The influence of the oncology-focused transgender-simulated patient simulation on nursing students' cultural competence development

BACKGROUND

Disparities experienced by transgender patients, especially in cancer care, leads to poorer outcomes and overall health. Simulation, using transgender simulated patients (SPs) with a focus on cancer care can be an effective way to foster cultural competence nursing education.

METHODS

Guided by the National League for Nursing (NLN)/Jeffries Simulation Theory and Cultural Competence and Confidence Model, this grant funded pretest (n = 48) and posttest (n = 41) comparison group, quasi-experimental study aimed to understand changes in students' transcultural self-efficacy (TSE) following the transgender-simulated patient simulation (TSPS) focusing on an oncological emergency management. Developed by following recommended guidelines and standards, the TSPS had content validity review and pilot testing. It aimed to improve students' knowledge, skills, and attitudes with regard to providing culturally congruent nursing care. The statistical methods included paired sample t-tests, independent t-tests, and correlation analyses.

RESULTS

Students who participated in the TSPS intervention had significantly higher posttest TSE scores (P < .05).

DISCUSSION

SP methodology can be an effective way to foster cultural congruence in nursing care. The findings contribute to the importance of continuous efforts for the inclusion of lesbian, gay, bisexual, transgender, queer (LGBTQ) topic in nursing education to enhance culturally congruent care.

Prostate Cancer Prehabilitation and the Importance of Multimodal Interventions for Person-centred Care and Recovery

BACKGROUND

Prostate cancer is the second most commonly diagnosed cancer globally. Cancer prehabilitation is defined as a process on the continuum of care that occurs between the time of a cancer diagnosis and the beginning of acute treatment. This article will discuss the importance of prostate cancer prehabilitation interventions in optimising physical and psychological recovery to enhance person-centred care.

DATA SOURCES

Electronic databases including CINAHL, MEDLINE, PsychINFO, Scopus, professional websites, and grey literature were searched using Google Scholar.

CONCLUSION

Prehabilitation in cancer care aims to enhance perioperative care and recovery. An emerging field of research suggests that the preoperative period may be physically and psychologically salient to introduce modifiable self-management behaviours to optimise overall recovery.

IMPLICATIONS FOR NURSING PRACTICE

Prostate cancer specialist nurses provide the hub of person-centred care across the entire cancer care continuum embedded within the multidisciplinary team. Individually tailored interventions such as exercise and pelvic floor muscle training programmes, nutritional advice, anxiety and depression reduction, and sexual well-being interventions should be considered in the prehabilitation phase of the cancer care continuum.

Fex-Talk: a Short Educational Intervention Intended to Enhance Nurses' Readiness to Discuss Fertility and Sexuality with Cancer Patients

Sexual and reproductive health is known to generally be insufficiently addressed by health care personnel working in cancer care. We hence developed a short educational intervention, Fex-Talk, to overcome the barriers to communicate about sexuality and fertility. The present study sought to evaluate the Fex-Talk intervention, which aims to enhance nurses' readiness to discuss fertility and sexuality issues with cancer patients. The educational intervention involves a single session with an optional follow-up session, and it includes different components in accordance with Kolb's experiential learning cycle. The evaluation was based on participants' oral and written feedback regarding the content and organization of the intervention, as well as on teachers' field notes from five educational events involving nurses who work with cancer patients (n = 140). The data were analyzed using a thematic approach. Four themes were identified, namely increased awareness, need for knowledge, challenging discomfort, and dealing with external obstacles. The intervention increased participants' awareness of patients' need to discuss sexuality and fertility and of their own need for additional knowledge. The role-play exercise was said to challenge personal discomfort, although the participants still felt it helped to boost their courage to, in the future, engage in such conversations. Several external obstacles to initiate a conversation about sexuality or fertility were identified, and possible strategies for overcoming them were discussed. In conclusion, the Fex-Talk intervention was experienced positively by the participating nurses. The results indicate that the intervention increased nurses' understanding of patients' needs related to sex and fertility and overcome barriers to initiate discussions about sex and fertility with patients.

Oncology Nursing Considerations in a Clinical Trials Environment

OBJECTIVE

To provide non-research-trained oncology nurses with targeted information they need to know when caring for research participants on clinical trials.

DATA SOURCES

Professional scopes and standards, published literature, and governmental websites.

CONCLUSION

To optimize the safe care of research participants enrolled in cancer clinical trials, oncology nurses must have knowledge of the study team composition, protocol navigation, grading of adverse events, patient education, and communication with clinical research nurses and study teams.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses are integral to the success of clinical trials and the development of new therapies for cancer patients.

Perspectives of Childhood Cancer Symptom-Related Distress: Results of the State of the Science Survey

Management of symptom-related distress is an important area of pediatric oncology nursing. Participants who attended the Children's Oncology Group (COG) State of the Science Symposium on symptom distress completed an anonymous survey. The purpose was to explore participant perceptions of symptom distress experienced by children receiving cancer treatment on clinical trials, determine how symptom distress is currently assessed at COG institutions, and to identify what interventions are used to reduce symptom distress for these children. Among the 90 symposium attendees, 72% completed the survey, the majority (92%) of whom were nurses. The five most distressing symptoms in children with cancer enrolled on clinical trials identified by survey respondents were nausea/vomiting, fatigue, pain, anxiety, and sleep disturbances. Results from our survey also suggest that symptom distress may differ by disease type. For example, symptoms associated with leukemia/lymphoma included steroid side effects, procedural pain, and neuropathy. The majority of respondents (90%) also reported that symptoms go unrecognized by health care providers. The most commonly described unrecognized symptoms were behavioral (i.e., sadness, anxiety, fear, depression, and emotional needs; 45%) and fatigue (19%). Key focus areas reported by respondents included informal and inconsistent symptom assessment, the need for uniform measurement tools, and improved documentation of symptom-related distress. Management of symptom-related distress is an important aspect of pediatric oncology nursing. Further exploration of symptom distress experienced by children with specific types of cancers, and the development of standardized symptom assessment processes, will provide a foundation for developing future interventions aimed at alleviating symptom-related distress.

The Longitudinal Parallel Process Analysis of Biomarkers of Oxidative Stress, Symptom Clusters, and Cognitive Function in Children With Leukemia

Background: During treatment for acute lymphoblastic leukemia (ALL), children report co-occurring symptoms of fatigue, sleep disturbance, pain, nausea, and depression as a symptom cluster. Central nervous system-directed ALL therapies also put children at risk for cognitive impairments. Cancer therapies can cause an increase in oxidative stress, which may contribute to treatment-related symptoms. This study examined the longitudinal relationships between biomarkers of oxidative stress in the cerebrospinal fluid, the Childhood Cancer Symptom Cluster-Leukemia (CCSC-L), and cognition, in children over the first year of ALL treatment. Methods: Glutathione (GSH) biomarkers of oxidative stress were measured in cerebrospinal fluid collected during treatment lumbar punctures. GSH biomarkers, symptoms, and cognitive function of 132 children aged 3 to 18 years were evaluated at four time points during the first year of leukemia treatment. Participants, 7 years and older, completed self-report measures, and parents reported for younger children. Cognitive function measurements for all participants were completed by parents. A longitudinal parallel-process model was used to explore the influence of the initial measurement and the subsequent change over four time points of the GSH biomarkers on the CCSC-L and cognition. Results: GSH biomarkers increased over the four time points indicating decreasing oxidative stress. When GSH biomarkers were higher (less oxidative stress) at the initial measurement, the CCSC-L severity was lower, cognition was better, and cognition improved over the four measurements. Screening children for high levels of oxidative stress would be a foundation for future intervention studies to address symptom distress and cognitive impairments.

The Roles of Nurses in Hematopoietic Cell Transplantation for the Treatment of Leukemia in Older Adults

OBJECTIVE

To review and summarize nurses' roles in the care of the older adult undergoing an allogeneic hematopoietic cell transplant (HCT) for the treatment of leukemia.

DATA SOURCES

Published literature indexed in PubMed, CINAHL, textbooks, and clinical expertise.

CONCLUSION

Nurses are a vital component of the highly specialized care delivered before, during, and after an allogeneic HCT.

IMPLICATIONS FOR NURSING PRACTICE

Nurses who are prepared for the complex HCT care trajectory will be able to optimally meet the complex needs of the older adult patient and their caregiver(s).

Novel Therapies in Acute Myeloid Leukemia

OBJECTIVE

To provide a comprehensive review of evidence-based data on the newly approved therapeutic agents in acute myeloid leukemia (AML) with regards to appropriate indications for use, efficacy, and safety.

DATA SOURCES

Published clinical trials and observational studies.

CONCLUSION

Optimal treatment decisions for AML should be personalized based on individual patients' performance status, disease risk as determined by mutational profile, response status, and prior therapies received. While the treatment options have expanded, several questions remain regarding appropriate patient selection, long-term efficacy and safety of these agents, and sequencing of therapies among available options.

IMPLICATIONS FOR NURSING PRACTICE

Nurses need to be familiar with the peculiarities of the administration regimens of newer AML therapies, adopt formal monitoring strategies for side effects that are unique to these agents, and develop a framework to facilitate timeliness of follow-up and monitoring while on these therapies.

Survivorship Care Practices and Confidence of Oncology Nurses in Singapore: A Cross-Sectional Study

Introduction: Cancer survivorship care is challenging because little is known about delivering comprehensive and coordinated survivorship care practices (SCP) to patients. The purpose of this study is to examine oncology nurses' perceptions of responsibilities of SCP, confidence levels of SCP, and factors that influence provisions of SCP. Method: A descriptive cross-sectional study was conducted using the Cancer Professional Questionnaire. Analysis was conducted using independent t-test and analysis of variance to examine the differences between variables. Results: Nurses (n = 147) agreed that it was their responsibilities to provide SCP, but the majority lacked the confidence to do so. Significant differences were found in the confidence levels of nurses with different education attainments (p = .004). A lack of time and educational resources were factors impeding SCP. Discussion: Organizational interventions and education programs are needed to ensure that oncology nurses are confident in providing culturally congruent survivorship care in a multicultural country such as Singapore.

Caring for Patients Treated With Checkpoint Inhibitors for the Treatment of Metastatic Merkel Cell Carcinoma

OBJECTIVE

To provide an overview for oncology nurses about Merkel cell carcinoma and its management with immunotherapy.

DATA SOURCES

A literature search was conducted from 2013 to the present using search terms including "Merkel cell carcinoma," "avelumab," "pembrolizumab," "immune-mediated adverse events," and "infusion-related reactions." Clinical experience of the authors was also considered.

CONCLUSION

Oncology nurses can expect to manage an increasing number of patients with Merkel cell carcinoma because of increased incidence of the disease, as well as evolving immunotherapy treatment paradigms. Both avelumab and pembrolizumab possess favorable safety profiles but are associated with immune-mediated and infusion-related reactions.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses need to understand Merkel cell carcinoma and be able to recognize the signs and symptoms of immune-mediated adverse events and infusion-related reactions associated with treatment to provide early intervention.

Perceptions of caring behaviours: A comparison of surgical oncology nurses and patients

AIMS AND OBJECTIVES

The purpose of this article was to compare surgical oncology nurses caring behaviours to perceptions of their surgical oncology inpatients and determine internal consistency of the CAT-Nurse.

BACKGROUND

Nursing practice at the H. Lee Moffitt Cancer Center & Research Institute in Tampa, FL is guided by Duffy's Quality-Caring Model© . No study using Duffy's model for both oncology nurses and patients has been found.

DESIGN

A descriptive correlation design was used adhering to the STROBE guidelines. Data were collected using CAT-Nurse and compared to data from a previous study using CAT (version V).

METHODS

Item responses were compared between nurses and patients using t tests.

RESULTS

Patients scored higher on perceptions of caring behaviours. Mutual problem solving was an area for improvement. The CAT-Nurse demonstrated internal consistency reliability.

CONCLUSION

Results from this study can make nurses more aware of the caring perceptions that are not as strong as others, and therefore may have the ability to promote transformation.

RELEVANCE TO CLINICAL PRACTICE

The results can serve as foundational knowledge for action plans aimed at increasing nurse comfort addressing lower scoring caring behaviours that would then result in improving patient perceptions which could be linked to patient satisfaction and reimbursement.

The impact of two triggered palliative care consultation approaches on consult implementation in oncology

INTRODUCTION

Studies show palliative care delivered concurrently with cancer treatment improves outcomes, yet palliative care integration with inpatient oncology is underused. A promising approach to improve integration is a triggered palliative care consultation (TPCC). This study evaluated the impact of two TPCC approaches on consistency and quality of consult implementation, operationalized as uptake and timeliness, on solid tumor medical and gynecologic oncology services at an academic hospital.

METHODS

The study timeframe was 2010-2016. TPCC in gynecologic oncology began in 2014 and was supported by a single strategy (written guideline); TPCC in medical oncology began in 2015 and was supported by multiple strategies (e.g. training, chart review). Palliative care consult information was chart abstracted and linked to hospital encounter data. We compared the effect of a single strategy vs. usual care, and multiple strategies vs. a single strategy on implementation. Difference-in-differences modified Poisson regression models evaluated whether implementation differed after TPCC; we estimated adjusted relative risk (aRR), controlling for patient demographic and clinical characteristics.

RESULTS

Overall, 8.8% of medical oncology and 11.0% of gynecologic oncology inpatient encounters involved palliative care consultation. In regression analyses, TPCC supported by a single strategy in gynecologic oncology was associated with greater uptake vs. usual care (aRR: 1.45, p < .05), and TPCC supported by multiple strategies in medical oncology was associated with greater uptake vs. a single strategy (aRR: 2.34, p < .001).

CONCLUSION

Across two inpatient oncology services, TPCC supported by multiple strategies had the greatest impact on uptake. How strategies affect sustained use of palliative care consults remains to be investigated.

Improving oncology nurses' knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer: A quasi-experimental design

OBJECTIVE

Our objective was to assess the effectiveness of a structured educational program on improving oncology nurses' knowledge, self-confidence, and self-efficacy in nutritional assessment and counseling for patients with cancer.

METHODS

A pretest-posttest quasi-experimental design was used. A sample of 60 nurses from oncology units participated as an experimental group (n = 30) and a control group (n = 30). The participants completed a knowledge test before completing the educational program. Self-confidence and self-efficacy also were assessed pre- and postintervention.

RESULTS

There was a significant difference between the experimental (mean [M] = 26.00, SD = 8.00) and control (M = 10.00, SD = 3.75) groups regarding knowledge after the interventional sessions (t = -16.00, P = 0.001). Furthermore, the results indicated a significant difference (t = -24.00, P = 0.001) between the experimental group (M = 60.50, SD = 13.10) and the control group (M = 36.50, SD = 7.60) regarding self- confidence in managing cancer patients. Finally, there was a significant difference between the experimental group (M = 33.50, SD = 3.10) and control group (M = 23.25, SD = 2.75) regarding self-efficacy (t = -10.25, P = 0.001).

CONCLUSIONS

The educational program improved the oncology nurses' knowledge, self-confidence, and self-efficacy in relation to nutritional assessment and counseling. Improving nurses' competencies will improve the quality of care provided to the patients and patient health outcomes.

Patients' characteristics informing practice: improving individualized nursing care in the radiation oncology setting

PURPOSE

A large number of patients attend for radiotherapy daily. Primary nurses in the study settings aim to individualize care for their patients. The individual characteristics of patients may determine their perceptions of nursing care, and provide guidance in tailoring their care. This study aimed to assess patients' personal characteristics on their perceptions of individualized care (IC) provided by nurses during a course of radiotherapy, and to determine predictor variables that may inform nursing practice.

METHODS

This cross-sectional, exploratory study was conducted in three radiotherapy departments in Australia. Patients (n = 250) completed the Individualized Care Scale_Patient (ICS_P). Data were analyzed using descriptive and inferential statistics, univariate analysis, and multiple regression analysis.

RESULTS

Males reported significantly higher perceptions of IC than females in 7/9 subscales. Patients with head and neck and prostate cancer, as well as those requiring hospitalization during radiotherapy, scored significantly higher in 5/9 subscales. Courses > 30 days, those not receiving chemotherapy, and partnered patients reported greater IC across all subscales. Gender and hospitalization were the main predictor variables for IC.

CONCLUSION

Patients reported moderately high levels of IC during their radiotherapy; however, standard demographic information may provide limited insight into improving care for the individual. Patient characteristics routinely chosen, such as age, gender, and education may not predict how patients perceive their care or support the tailoring of interventions to improve IC. Researching a range of related patient characteristics may prove a more useful concept for future nursing studies aiming to predict outcomes to tailor nursing practice.

Staff Perceptions of Symptoms, Approaches to Assessment, and Challenges to Assessment Among Children With Cancer

Nurses are often the first to recognize and respond to children's symptoms. This descriptive, exploratory study characterized how pediatric oncology health care providers characterize and assess children's cancer-related symptoms. The study also explored challenges associated with symptom assessment and information perceived as helpful in planning interventions. The setting was a Children's Oncology Group-affiliated hospital in the Intermountain West of the United States. Twenty-two pediatric oncology health care providers (95% female; 68% nurses) participated in one of four focus group sessions. Sessions were facilitated by two individuals and included six open-ended questions addressing participants' perspectives of cancer-related symptoms, approaches to symptom assessment, challenges and frustrations encountered when assessing symptoms, and information needed to plan interventions. Participants identified 75 physical and psychosocial responses that included both subjectively experienced symptoms and other consequences of the cancer experience. Qualitative content analysis procedures organized other responses into categories and subcategories. Participants most frequently reported using observational approaches including physical assessment findings and observation of the child's behavior to identify symptoms. Strategies that sought the child's input such as the use of a rating scale or seeking the child's verbal description were less frequently named. Participants related discerning and interpreting the child's behaviors as a challenge to symptom assessment. They also reported attention to symptom characteristics as important to planning interventions. Future directions include building capacity to support child-centric symptom assessment. Development of reliable and valid resources for use in clinical settings may support a more child-centric approach to symptom assessment.

Health Literacy: Exploring Nursing Challenges to Providing Support and Understanding

BACKGROUND

As patient advocates, oncology nurses must attend to varying levels of health literacy among patients and families. However, little is known about nurses' experiences and comfort with health literacy assessment and providing health literacy support.
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OBJECTIVES

The purpose of this study is to explore nurse communication and patient health literacy.
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METHODS

A cross-sectional survey design (N = 74) was used to explore nurse communication challenges with low-literacy patients and to measure nurses' frequency of assisting with patient literacy needs, perceived degree of difficulty communicating with low-literacy populations, and perceived comfort with health literacy support.
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FINDINGS

A majority of the nurses reported communication challenges with patients who spoke English as a second language. Oncology nurses did not identify patient communication behaviors that indicated low health literacy. Nurses were least comfortable identifying low-literacy patients and assessing a patient's health literacy level. More experienced nurses reported more difficulty with low-literacy populations than less experienced nurses. Providing health literacy support to patients should be a core nursing skill.

Playing music improves well-being of oncology nurses

BACKGROUND

Nurses experience high levels of stress associated with the demands of their workplace. Anxiety and depression symptoms are common in this occupational group and the necessity of supportive actions is vital. This is especially true for nurses working in high intensity and demanding settings such as oncology units.

AIM

This study examined the effects of a music intervention on anxiety, depression, and psychosomatic symptoms of oncology nurses.

METHODS

Forty-eight oncology nurses, were randomized to either an intervention group (n = 22) attending four consecutive weekly 1-h music classes or a control group with no intervention (n = 26) who maintained their usual lifestyle habits, for one month. Intervention group played and improvised music using percussion instruments. Courses consisted of varied multitask exercises of progressive difficulty, sometimes involving team playing, or individual performances. Depression, anxiety, and physical symptoms were measured before and after the end of the intervention. Anxiety and depression were assessed with the Hospital Anxiety and Depression Scale. Psychosomatic symptoms were assessed with Pennebaker Inventory οf Limbic Languidness.

RESULTS

Anxiety, depression and psychosomatic symptoms significantly reduced for the intervention group at the end of the study. No statistical significant change was observed for the control group in any of the three psychological indicators.

CONCLUSION

The findings of our study highlight the fact that music can be a cost-effective resource in developing interventions to reduce stress and improve well-being. Playing music can be the next step for further investigation, since we already know that listening to music is beneficial.

Cancer Screening and Early Detection in Older People: Considerations for Nursing Practice

OBJECTIVE

To synthesize relevant issues in cancer screening for older people for nursing practice.

DATA SOURCES

Published scientific literature, clinical literature, and published cancer screening guidelines from the United States and Canada.

CONCLUSION

Nurses are caring for increasing numbers of older patients and, with this demographic shift, face increasing demands to address cancer screening and detection in both primary and specialty practice.

IMPLICATIONS FOR NURSING PRACTICE

Ageism, self-stereotyping, cancer fear and fatalism, and cancer survivorship experiences influence cancer screening and generate the need for improved awareness of these issues to advance nursing practice.

Oncology Nursing Perceptions of Patient Electronic Portal Use: A Qualitative Analysis

PURPOSE/OBJECTIVES

To identify nursing staff reactions to and perceptions of electronic portal use in a cancer setting.
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RESEARCH APPROACH

Qualitative.
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SETTING

Outpatient clinic at the Harold C. Simmons Comprehensive Cancer Center of the University of Texas Southwestern Medical Center in Dallas.
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PARTICIPANTS

13 nurses with a range of credentials and experience, representing infusion, medical oncology, and bone marrow transplantation clinics.
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METHODOLOGIC APPROACH

Two focus groups were conducted. Theoretical thematic content analysis of data was performed.
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FINDINGS

Key themes that emerged for consideration of electronic portals included work volume and flow, patient expectations and safety, variation in use of communication technologies, and education and management.
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INTERPRETATION

The current study provides insight into the implications of electronic portals by identifying nursing staff reactions to this technology. These reactions are predominantly related to the impact on clinical workload and patient safety and expectations.
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IMPLICATIONS FOR NURSING

As clinical cancer facilities incorporate electronic portal technology into their operations, attention to the impact on staff workload, division of labor, patient safety, and patient expectations should be considered.

[Glioblastoma and nursing care in neurosurgery]

Nurses in neurosurgical departments play a critical role as they are involved in the first stages of the care pathway of patients with glioblastoma. Indeed, surgery enables a definitive histopathological diagnosis to be established and the size of the tumour to be significantly reduced, thereby improving the prognosis.

Response to "Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses"

We read, with great interest, the study by Baldwin and Rodriguez (2016), which described the role of the verification nurse and details the verification process in identifying errors related to chemotherapy orders. We strongly agree with their findings that a verification nurse, collaborating closely with the prescribing physician, pharmacist, and treating nurse, can better identify errors and maintain safety during chemotherapy administration.

Missed Opportunities: A Mixed-Methods Analysis of CAM Discussions and Practices in the Management of Pain in Oncology

CONTEXT

Treatment of pain in cancer is a clinical priority. Many cancer patients seek and use complementary and alternative medicine (CAM) therapies.

OBJECTIVES

The aim of this study was to describe the role CAM plays in oncology, clinicians' approaches to pain management and its alignment with patient preference and self-care.

METHODS

We used quantitative criteria to identify patients with high, self-reported pain and reduced quality of life. For these patients, we merged quantitative and qualitative data from encounter audio recordings, patient surveys, and the medical record.

RESULTS

We identified 32 patients (72% women, average age 60) experiencing significantly symptomatic pain at enrollment. Merged themes were 1) Restricted and defined roles: Oncology clinicians suggested and documented cancer-specific approaches to pain management. Patients often (17, 53%) used CAM but rarely desired to discuss it in their encounters. 2) Proactive patients in setting of neutrality: Pain management strategies were considered in 22 instances. CAM was mentioned in 4 (18%) of these discussions but only after patient initiation. Clinicians took a neutral stance. 3) Missed opportunities for person-centered CAM discussions and management: Most (88%) patients were receiving conventional pain medications at enrollment or had them added or escalated during follow-up. Some patients in pain expressed preferences for avoiding opioids. One patient reported wishing CAM would have been discussed after an encounter in which it was not.

CONCLUSION

Bringing CAM discussions into the oncology encounter may facilitate a stronger patient-clinician partnership and a more open and safe understanding of pain-related CAM use.

Prevention and Management of Post–Lumbar Puncture Headache in Pediatric Oncology Patients

Pediatric oncology patients are at risk for developing a headache after they undergo a lumbar puncture for diagnostic or therapeutic purposes. These headaches are likely due to leakage of cerebrospinal fluid at the puncture site. While usually mild and self-limited, some headaches may be persistent and severe, adding to the distress of these young patients. In the past 10 years, refinements in lumbar needle size and shape as well as procedural techniques have reduced the tissue trauma that predisposes patients to headache. A number of interventions, such as bed rest, hydration, caffeine administration, and epidural blood patching, have been suggested to prevent and relieve the headaches that follow lumbar punctures. This article outlines the pathophysiology and incidence of headaches related to lumbar punctures in the pediatric oncology setting and reviews the evidence from research trials to suggest which interventions clinicians should adopt into their practice to minimize this complication of lumbar punctures.

Cultural Influence on Family Management of Children With Cancer

A family's cultural context directly influences how they define and manage their child's cancer. Knowing this dynamic can guide nurses in delivering holistic, culturally competent care. This literature review examines the international and domestic pediatric oncology research as it relates to the inclusion of family and cultural variables. Most international studies and comparative studies have investigated Asian cultures and found that health beliefs, communication beliefs, religious practice, and family structure are common themes of cultural influences on families. Additional studies within the United States are needed to explore cultural beliefs through carefully tailored family assessments. Implications for practice include the possibility of providing evidence-based culturally competent care to families of children with cancer.

Self-Care Operations and Nursing Interventions for Children With Cancer and Their Parents

As individuals assume more responsibility for their healthcare, nurses need to explore methods to support families’ self-care practices. The purpose of this qualitative study was to: (a) determine what self-care and dependent-care operations children and parents perform to address self-care requisites, and (b) explore nursing interventions to promote operations. Orem’s theory of self-care, theory of self-care deficit, and theory of nursing system were employed. Twenty-seven participants were interviewed about their cancer experiences. Results were that children and parents performed estimative, transitional, and productive operations to meet self-care requisites. Various nursing interventions that promoted these operations were identified. Recommendations were made for further interventions to support families.

Cancer Prevention: HPV Vaccination

OBJECTIVES

To provide an overview of human papillomavirus (HPV) vaccination as cancer prevention with current strategies that nurses can use to help patients and parents overcome barriers to HPV vaccination.

DATA SOURCES

Peer-reviewed literature, presentation abstracts, and current immunization recommendations from the Advisory Council on Immunization Practice.

CONCLUSION

Nurses can help prevent cancer by encouraging HPV vaccination during routine immunization and make HPV vaccination normal and routine.

IMPLICATIONS FOR NURSING PRACTICE

A vaccine to reduce/eliminate HPV-related cancers enables nurses' at all educational levels to advocate for cancer prevention through initiation and completion of the HPV vaccine series.

Mindfulness as an Intervention for Breast Cancer Survivors

Breast cancer survivors often turn to complementary health approaches (CHAs) to address the effects of treatment. Mindfulness-based stress reduction (MBSR) is a type of CHA that uses attentional and meditative exercises to minimize stress and increase awareness of the present. This article aims to determine whether adequate evidence-based research with uniform methodologies and outcomes to support MBSR as an intervention for breast cancer survivors exists.

Nutritional Status and Diet in Cancer Prevention

OBJECTIVES

To discuss the relationship between weight management and diet and cancer prevention, current nutritional guidelines, and evidence-based strategies to reduce cancer risk.

DATA SOURCES

Current nutritional guidelines, journal articles published between 2012 and 2015, and internet resources.

CONCLUSION

Evidence indicates that attaining and/or maintaining a healthy weight and adopting a diet that is primarily plant-based, low in red and processed meats, simple sugars, and refined carbohydrates, limits alcohol, and relies on food for nutrients can aid in preventing cancer.

IMPLICATIONS FOR NURSING PRACTICE

Nurses can take the lead to educate patients and families about weight management and diet and to promote adherence to nutritional guidelines.

Childhood and Adolescent Cancer Survivors’ Knowledge of their Disease and Effects of Treatment

Most children diagnosed with cancer will become survivors of their disease. However, a large number of these children may be at risk for the development of late complications. It is not clear whether these survivors and their families are aware of their treatment history including diagnosis, treatment, and the late complications of their treatment. The purpose of this needs assessment was to ascertain survivors’ knowledge of their disease, the various treatment modalities, and whether they were aware of their individual risks for developing late complications of their treatment. A brief six-item questionnaire was developed to determine survivors’ knowledge of their cancer treatment and to be completed just before at their survivor visit. A total of 141 survivors completed this questionnaire. The mean age at diagnosis was 6.8 years, and the median age at the time of this assessment was 16 years. Although all of the subjects stated they knew their disease, only 84% (n = 118) listed their diagnosis. The majority of the survivors knew they received chemotherapy, but only 50% were able to list one or more specific drugs they received. Further lack of knowledge was also evident for survivors who received radiotherapy. The results of this assessment represent a lack of knowledge especially of the survivors’ individual risk for developing late complications of their therapy. Education about late complications of therapy should be introduced early and often such as at diagnosis, within months of the completion of therapy, and during every survivor clinic visit. A complete treatment summary should be provided to all survivors. This summary should include the survivors’individual risks for developing late complications and how their own health behaviors may influence the development of these late complications.

Protective Isolation in Hemopoietic Stem Cell Transplants: A Review of the Literature and Single Institution Experience

Princess Margaret Hospital for Children, Perth, Western Australia, is a pediatric bone marrow transplant center. This center has both laminar flow and HEPA- (high-efficiency particulate air-)filtered rooms for children under-going allogeneic and autologous transplantation. HEPA-filtered rooms on negative pressure are used to nurse oncology children with infectious diseases. Over the winter months of 2001, there was an increased demand for single rooms for children with infectious diseases. Over the same period, a number of transplants were planned. Consequently, to guide practice decisions, a review of the literature and a survey of nursing practice in Australian and North American pediatric oncology units were undertaken. Findings showed that protective isolation measures such as positive-pressure single rooms, low microbial diets, and strict hand washing should be used only for children requiring allogeneic transplants. Use of other isolation measures were found to be of no added value for transplantation. As autologous transplants are increasingly performed in outpatient clinics, these children should not require the same level of protective isolation.

Assessment of Chemotherapy-Induced Oral Complications in Children With Cancer

Objective: To assess children with cancer for oral complications using the oral assessment guide (OAG) and ascertain the efficacy of an oral hygiene care regimen in children undergoing chemotherapy and at 1 to 2 weeks postchemotherapy administration.Methods: Thirty pediatric cancer patients with either leukemia or lymphoma were randomly selected from 3 medical centers. A quasi-experimental design was used to evaluate the difference between pre- and post-oral hygiene care. Descriptive and inferential statistical techniques were used to analyze the data. The interrater agreement between the nurse and the dentist was calculated using a Kappa score. A paired t test was to examine the difference between preand post-oral hygiene care regimen.Results: The OAG scores ranged from 8 to 24. The higher the score, the more severe the oral complications. Ninety-six percent of the participants had a score [. greaterequal] 9, on the pre-test, 26. 7% had an OAG score [. greaterequal] 12. Oral complications included ulcerated mucous membranes, dry lips, deeper or raspy voice, and oral debris. No scores were [. greaterequal] 12 on the OAG following the posttest. The oral hygiene care regimen significantly improved oral assessment among patients (P <. 05).Conclusions: The authors postulate that the OAG and oral hygiene care regimen may be clinically useful in improving oral assessment and hygiene in children with cancer during and after chemotherapy, thus decreasing associated infection and enhancing patient comfort.

Adventure Therapy: A Mental Health Promotion Strategy in Pediatric Oncology

In adventure therapy (AT), health professionals and adolescents with cancer come together to explore the wilderness of nature. One goal of this therapy is to encourage the adolescents to enhance their self-concept as part of an overall physical, cognitive, emotional or spiritual, social and psychological, or developmental rehabilitation that promotes health. The adolescents with cancer who participate in AT also learn about themselves through self-evaluation, self-exploration, self-reevaluation, self-acceptance, and self-realization. Mental health promotion (MHP) is considered a perspective and a strategy to promote health. An AT experience could be an example of an MHP initiative in which nurses can take a leadership role in participating, and further investigating, the health effects of AT on adolescents with cancer.

Programmed Death-1 Inhibition in Cancer With a Focus on Non-Small Cell Lung Cancer: Rationale, Nursing Implications, and Patient Management Strategies

BACKGROUND

Programmed death-1 (PD-1) immune checkpoint inhibitors are novel immuno-oncology agents. Unlike chemotherapy or targeted agents, which inhibit tumor cell proliferation or induce tumor cell death, immune checkpoint inhibitors are designed to stimulate a patient's own immune system to eliminate tumors. As a result of their mechanism of action, PD-1 pathway inhibitors are associated with adverse events (AEs) with immunologic etiologies, termed immune-mediated AEs (imAEs). These include skin and gastrointestinal AEs, and endocrine, hepatic, renal, and respiratory AEs, including pneumonitis. Most imAEs can be effectively managed with treatment interruption/discontinuation and/or steroids or other immunosuppressive agents. A specialist consult may be required in some cases, and endocrine imAEs may require permanent hormone replacement therapy.

OBJECTIVES

This article provides an overview of PD-1 inhibitors, including the potential mechanism of action, key clinical trial data, and strategies for managing patients who may receive PD-1 inhibitors for the treatment of non-small cell lung cancer.

METHODS

Information in the article comes from PubMed literature searches and the author's experience with these agents in clinical trials.

FINDINGS

Oncology clinicians must thoroughly assess baseline functioning and symptoms and be vigilant for imAEs, which require prompt diagnosis and management. A good understanding of the clinical profile of PD-1 pathway inhibitors is instrumental in helping clinicians manage patients receiving these new therapies.

Factors Influencing Nurses' Use of Hazardous Drug Safe-Handling Precautions

PURPOSE/OBJECTIVES

To identify factors associated with oncology nurses' use of hazardous drug (HD) safe-handling precautions in inpatient clinical research units.
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DESIGN

Descriptive, cross-sectional.
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SETTING

The National Institutes of Health Clinical Center in Bethesda, Maryland.
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SAMPLE

115 RNs working on high-volume HD administration units. 
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METHODS

Survey data were collected online using the Hazardous Drug Handling Questionnaire. Data were analyzed using descriptive statistics and multiple regression analysis.
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MAIN RESEARCH VARIABLES

Exposure knowledge, self-efficacy, barriers to personal protective equipment use, perceived risk, conflict of interest, interpersonal influences, workplace safety climate, and total mean HD precaution use.
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FINDINGS

Participants demonstrated high exposure knowledge, self-efficacy, perceived risk, interpersonal influences, and workplace safety climate. Participants demonstrated moderate barriers and conflict of interest. Total mean HD precaution use proved highest during HD administration and lowest for handling excreta at 48 hours. Average patients per day significantly influenced total HD precaution.

CONCLUSIONS

Despite high exposure knowledge, barriers to personal protective equipment use and conflict of interest may contribute to reduced adoption of personal protective practices among oncology nurses.
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IMPLICATIONS FOR NURSING

Hospital and unit-specific factors captured by the predictor variables could contribute to institutional HD policy.

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