the committee initiated an annual recognition event coinciding with national Oncology Nursing Day. This one-day celebration was initiated to demonstrate appreciation for the physical and emotional challenges involved in caring for this population and to promote collegiality among staff. The event was replicated in 2002 and 2003 as it aligned with institutional initiatives related to staff satisfaction and retention.
Over the past three years the day’s events have included refreshments, door prizes, and awards in an environment conducive to professional interaction. Poster displays highlight the accomplishments of OCN^® and AOCN^® certifications, educational presentation, publication, and years of oncology experience of each individual nurse. In 2001 and 2002, a certificate of appreciation was developed and awarded to nurses working within the specialty. In 2003, the annual Oncology Nursing Society’s logo was developed into a magnet and provided to each attendee. This event was made possible through a modest budget and the support of nurse managers and leadership.
While this event began as a recognition day for nurses, it has evolved to include other members of the healthcare team throughout the cancer care continuum. In addition, professionals from outpatient oncology, radiation oncology, and the cancer center administrative offices were able to network with inpatient nurses. The committee took great satisfaction in observing the increasing participation in this recognition event.
Positive feedback, a high attendance rate, and minimal resource utilization have combined to establish this as an annual event.

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CANCER CARE CUE CARDS: AN EDUCATIONAL TOOL IN ONCOLOGY FOR NEW NURSING STAFF AND NURSING GRADUATES. Diana Hinton, RN, BSN, OCN^®, Boulder Community Hospital, Boulder, CO.

Oncology is a challenging and rewarding field of nursing. It requires excellent critical thinking skills, care, compassion, and specialized knowledge in oncology. Nurses entering this field often feel overwhelmed with the amount of information they need to give safe, skillful, and competent patient care. In a time when there is a critical nursing shortage, it is imperative that the older generation of nurses assist new graduates in making the transition from school to practice as comfortable and pleasant as possible. It is also desirable that nurses entering the field of oncology nursing will wish to continue in the care of oncology patients.
As a group, the nursing staff on the cancer care center has contributed their knowledge, expertise, and research in developing cancer care cards (also known as CCCues). Their willingness to participate in this project demonstrated their leadership.
The purpose of these cards is to provide a “quick look” at the major areas of oncology nursing so that new staff can have a brief, but comprehensive overview of their patients’ needs. Five main areas were identified and each card is color coded according to topic. Blue cards identify a type of cancer with signs and symptoms, sites of metastasis, complications, and nursing and medical interventions; red cards discuss oncologic emergencies; yellow cards address symptom management; and purple cards address the post-op care of oncological surgeries. Miscellaneous topics such as the administration of certain medications (amphotericin) and blood transfusions are on orange cards. Each card has the information in a short precise manner that is easy to read and understand.
In order to obtain the information in a consistent manner, data collection forms were available to the staff. However, each card is unique to the nurse who developed it. The LPNs and patient care associates have also developed cards pertinent to their practice.
Verbal feedback regarding CCCues has been very positive—that they are indeed helpful, educational tools not only for new staff, but also for existing staff who use them for a quick review. Occasionally, when our unit is full and our patients are admitted to other units, we send a CCCue card to the other unit to assist them in caring for the patient.
The implications for oncology nursing are identified. The suggestions for using this information are included.

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INCORPORATION OF CLINICAL TRIALS INTO NURSING ORIENTATION AND CONTINUING EDUCATION. Tracy Douglas, RN, BSN, OCN^®, Kathy Elza Brown, Amy Goodrich, CRNP, and JoAnn Finley, RN, MS, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.

Clinical trials education is imperative to our goal of better cancer treatment for patients at this NCI-designated comprehensive cancer center. The mission of our cancer center is, “to decrease the mortality and morbidity from cancer; to excel in cutting edge basic, clinical, and translational research; to provide the full range of highest quality, affordable, preventative, diagnostic, and therapeutic services; to be a leader in education; and to demonstrate respect and to provide support for faculty and staff while fulfilling the center’s mission.”
In order to excel at our mission of doing cutting edge basic, clinical, and translational research, staff nurses must be proficient in the administration of therapies for clinical trials, education of patients about clinical trials, and participation in patient recruitment.
During orientation lectures for new staff, we discuss our mission and what the nurse’s role is in contributing to the goals of the mission. Terms such as clinical trials and translational research are defined, as well as how the clinical areas are connected with the cancer research areas. Clinical trials that are being done at our institution are included in each class about specific diseases. As well as having clinical trial content in each class, a research nurse presents information specific to clinical trials. At this institution, every clinical trial has assigned to it a specific research nurse. One of the duties of this nurse is to educate the nursing staff directly caring for the patients on the clinical trial. Clinical trials are so integral to the mission of our center that we will be launching a clinical trials week. The agenda for this week will include “Ask the Expert Sessions,” presentations on different clinical trials, instruction on methods to increase recruitment, and content on the protection of the rights of human subjects.
This educational program is evaluated by assessing changes in the total number of patients on clinical trials each year, and by class evaluations. Staff nurses are essential members of the clinical research team. Their education and support enhances patient outcomes, research outcomes, and this cancer center’s mission.

183
HIGH DOSE RATE BREAST BRACHYTHERAPY: BRIDGING GAPS IN STAFF DEVELOPMENT AND PATIENT EDUCATION. Stephanie Gilbertson White, MS, RN, School of Nursing, University of Wisconsin, Madison, WI, and Julie Griffie, RN, MSN, CS, AOCN^®, and Dawn Radsek, MA, Froedtert Hospital, Milwaukee, WI.

High dose rate (HDR) breast brachytherapy is becoming an increasingly common way for women with breast cancer who are undergoing breast conservation surgery to receive radiation therapy. However, the treatment protocol is quite different than traditional external beam radiation. For nurses working in oncology clinics and on surgical units that treat these women, it is important to have a strong knowledge base about HDR breast brachytherapy, including both the theory and the physical care appropriate for these patients.
The purpose of this poster is to present a staff education project that was implemented at a major mid-western hospital developed to meet the staff’s learning needs.
Materials were prepared consisting of current educational information about HDR breast brachytherapy, including information about the theory of the treatment, patient eligibility criteria, a protocol for postoperative nursing care, and standardized patient education materials. This poster was presented to all nursing staff during a two-week staff education fair. Nursing staff from the oncology clinic and the inpatient surgical units will be alerted that this poster is particularly relevant for their practice setting. Following the fair, the poster was displayed on two of the surgical units for two weeks. At the end of two weeks, staff (N = 90) from those units were asked to complete surveys assessing their knowledge and satisfaction.
Survey results will be analyzed to show if knowledge was increased by the content and if the poster and patient education materials were considered useful in their practice.
Research was demonstrated that HDR breast brachytherapy is a highly effective form of radiation for the treatment of breast cancer for certain women. Nurses in practice settings that care for women with breast cancer need to keep up to date on the latest standards in order to provide optimal care. Continuous staff development efforts, including follow-up evaluations, are needed to ensure that practicing nurses are indeed delivering optimal patient care.

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ASSESSMENT OF THE ELDERLY CANCER PATIENT: OPTIMIZING TREATMENT OPTIONS. Anne Anselmo Murphy, MSN, RN, APRN, BC, The Cancer Institute of New Jersey, New Brunswick, NJ.

Nurses are in the unique position of being in the forefront in providing direct care to patients. And, advanced practice nurses (APNs) develop the medical plan of care with their collaborators. With the recent development of the NCCN guidelines in the assessment of older patients with cancer, nurses can incorporate these guidelines into their practice and greatly effect cancer care for the elderly. At the Cancer Institute of New Jersey, an NCI-designated cancer center, a multidisciplinary group developed a plan to disseminate this information. We were awarded the grant we wrote for a professional education outreach program.
The purpose of the educational program is to make nurses aware of the NCCN guidelines and assist them in adopting these guidelines into their practice. The literature reveals that a great number of elderly patients with cancer are under treated or are not referred to oncology specialists because of age bias. The health status of elderly patients can be highly variable. The key to identifying age appropriate treatment is performing a comprehensive geriatric assessment. The NCCN recently suggested guidelines in the assessment of the older patient with cancer and includes a management decision algorithm.
The Cancer Institute of New Jersey is planning a full-day educational program to address the training of oncology nurses and social workers in assessing the elderly patient with cancer. Content will include the NCCN guidelines, including the management treatment algorithm with emphasis on special considerations in treating the elderly patient with cancer and will incorporate multicultural sensitivity into the geriatric assessment. A model of effective organizational change is part of the training.
We will evaluate knowledge of the program content through pre- post-testing. The post-test will be incorporated into the program through a progressive case review with a multidisciplinary panel. Contact with participants will be maintained via a listserv to support their implementation of change. In addition, six-month follow-up of the program participants will identify institutional barriers to adoption of the training material.
The issue of managing cancer treatment in the elderly is a progressive common problem. There is little evidence-based or clinically-based consensus on the treatment of the older person with cancer. Adopting the NCCN guidelines into nursing practice will provide a basis for the integration of geriatric tools in the multidimensional evaluation and treatment of older patients with cancer. Research questions will undoubtedly arise as these guidelines are consistently used for initial and follow-up patient assessments.

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IMPROVING ONCOLOGY NURSES’ KNOWLEDGE OF PATIENTS UNDERGOING THORACIC SURGERY FOR LUNG CANCER: DEVELOPING A SELF-LEARNING MANUAL FOR INPATIENT ONCOLOGY NURSING STAFF. Nancy Steward, MSN, RN, CRNI, and Darcy Burbage, RN, MSN, AOCN^®, Christiana Care Health System, Newark, DE.

Currently, a shift in the paradigm of cancer care at Christiana Care Health System will require that lung cancer patients who need further surgery will be cared for on a traditionally all-medical oncology unit. In an effort to maintain quality care to these patients, the lung cancer care coordinator identified a need to educate inpatient oncology nursing staff on the care of patients undergoing thoracic surgery.
In collaboration with members of the thoracic multidisciplinary team and the inpatient oncology unit, a self-learning manual was developed to prepare the nursing staff to properly care for these patients. The components of the manual include an anatomy review, indications for thoracic surgery, a brief review of lung cancer diagnostic and staging, nursing assessment, documentation standards, and clinical practice guidelines for chest tubes and post-op thoracotomy care.
A pilot study was conducted to evaluate the content, readability, and the average time taken to complete the study. Based on pilot study results, the manual was updated to include discharge instructions and thoracic guidelines. Staff inservices will be conducted to review the material and provide an opportunity for the inpatient staff to get to know the members of the thoracic team.
Continuing education units were applied for, and each staff member will receive their own copy of the manual that can serve as a resource guide. A post-test will be given with a score of 100% prior to awarding contact hours. As the program continues to evolve, staff will be surveyed and educational programs will be developed and implemented.
An estimated 171,900 people in the United States will be diagnosed with lung cancer in 2003. The thoracic multidisciplinary team, consisting of medical oncology, surgeons, pulmonologists, physical therapists, nurses, and researchers has seen an upward trend in the number of persons with abnormal chest masses and symptoms suspicious for a malignancy. Most of these patients will be subsequently diagnosed with lung cancer and will need further surgery. Information acquired from the self-learning manual will be applied to thoracic surgery patients throughout the continuum.

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AMBULATORY PUMP PROBLEMS—METHODOLOGY TO ADDRESS EDUCATIONAL ISSUES. Kathleen Shuey, MS, RN, AOCN^®, APRN, BC, U.S. Oncology, Houston, TX; Dori Greene, MS, RN, AOCN^®, U.S. Oncology, Raleigh, NC; Dianne Richardson, RN, OCN^®, U.S. Oncology, Houston, TX; and Mary Goggin, RN, OCN^®, Texas Oncology Cancer and Research Center—Waco, Waco, TX.

In the outpatient clinic setting, a wide variety of ambulatory pumps may be employed to administer therapy. Nursing staff must be experienced in the management of all equipment utilized in the setting.
Due to the uniqueness of the treatment setting, resources common in the hospital (advanced practice nurses, educators) are available in many clinics on a more limited basis. All sites within our network have experienced clinical leadership and staff who manage a multitude of clinical-, equipment-, and administrative-related issues. Companies that manufacture ambulatory pumps provide educational materials related to their products. These tools are comprehensive and cover all actual and potential problems that can occur. The tools can also provide the basis for procedures specific to individual products. In addition to tools provided by the company, a reference sheet and competency checklist would provide additional resources to clinical staff.
Each ambulatory pump utilized by clinic staff will have a one-page quick reference sheet, which will contain key information for use of the pump. Additionally, a competency check off list will be available on the individual pumps. To facilitate documentation in the medical record, a verification order sheet will be developed. Information to be included on the sheet includes specifics of programming and information on the chemotherapy agents being infused.
To evaluate implementation of clinical tools related to ambulatory pumps, the quality of care subcommittee will review affect on variance reporting.
Upon hire, nursing staff within our network must demonstrate competency in chemotherapy administration and management of central lines. This is managed through the use of self-study and competency tools. Additionally, annual competency in chemotherapy is documented. Because of the wide variety of ambulatory pumps available, an additional competency related to ambulatory pumps will be provided for clinical staff.

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INCREASING STAFF AWARENESS OF ADVANCE DIRECTIVES ON AN INPATIENT ONCOLOGY UNIT. Deborah Mast, RN, BSN, OCN^®, Northwestern Memorial Hospital, Chicago, IL.

Medical, legal, bioethical, and consumer advocacy communities agree that supporting patients in the preparation of written advance directives for health care serves the best interests of the patient and can prevent needless patient and family suffering. Ideally, the discernment of patients’ and families’ goals and preferences regarding treatment is a continuous process involving the patient and the patient’s family, as well as the physicians and nurses engaged in their care.
Although providers may follow patients in the inpatient, outpatient, and home settings, and come to know them well, discussions about advance directives do not necessarily occur because discomfort with the subject of advance directives often precludes these important conversations. Patients may incorrectly assume that the oncology team “knows what I want done,” while providers may lack the confidence and knowledge necessary to facilitate these discussions. But with honest communication and shared decision making, where the clinical judgment of care providers is married with the wisdom and values of the patient and family, advance directives can assure that the individual’s goals for treatment and palliative care will be met.
In order to improve staff performance in this area, we conducted a survey of staff nurses on our inpatient oncology unit to assess their knowledge of advance directives. In addition, 30 inpatient charts were checked for the presence of an advance directive form and any notes from the healthcare team referencing an advance directive discussion.
Fifty percent of staff nurses completed the survey (N = 30), 75% of respondents indicated that they did not have the information they needed to discuss advance directives with patients, and 45% of respondents reported that they did not feel comfortable talking about advance directives. Fifteen of the charts reviewed (50%) did not have an advance directive, three charts contained notes alluding to a discussion of advance directives by attendings, three charts included a similar note by house staff, and one chart contained a nursing note regarding advance directives.
In an effort to address identified learning needs, strategies to increase the level of awareness and knowledge of advance directives among staff nurses included education and poster presentations.

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DEVELOPING THE ROLE OF THE ONCOLOGY CERTIFIED NURSING ASSISTANT THROUGH A FOCUSED STRUCTURE ADDRESSING PROFESSIONAL IMAGE, EDUCATION, AND PRACTICE. Bernadette Ciukurescu, BSN, RN, Margaret Kearns, RN, BSN, MS, and Anne Jadwin, RN, MSN, AOCN^®, Fox Chase Cancer Center, Philadelphia, PA.

The nursing shortage has necessitated a change in the nursing practice model at a comprehensive cancer center in the northeast. Incorporating certified nursing assistants (CNAs) into the skill mix has created interesting challenges to the management group, including responding to the CNAs’ requests to assist them in enhancing their professional image within the department.
Using the acronym PEP for professional image, education and practice, two nursing supervisors at Fox Chase Cancer Center developed and implemented a monthly program for CNAs, which focuses on those issues. A grant was obtained through a local nursing leadership organization to support activities for CNAs such as recognition for National Certified Nursing Assistant Week, a journal subscription, and snacks at meetings.
Two meeting times were determined to include all three shifts. Agenda items follow the subheadings of professional image, education, and practice, and address issues such as CNA clinical ladder advancement, scholarship opportunities, effective communication, hand washing, and absenteeism. A short educational inservice is included to increase CNAs’ knowledge of oncology issues.
The nursing supervisor facilitates an interactive exchange in a supportive environment, and is able to clarify departmental expectations and policies, while supporting professional development.
A survey was completed at the first meeting addressing CNA role perception and degree of unit inclusiveness. Results of the survey were shared with the management team and strategies were developed to promote role clarity and CNA retention. Six months following implementation of the PEP Rallies, 13 CNAs applied for promotion to Level II of the clinical ladder, CNAs from every nursing unit created posters focusing on the importance of their role, one CNA offered to share their expertise with the nurse extern and graduate nurse programs during orientation, and five CNAs are continuing their professional education in nursing or Allied Health careers.
The PEP Rallies reinforce the importance of the CNA role in promoting patient safety and comfort and enhancing overall patient satisfaction. Nursing administration’s vision to supplement patient care hours and improve patient outcomes has been positively influenced since the introduction of this program.

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DESIGNING AND UTILIZING A NURSING WEB SITE FOR EDUCATION AND PROFESSIONAL DEVELOPMENT. Brian Millan, RN, BA, AAS, and Dennis Graham, RN, MSN, ANP, OCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Web-based communication and information retrieval have become increasingly commonplace for oncology nurses (Cobb, 2003). At this NCI-designated comprehensive cancer center, a need was identified for an informational nursing web site designed by and for nurses.
A survey was conducted among staff nurses, advanced practice nurses, nurse managers, and nursing administrators as to what components should comprise a hospital-based nursing web site. Utilizing a grass-roots approach, a staff nurse with web editing skills worked in conjunction with the Nursing Division Professional Development Committee to develop the site. No outside contractors were used and no funding for the project was required.
A multi-section web site was designed. The user first encounters a “Home” page that provides links to “Nursing Education,” “Nursing Practice,” “Multimedia,” “What’s New,” and other pages. Hit counters were added to each page so that each time any page was opened, a hit was recorded.
For two months, total hits and average page views per day (APV/D) were recorded. Total Hits APV/D Home 2298 35.8, Nursing Education 889 10.3, Calendar 396 6.3, What’s New? 106 1.0, Links 105 0.7, Advanced Practice 52 1.0, Contact Us 49 0.0, Multimedia 45 0.3, Journal Club 22 0.2.
The “Home,” “Nursing Education,” and “Calendar” pages were the most frequently accessed. Relatively fewer users accessed the “Multimedia” page, which contains recorded in-service videos, nursing grand rounds, and CE presentations. This presents the question as to whether multimedia presentations are best offered to the nurse in an online format, or if a more traditional classroom-viewing situation would be more effective. Revisions are planned to move this material to the “Nursing Education” page. This preliminary study supports that using a nursing-designed web site improves opportunities for nurses to find and utilize areas for educational support and professional development. Reference: Cobb, S.C., (2003). Comparison of oncology nurse and physician use of the Internet for continuing education. Journal of Continuing Education in Nursing, 34, 184–188.

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WORKING WITH CLINICAL EDUCATION TO DEVISE, IMPLEMENT, AND REFINE AN ONCOLOGY NURSE RESIDENCY PROGRAM. Norma Sheridan Leos, RN, MSN, AOCN^®, CPHQ, Curtis and Elizabeth Anderson Cancer Institute, Savannah, GA, and Patti MacDonald, RN, Memorial Health University Medical Center, Savannah, GA.

This abstract will describe how the oncology clinical nurse specialist (OCNS) and clinical education specialist collaborated to devise, implement, and refine an oncology nurse residency program. This program provided the new graduate nurse with a supportive, educational program to ensure their success as an oncology nurse. Details will be provided so that other organizations can implement a similar program.
Hospitals and community cancer centers struggle with the serious and recurring issue of the lack of oncology nurses. This shortage will become more acute as the population ages and the incidence of cancer increases. Compounding the problem is that many nursing schools do not have educators who are comfortable teaching students about this specialty.
In March 2002, an OCNS worked with the clinical education specialist to devise and implement an oncology nurse residency for the May 2002 graduating class. Working closely with the clinical education specialist, the OCNS built upon an existing generic nurse residency program to devise and implement an oncology nurse residency.
Clinical objectives were defined for the nurse residents. Additionally, weekly evaluations during the residency by the nurse resident, unit preceptor, and the clinical education specialist served as formative evaluation. Two nurse residents have completed the 2002 residency program, and they have been employed at the cancer institute for over a year. Based on feedback from the residents and the pressing need to rapidly educate nurses, the residency for 2003 has been refined. Three students have enrolled in the 2003 program.
Oncology nursing is a specialty. In-depth education needs to be provided to new graduates. Having specialized education and support assists the new oncology nurse’s transition into the specialty.

191
THE CANCER NURSE INTERNSHIP: A MODEL FOR PROFESSIONAL DEVELOPMENT. Maria deCarvalho, RN, MSN, AOCN^®, and Cynthia Herringa, RN, National Institutes of Health, Clinical Center, Bethesda, MD.

Most nursing programs build a foundation for the acquisition of specialized nursing knowledge and skills but do not include theoretical or clinical courses in the many dimensions of oncology nursing care.
Given the nursing shortage and lack of specialized nurses, new graduates feel overwhelmed entering oncology practice, emphasizing the importance of a detailed, supportive clinical program to ensure a smooth transition and long-term retention. Thus, the Cancer Nurse Internship Program (CNIP) has become one of our institutions primary strategies for recruiting new graduates.
The goals of the CNIP are to (1) provide nurses with the knowledge and clinical experience for those desiring to specialize in oncology nursing, (2) provide the support to promote the transition of new graduate nurses to professional nurses who function as members of the biomedical research team, and (3) retain competent oncology nurses at the expert level with the knowledge to provide optimal care to individuals and families dealing with the cancer experience in the unique research setting.
Nurse educators and mentors guide, counsel, and facilitate opportunities to develop professional nursing skills and deliver holistic, individualized, care in a setting that supports primary nursing. They foster an environment encouraging trust, respect, openness, values, and diversity. The intern is empowered to actively direct the learning experience and utilize educators and clinical specialists as resources for consultation for development, nursing research, and clinical problem solving. Leadership qualities are developed through communication and collaboration with the interdisciplinary team, presentations to colleagues using varied teaching strategies, and encouragement to act as change agents to improve nursing practice.
This presentation will focus on presenting details on tools and learning activities designed specifically for transition into the oncology nursing specialty as well as the positive implications of this program to certification and specialty recruitment and retention.

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A STEP AHEAD: JOINING THE ONCOLOGY NURSING SOCIETY. Mary Scherbring, MS, RN, OCN^®, Julie Earle, RN, BSN, RT(T), OCN^®, and Sherry Looker, RN, BSN, Mayo Clinic, Rochester, MN.

Membership in a professional organization is recognized as a means to enhance nursing practice for both the individual and the discipline. The Oncology Nursing Society (ONS) is a professional, international organization with approximately 30,000 members worldwide who are committed to promoting excellence in the care of individuals with cancer. Activities of ONS encompass the domains of practice, education, and research.
Nurses who make the decision to join the ONS are provided many opportunities to expand and advance their careers, as well as create friendships and professional bonds. This poster provides an introduction and invitation to participate in this organization.
Well-designed posters can serve as an effective method of soliciting attention and disseminating information. This poster was developed as an educational and marketing strategy to promote and make explicit the benefits of membership in the ONS. Intended audiences include nurses in the oncology specialty, nursing students, associate professionals, and the public, along with current ONS members.
Target audiences are informed of the multiple benefits of membership in ONS, including access to:

• Scholarly literature
• ONS website
• Networking opportunities
• Special Interest Groups
• High quality education
• Information about legislative initiatives
• Research funding
• Mentorship
• Awards and recognition for individuals and groups
• Opportunities for community and public service
• The most current information about standards and certification

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SUPPORTING CERTIFICATION OF ONCOLOGY NURSES ON AN INPATIENT HEMATOLOGY/ONCOLOGY UNIT. Colleen O’Leary, RN, BSN, OCN^®, Maribeth Mielnicki, RN, BSN, OCN^®, Julie Mills, RN, BSN, Jane Hawksley, RN, MS, APRN-BC, and Beverley Caraher, RN, MS, APRN-BC, AOCN^®, CHPN, Northwestern Memorial Hospital, Chicago, IL.

As cancer treatments become more complex, safe delivery of care requires specialized knowledge and significant clinical nursing expertise. Patients have become savvy consumers of health care who demand the best. Oncology certification offers significant benefits for patients, employers, and nurses.
In institutions with a high percentage of oncology certified nurses (OCNs), patient confidence in caregivers is strengthened. Employers differentiate themselves from their competitors by providing the highest level of care from a knowledgeable, skilled nursing staff. Nurses increase their knowledge of current nursing practice, thereby increasing their confidence, competence, and job satisfaction. Despite its benefits, many oncology nurses fail to pursue certification. Barriers include cost of testing, lack of preparation time, inadequate recognition of certification’s value, and lack of acknowledgement from employers.
Northwestern Memorial Hospital has made a concerted effort to support certification of oncology nurses. A mentoring program for nurses working toward certification is in place with an individualized education program based on learning preference and experience designed for each participant. Each participant is paired with an oncology certified nurse as their mentor. The mentor assists with the application process, acts as a liaison between the applicant and educational team, and provides support and encouragement through the entire process. Time away from patient care is afforded the nurse to facilitate individual study as well as group study sessions. Computer-based practice tests are offered on unit and home use, and published study guides and reference books are made available to each applicant. Required fees for the exam are subsidized by the institution. Public recognition and acknowledgement of certification includes awarding each newly certified nurse with a gold OCN^® pin, a plaque with their name engraved hung on the nursing unit, and special recognition during Oncology Nurse Week.
These efforts have shown a 300% increase in the number of nurses taking the OCN^® exam. An attendant rise in overall patient satisfaction has been noted, and staff turnover has decreased.
Earning certification shows excellence in nursing practice to patients, colleagues, and employers. Instilling a sense of pride and accomplishment through certification is truly a mark of excellence that deserves respect.

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MANAGING CHANGE: AN EMPOWERING EXPERIENCE FOR ONCOLOGY NURSES. Josephine Visser, RN, BSN, OCN^®, and Angela Hatton, RN, BSN, H. Lee Moffitt Cancer Center, Tampa, FL; Vicki Dugger, RN, OCN^®, H. Lee Moffitt Cancer Center, Odessa, FL; and Kathy Kopec, RN, CRNI, OCN^®, H. Lee Moffitt Cancer Center, Tampa, FL.

We believe nurses who have the authority and accountability to make significant decisions about their work are more satisfied with the outcome.
The purpose of this presentation is to describe one infusion center’s experience in empowering nurses to implement a significant change. The infusion center at H. Lee Moffitt Cancer Center and Research Institute was moving into a new building. Issues needed to be resolved in order to complete the transition. The new center had a different physical layout and required additional staff to maximize workflow.
Several goals existed for the implementation of this change. We needed to minimize disruption to patient care. We wanted our patients to view this as a change to a new building without interruption in the quality of care to which they were accustomed. We wanted this opportunity to solve existing workflow problems. Finally, we wanted the RNs who provide patient care to orchestrate the move. The manager identified issues and assigned corresponding committees. The issues included aesthetics, facilities, policy/procedures, patient education, scheduling, staffing, orientation/competencies, and workflow. RN level IIs and IIIs were assigned a committee and the RN IV was designated project manager. Committees met regularly to develop plans and address issues for the move. Staff had the autonomy and authority to contact department heads to facilitate the process. Problems were solved creatively and conflict resolution skills were utilized within each group.
Involving patient care providers in decision making contributed to a smooth transition. Infusion services were provided to patients at our original location on one Friday, and on Monday our new center was open to treat 170 patients. Both patients and nurses expressed a high degree of satisfaction with the process.
Adjustments to this significant change will take months to evaluate, however, as a result of our experience, we feel prepared to readily identify and address future issues. Change need not always be painful. Empowering nurses who provide patient care to engineer a significant change such as the one described allows them to embrace and grow with the process.

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THE LABYRINTH OF NURSING RESEARCH: A STRATEGY OF BRINGING THE RESEARCH PROCESS TO THE BEDSIDE NURSE. Fedricker Diane Barber, RN, MSN, ANP, AOCN^®, Cynthia Segal, RN, MSN, Fely Pinyopusarerk, RN, OCN^®, Valerie Rioux, RN, Marily Elopre, RN, and Terry Throckmorton RN, PhD, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Many nurses at the bedside express an interest in becoming more involved in nursing research or in using evidence-based practice. However, several barriers identified by our nurses and in the literature discourage bedside nurses from conducting research. Some of those barriers are lack of time, limited nursing knowledge of research, resistance to change, nursing culture, a lack of support, and a perception that research is an intimidating process.
In an effort to increase knowledge of research and stimulate evidence-based bedside care, our nursing research council developed a program titled “The Labyrinth of Nursing Research,” which included seven posters.
Each poster served as an interconnecting passage through the nursing research process. The opening of the Labyrinth began with the poster titled “Stating the Problem,” followed by “Searching the Literature,” “Designing the Research/Methods & Statistics,” “Approval IRB/PDOL,” “Conceptual Framework,” “Funding & Grant Writing,” and ending with “Publication/Meet the Author.” A member of the nursing research council was stationed at each poster to answer questions and provide information to visitors of the Labyrinth. The “Publication/Meet the Author” poster area included nurses from our institution who had published their research and who signed and distributed copies of their articles. Experts from the departments of biostatistics, scientific publications, and the library were available to answer questions and offer advice.
The Labyrinth was placed in the main lobby of the hospital for easy access and visibility. Nurses who visited the Labyrinth provided positive feedback to the research council members and were entered into an hourly gift basket drawing. The Labyrinth of Nursing Research is a simple, non-threatening strategy to expose the bedside nurse to the research process and to stimulate evidence-based nursing practice to improve patient care.

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FIRST YEAR EVALUATION OF THE RESEARCH NURSE DEVELOPMENT MODEL (RNDM): A COMPETENCY-BASED PROFESSIONAL MODEL FOR RESEARCH NURSES. Laura Esparza Guerra, RN, CCRC, Yvonne Lassere, RN, OCN^®, CCRP, CCRC, Deborah Francis, RN, BSN, Harriett Chaney, RN, PhD, CNS, Jan Jenkins, RN, and Debbie Frye, RN, BSN, University of Texas M.D. Anderson Cancer Center, Houston, TX.

For more than 25 years, research nurses have been an integral part of oncology research. One year ago, we implemented a professional development model for research nurses, the Research Nurse Development Model (RNDM). A working group of clinical research nurses in the medical, surgical, and radiotherapy oncology fields developed this model.
The basic design of the RNDM reflect Benner’s model, Novice to Expert for development progression and incorporates Dreyfuss’ work related to skills acquisition. Goals of the RNDM are: (1) Recognize and elevate the practice standards for research nurses, (2) Ensure that clinical research meets or exceeds all industry, federal regulatory, and good clinical practice requirements in the conduct of clinical trials, (3) create a performance based tool to evaluate performance and promote professional development, (4) facilitate salary equity, and (5) promote recruitment and retention of research nurses.
The RNDM was designed as an applicable tool for evaluation of research nurses involved in prospective clinical trials using five performance categories: protocol management, data management, clinical practice, education/team orientation, and communication/respect. Within each category, professional behavioral criteria are defined for three achievement levels with mandatory completion timelines of six months, three years, and five years for Levels 1, 2, and 3, respectively. Our standard of research nursing practice is Level 3, with designation of Senior Research Nurse upon achievement.
The RNDM was implemented in September 2002. Selected RNDMs were reviewed for accuracy and quality-of-form completion. A user survey to evaluate the RNDM process was conducted in July 2003. The survey went out to 179 research nurses (RsN) and 19 research nurse supervisors/evaluators (RsNS).
62 RsNs and 12 RsNSs responded to the survey. 65% of the RsNs and 83% of the RsNSs rated the RNMD to be mostly or completely successful at addressing the skills category. 72.5% of the RsNs and 75% of the RsNSs felt that they had appropriate time to complete the RNDM.
These results indicate that there is positive regard toward the RNDM. Our analysis of completed evaluations documented compliance with the RNDM. We recommend this competency-based program to ensure adequate practice standards, professional development, and equitable compensation.

197
BLENDING NURSING ROLES: AN INNOVATE STRATEGY IN ONCOLOGY AND IMAGING NURSING. Theresa Hoelz, RN, BSN, OCN^®, Ridgeview Medical Center, Waconia, MN.

Breast cancer is the leading cancer diagnosis at our institution. Women with breast cancer are seen in outpatient settings for testing, short-stay surgery, and additional treatment. These patients identified testing as the most stressful part of their cancer journey. This stage involved the least amount of nursing contact at our institution. Ridgeview’s imaging services averages 150 examinations per day. With increased interventional procedures (CT-guided biopsies, abscess drainages, thoracenteses, paracenteses, VCUGs), integrating nursing care was identified.
Our Quality Improvement Team recognized an opportunity to improve patient care. Due to Ridgeview’s size and budget constraints, the team’s outcome resulted in the blending of the breast care coordinator and imaging nurse.
The QA team used an Aim, Plan, Do, Check, Act (AIM-PDCA) model to develop this role.
The breast care coordinator assists the radiologist during breast biopsies, as well as offers emotional support and educational materials pre- and post-procedure. Patients are contacted post-biopsy for evaluation of their biopsy site and questions are elicited. As appropriate, the patient is followed through surgery, chemotherapy, and recovery. As imaging nurses, we respond to SOS calls from all departments (CT, MR, nuclear medicine, general radiology, ultrasound, and mammography). Emergent needs (chest pain, panic attacks, contrast reactions) are assessed and routine nursing activities like IV starts, port-a-cath access, and catheterizations are performed. CT-guided biopsies, abscess drainages, and pediatric procedures require moderate sedation. Pre- and post-procedure teaching are integral components of practice.
Surveys show that patients have benefited from early nursing involvement and appreciate the nurses’ care across the continuum. Two years later, this role has grown to include additional cancer care services—not only for breast but other types of cancers. Cancer clinical trials, education classes, and resource notebooks are offered. Cancer program participation includes screenings, inservices, and community presentations.
This hybrid of care has expanded our practice from the hospital into our affiliated oncology clinics. Having seasoned RNs with extensive oncology experience was advantageous, and training provided the additional skills required for imaging and pediatrics. Patient diversity promotes our high interest level and advances our knowledge. Similar-sized hospitals can feel confident implementing this effective dual nursing role.

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ASSUMING THE LEADERSHIP ROLE IN THE ABSENCE OF THE NURSE LEADER: A RESOURCE FOR NURSES. Erin Punturieri, RN, MA, AOCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Advanced practice nurses frequently need to adapt themselves to meet the needs of patients, nurses, and healthcare organizations. One role that they may be asked to assume is nurse leader.
In a healthcare environment where change is the norm rather than the exception, qualified nurse leaders are in a pivotal position to influence outcomes. How do you know if you are qualified to be an acting nurse leader (NL)? And, what qualities are necessary to possess to be successful in this role?
The advanced practice nurse (APN) may be asked to take over the responsibility of NL with minimal orientation to the role, and also be expected to maintain the cohesiveness of the unit until the return of the NL. An APN at this NCI-designated cancer center recognized the need to develop a resource for nurses who are asked to become the acting nurse leader. Goleman’s model, Emotional Intelligence Framework, was adapted to identify competencies that are needed in the path toward outstanding performance. These competencies are grouped into the following four categories: self-awareness, social awareness, self-management, and social skills.
A literature search identified research articles related to common attributes associated with nurse leaders, but little on how to develop oneself in the role of effective NL. A survey was presented to all staff on an inpatient medical/surgical oncology unit to help identify common mutual objectives, as well as personal goals, during this time of transition.
The survey was a necessary component to the development of this project because staff plays an integral part in the personal development of an acting NL. The literature search was able to identify traits commonly found in nurse leaders, which were then translated into Goleman’s model. A personal development strategy was created for nurses new to the role of NL.
The information obtained is important for all new nurse leaders, as well as nurses who have an interest in developing skills to become a nurse leader. This presentation will discuss the competencies one needs to possess/acquire when asked to fill the role of nurse leader, and how to do so while maintaining a sense of unity among the staff.

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CHARGE IN CHARGE: EMPOWERING NURSES IN SUPPLY COST CAPTURE. Aiko Kodaira, RN, MS, OCN^®, The Johns Hopkins Hospital, Baltimore, MD.

In today’s healthcare climate, hospitals are struggling to maintain financial stability. One way to increase revenue is by ensuring all supplies charges are captured. Various methods and devices for capturing supply costs have been developed and examined. What can be done to change the culture of the unit in order to optimize available technology? This is a report on an attempt to improve charge capturing by enhancing the nurses’ self-governance.
The purpose of this project was to create a system that can bridge the gap between the culture of the unit and technology in order to maximize the cost charge capture. The charge capture on our hematology oncology unit was never optimal. The Par Excellence System (Par Excellence System, Inc.), a point-of-use supply chain management system, is a quick and easy system. It was well adapted by nurses when it was implemented three years ago. However, as with many other systems, we soon came to realize that the crucial aspect of charge capturing relied on nurses remembering to use the system.
To improve this situation, the clinical nurse specialist (CNS) decided to remind nurses to charge at the end of each shift. This approach significantly increased the charge capture, however, the charge capture fluctuated with the availability of CNSs. In order to address this, the CNS started the “charge in charge” project. Each shift the charge nurse identifies a nurse who is responsible for reminding staff to charge supplies, and it was marked on the assignment sheet.
This simple but effective approach increased the staff’s awareness of the need to charge for supplies and significantly improved the supply charge capture on our unit. Pre- and post-intervention monthly supply cost and supply revenue are compared to evaluate the outcome of this project.
In order to increase revenue, it is important to utilize available technology. It is necessary to analyze staff interaction with that technology and adjust the gap between the two. This abstract describes how to achieve this by creating a system to help nurses remember to make appropriate charges.

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UTILIZATION OF A NURSING ROLE ACQUISITION FRAMEWORK IN A NON-TRADITIONAL NURSING ROLE. Lisa Sweeney, RN, MSN, AOCN^®, Barbara Poniatowski, RN, MSN, AOCN^®, Susan Temple, RN, MSN, AOCN^®, and Cynthia Umstead, RN, MSN, AOCN^®, GlaxoSmithKline, Philadelphia, PA.

The diversity of oncology nursing roles in non-traditional settings is not yet well defined or well described in the oncology nursing literature. Increasing numbers of oncology nurses are seeking employment as educators, researchers, consultants, administrators, and sales representatives. Many of these roles are found within the pharmaceutical industry. Expectations of role performance in these non-traditional settings are often defined by the paradigm of the corporate goals and initiatives. The clinical nurse educators of GlaxoSmithKline Oncology recently developed a conceptual framework, presented at the Oncology Nursing Society Congress in 2003, which forms an organizational structure for the clinical educator job description, orientation manual, and performance evaluation measurement.
This structure is unique in its ability to connect nursing role expectations to the corporate initiatives. This linkage enhances the educator’s ability to apply nursing responsibilities in a nontraditional setting.
The performance evaluation tool was created using Patricia Benner’s model of nursing role acquisition. The application of this fluid model of role development allows for the individual behaviors and activities to be assigned to the novice, proficient, or expert level of practice.
Specific expectations and behaviors were matched with the corporate dogma of a Management by Objective role performance evaluation system. These nursing behaviors were stratified to reflect the novice educator through to the expert level of practice. Once the behaviors were delineated, they were, in turn, applied to the five areas of objectives set forth by the corporation. Within the areas of business analysis, professionalism, resource optimization, customer focus, and product knowledge, specific expectations are outlined that typify behavior based on the skill set and level of practice of the educator.
The revised performance evaluation tool was put into practice in the fall of 2002, and remains the primary tool for performance evaluation for the clinical educators at GlaxoSmithKline Oncology.
The benefits of linking a nursing model to the corporate process for evaluation are multifaceted. First, it allows for clear delineation of expectations at all levels of development while taking into consideration the individual’s experience and expertise. The creation of this type of evaluation criteria also enables the continued articulation of the unique and valuable contribution that oncology nurses bring to nontraditional roles. As more oncology nurses move into these nontraditional roles, the incorporation of nursing frameworks will result in the expansion of oncology nursing knowledge.