The ambulatory oncology nurse's role

Standardization of Telephone Triage in Pediatric Oncology

Nurses in pediatric oncology are often the main resource for overwhelmed parents and deal with complex patient issues over the telephone but often not without concerns about best patient care, liability, and accountability for the advice given. The question is whether using standardization of telephone triage practices can provide opportunities for improvement in the care of pediatric oncology patients. A review of the literature pertaining to telephone triage, standardization of practice, and the practice in outpatient oncology was conducted. The utilization of easy-to-use, accessible yet nonrestrictive resources and a well-designed documentation tool can help guide the decision-making process while addressing legal concerns and ensuring best possible patient care. An advantage that nurses in outpatient oncology settings have in performing telephone triage is the knowledge they have of their patient population and the disease process and treatments. Using a balanced approach to standardization of telephone triage practices can provide opportunities for improvements in care while still capitalizing on the intuitive knowledge and experience of the nurses involved.

Tele-practice guidelines for the symptom management of children undergoing cancer treatment

The provision of tele-practice symptom management is often without the provision of evidence-based guidelines. Under the auspices of the Pediatric Oncology Group of Ontario, a nursing task force was established to appraise the evidence and develop guidelines. Promising new efforts to enhance symptom management through tele-practice are emerging. Seven guidelines and one documentation tool were created from evidence compiled from case reports, clinical examples, and nonexperimental studies. The symptom management guidelines contribute to the paucity of literature and may serve as a useful resource for health professionals providing telephone advice and conducting tele-practice symptom management assessments.

Patient satisfaction and quality of life in cancer outpatients: results of the PASQOC study

BACKGROUND

Satisfaction with care and quality of life (QoL) are indicative of the quality of care of cancer patients. The purpose of this study was to lay a cornerstone for patient-centred quality management by assessing the current status of satisfaction with care and QoL among oncological outpatients in Germany, and by identifying the key factors that determine a patient's willingness to recommend a medical facility.

PATIENTS AND METHODS

A self-constructed and validated patient satisfaction questionnaire plus the SF-36 were distributed to a random sample of 3384 cancer patients who presented at 24 investigators' offices nationwide within a defined recruiting period and who met the inclusion criteria. The return rate was 81.9% (n=2772). A total of 2659 (78.6%) questionnaires were evaluable. The most common cancer types were breast (22.9%) and intestine (19.8%).

RESULTS

Overall satisfaction was high, but specific reporting questions revealed many areas for improvement such as shared decision making, doctor-patient communication and organization of care. QoL was significantly impaired in many domains. Patient-provider relationship, facility setting and information on diagnosis and treatment options are major determinants of a patient's willingness to recommend a facility to a friend or relative if needed.

CONCLUSIONS

This multicentre study focusing on patient perspectives highlights that, although the overall degree of satisfaction was quite high, there are numerous areas for improvement.

Resurfacing the care in nursing by telephone: lessons from ambulatory oncology

The practice of providing telephone mediated advice and assistance is often described as "telephone triage" in relevant literature. The decision-making processes required for priority-setting and the provision of advice have been found to be complex and multifaceted. Conceptualization of this valuable patient care activity as a linear "triage" function serves to make invisible the nursing care provided. This article explores the current practice of providing telephone mediated advice and assistance in the following 2 distinct nursing care settings: emergency departments and ambulatory oncology centers. Examination of this activity in these 2 settings provides a forum to discuss and critique legally and fiscally driven prescriptive protocol use to inform decision-making. The effectiveness of experiential knowledge coupled with the strengths of nurse-patient relationships suggests that a need exists to highlight the caring aspects of telephone mediated assistance.

Nursing care of patients receiving Campath

Monoclonal antibodies are focused therapies with unique infusion-related complications. Campath (alemtuzumab, Berlex Laboratories, Richmond, CA) is indicated for the treatment of refractory chronic lymphocytic leukemia and has a complicated administration schedule, severe infusion-related toxicity, and profound immunosuppressive capability. Ambulatory cancer care is challenging simply because of the complex nature of the disease. Management of complicated therapies, such as Campath, stretches resources and requires a coordinated effort by the healthcare team for successful patient outcomes.

Oncology out-patients nursing: a challenge within the changing face of cancer care

Eighty to 90% of cancer care is delivered in the out-patient setting, and thus the out-patient nurse's role is pivotal to patient care. A report published in 1990 (NHS Management Executive) suggested that there had been no change in the traditional 'handmaiden' role of the out-patient nurse over the previous 20 years. This study was designed using the conceptual framework of the domains of ambulatory nursing practice developed by Verran (1981). Two self-report questionnaires were developed in order to identify what nurses were actually doing in out-patients and the activities which both nurses and doctors felt should be undertaken by nurses. Questionnaires were distributed to all out-patient nurses, clinical nurse specialists and doctors working within an oncology out-patients department in a London teaching hospital. Results showed that oncology-trained nurses were more involved in areas where specialist skills and knowledge are important for patient care. However, there were still non-nursing aspects of care that could be relinquished. Both nurses and doctors saw the role of the oncology-trained nurse as important in undertaking professional nursing activities within the out-patient department. This study suggests that specialist oncology out-patient nurses are beginning to break away from the traditional 'handmaiden' nurse's role utilizing their knowledge and skills within these departments. However, they still have to develop the role further in order to meet the needs of patients and their families within the out-patient setting.

The research nurse role in a clinic-based oncology research setting

Public demand and government support for evaluating new cancer drugs and methods in a more timely manner have significantly affected clinical research programs. To meet these demands, it is critical to have research personnel with an appropriate skill mix to ensure that clinical trials are conducted safely and effectively, while scientific integrity is maintained. This article describes the development and integration of the research nurse role within an oncology research program in a large outpatient oncology clinic. Methods for evaluating the research nurse role included literature review, analysis of job descriptions, and dialogue with research staff, oncology staff, and a clinical nurse specialist. A Review of the Nurse Practice Act of Wisconsin and the Oncology Nursing Society standards provided license and practice standards. Similarities and differences between the roles of the research nurse and the chemotherapy nurse are analyzed. Complementary roles and functions are identified, and areas of role overlap are defined. This report expands the limited current literature regarding this subject. The findings provide the reader with a framework for evaluating the roles of registered nurse personnel in a clinical setting. Although each institution has unique characteristics or research needs, the method used to address the reported program is transferable.

Telephone communications between diabetes clients and nurse educators

The purpose of this study was to describe the use of telephone communications between diabetes nurse educators (DNEs) and their clients with diabetes. A questionnaire was designed to examine the use of the telephone with diabetes clients from the perspective of DNEs. A total of 465 DNEs across the US were selected using a systematic sample from the membership directory of the American Association of Diabetes Educators. A total of 247 were questionnaires completed and returned (55%). Ninety-one percent of DNEs reported using the phone with clients and averaged 15 phone calls per week. Over 90% frequently reported discussing the following topics with clients: home blood glucose monitoring, hyperglycemia, hypoglycemia, insulin use, and diet. Analysis of telephone users showed that DNE experience and diabetes educator certification were significant factors in the differences observed in the reported topics discussed over the telephone. These findings suggest the need for guidelines for telephone contact with diabetes clients.

Nursing management of patients receiving biological therapy

OBJECTIVE

To provide an overview of the most common toxic effects associated with biotherapy and strategies for effective patient management, predominantly in the outpatient setting.

DATA SOURCES

Review articles and book chapters related to nursing care of patients receiving biotherapy.

CONCLUSIONS

Biological response modifiers can produce several toxic effects that may have a significant impact on the patient's quality of life. Additionally, biotherapy is being delivered more frequently in the ambulatory and home care settings.

IMPLICATIONS FOR NURSING PRACTICE

As the role of biotherapy expands in the treatment of cancer, oncology nurses must be attuned to the special needs of patients receiving this therapy. Nurses must be knowledgeable of not only symptom management but reimbursement and managed care issues as well.