CANO 2005 Conference
Keynote Presentations
Keynote I
Life in the Balance
Kendrick Lacey, MD
Author, “Flu Shot”
Ever get the feeling that life is leaving you behind? Ever snap at your spouse or friend for something that’s actually your
own fault? Ever want to run away to a deserted island? Ever feel that even one more tiny request for your time, will drive
you to scream into your purse, or will leave you drooling on the floor?
Dealing every day with cancer and death, suffering and despair, demands and deadlines, can leave us all with our own
sanity hanging by a thread. We cannot provide the best possible care for those who depend on us, unless we are able to
weather the emotional storm that threatens to wash us away; and that storm is there, if not today then tomorrow. Your
own well being, your own professional career, and in some cases your own life may hang in the balance.
There is no guaranteed, certified cure for the stresses that bellow at us from behind every demand in our lives; but
adding a little balance in your life can buoy you up when you’re feeling swamped.
*************************************************
Avez-vous jamais l’impression que le train de la vie vous a laissée en route? Avez-vous déjà manqué de patience envers
votre époux ou un de vos amis pour quelque chose dont vous étiez en fait responsable? Vous arrive-t-il de vouloir vous
enfuir dans une île déserte? Sentez-vous parfois que si quelqu’un exigeait une partie aussi infime soit-elle de votre
temps, vous alliez exploser et « péter les plombs »?
Faire face, jour après jour, au cancer, à la mort, à la souffrance et au désespoir, aux demandes et aux échéances, peut
nous laisser à deux doigts de devenir complètement fous. Nous ne pouvons pas fournir des soins optimaux aux patients
qui dépendent de nous à moins d’être capables de tenir le coup face à la tempête affective qui menace de nous
submerger. Et si cette tempête n’est pas là aujourd’hui, elle pourrait fort bien l’être demain. L’équilibre peut se rompre
et votre propre bien-être, votre propre carrière et, dans certains cas, votre propre vie peuvent être en jeu.
Il n’existe aucun remède garanti à 100% pour les stresseurs qui se cachent derrière chacune des demandes dont nous
sommes assaillis dans la vie. Mais en ajoutant un peu d’équilibre à votre vie, vous vous sentirez maintenue à flot
lorsque vous avez l’impression d’être emportée par le courant.
Keynote II
Nursing Presence: a Powerful Imprint
Presented by Sue Ness on behalf of Beth Sparks, RN, BScN, MN
Have you ever wondered why it is that you really connect with certain people and that you may meet them years later
and they will remember you and say something like: “I never forgot you: you made such a difference in my life when I
was sick”. As a nurse and a consumer of health care, I have had the privilege of being cared for by nurses who have left
a lasting imprint in my heart, mind and soul. It was not what they did for me but how they did it during the provision of
care. This leads me to conclude that it is not the tasks we do for individuals in health care that make a difference to them
but rather, the way we are with them when we carry them out.
Illness usually makes us reassess our priorities in life and see things from a different perspective. “The death rate is very
low from dust on the piano”, is one of my favorite new expressions and serves me well as I undergo chemotherapy and
continuing health challenges. Humor is an integral part of living and has amazing healing properties, to which we can all
attest. I will share with you, nursing strategies, which can make a profound difference to individuals as they navigate the
health care system. I will also touch on the comments of your planning committee “that time can erase many things, but
it can never erase the caring and enduring friendships we share with others”.
*************************************
Vous êtes vous déjà demandé pourquoi il arrive qu’un contact étroit se noue entre vous et certaines personnes dès que
vous vous rencontrez pour la première fois et que quand vous les revoyez plusieurs années plus tard, elles se
souviennent très bien de vous et vous disent : «Je ne vous ai jamais oubliée; vous avez fait une telle différence pour moi
lorsque j’étais malade.» En tant qu’infirmière et que consommatrice de soins de santé, j’ai eu le privilège d’avoir été
soignée par des infirmières qui ont laissé leur marque durable dans mon cœur et dans mon âme. Lorsqu’elles
dispensaient les soins, ce n’était pas ce qu’elles faisaient pour moi qui comptait, mais bien la manière dont elles le
faisaient. Cela m’amène à conclure que ce ne sont pas les tâches que nous effectuons pour le compte de nos clients qui
font une différence pour eux, mais plutôt la manière dont nous nous comportons avec eux lorsque nous les
accomplissons.
«Le taux de décès dû à l’accumulation de poussière sur le piano est très bas» est une des nouvelles expressions que je
me suis inventées, que j’affectionne et qui me sont des plus utiles au moment de subir mon traitement de chimiothérapie
et de faire face à mes défis de santé continus. L’humour fait partie intégrante de la vie et il possède d’incroyables
propriétés curatives, et je suis là pour le prouver. Je vais partager avec vous des stratégies infirmières qui peuvent faire
une immense différence pour les personnes qui cheminent à travers le système de soins de santé. Je vais également
aborder le commentaire de votre comité organisateur selon lequel « le temps efface bien des souvenirs, mais il ne peut
pas effacer la sollicitude et les amitiés durables que nous partageons avec les autres. »
Keynote III
The Images of Oncology Nursing: A Lasting Imprint
Nancy Guebert RN, BSN, MCEd
It has been said that nursing is a powerful experience that is based upon the interactions between the nurse, the patient
and the family. It is the time when we give our best each and every day; where we experience moments of inspiration
and innovation.
It is through the teachings of our patients and families that we are taught many valuable lessons and where we are
given the tools that we need everyday. It is where we find and experience the meaning of courage and strength; where
the purpose of oncology nursing is made real. It is through these interactions that we create the images of oncology
nursing.
Utilizing art and music and based upon my personal journey as an oncology nurse, a lasting image of oncology nursing
will emerge with the hope that it will be forever imprinted on our hearts and minds.
******************************************************
On dit parfois que les soins infirmiers constituent une expérience forte qui repose sur les interactions entre l’infirmière, le
patient et les proches. Ce sont les moments où nous donnons le meilleur de nous-mêmes jour après jour; lorsque nous
éprouvons des moments d’inspiration et faisons preuve d’innovation.
Nos patients et les membres de leur famille nous permettent d’apprendre de précieuses leçons et nous donnent les outils
dont nous avons besoin chaque jour. C’est auprès d’eux que nous trouvons le sens des termes « courage » et « force »
et que nous les éprouvons; c’est auprès d’eux que la raison d’être des soins infirmiers en oncologie se concrétise. C’est
par le biais de ces interactions que nous créons les images des soins infirmiers en oncologie.
Je vais faire appel à des oeuvres artistiques et musicales et mettre à profit mon cheminement personnel à titre
d’infirmière en oncologie pour faire naître une image durable des soins infirmiers en oncologie en espérant qu’elle restera
gravée dans nos cœurs et nos esprits.
2
17th Annual National CANO Conference · Moncton · October 2-5, 2005
Abstracts
WORKSHOP I
BULLYING AND INTIMIDATION IN THE WORKPLACE –
HOW TO RECOGNIZE AND HOW TO RESPOND
WORKSHOP II (Abstract 1 of 3)
HELPING CANCER PATIENTS MANAGE FATIGUE: CASE
ILLUSTRATIONS
Patricia Benjaminson, RN, CON(C); Kristie Morydz, RN, BN,
CON(C); CancerCare Manitoba, Winnipeg, Manitoba
Lois Dumenko-Russell, RN, BN, CON(C); Terry Kelly, RN, BScN,
CON(C); Tom Baker Cancer Centre, Calgary, Alberta
Nurses are increasingly aware of the detrimental and long lasting effects of
workplace bullying. “(Bullying) affects staff absenteeism, turnover,
productivity and morale, as well as patient care.” (Sweet 2005) Nurses
who are subjected to intimidation and bullying become poor advocates.
Some may even leave the profession of nursing altogether. Workplace
bullying can affect the meaningful relationships that are important to job
satisfaction. Ultimately the patients and families can be affected by poor
job satisfaction, as it results in lack of job interest and loss of experienced
staff. Randle (2003) states, “A clear relationship exists between nurses’
self-esteem and the delivery of patient care” (p. 400). The difficulty with
bullying in the workplace is two-fold; those who experience the behavior do
not report or confront the problem and those who are witness to it turn a
‘blind-eye’ (Jackson, Clare & Mannix, 2002). Job satisfaction and reduced
workplace stress are important factors in the retention of nurses. In
oncology particularly, there is a lack of experienced oncology nurses and
retention of nurses and ensuring job satisfaction should be a priority.
Sengin (2003) states, “relationships with co-workers and supervisors, team
work, as well as collaboration with physicians in decision-making about
patient care are important correlates of job satisfaction” (p. 317). The first
anti-bullying law in North America came into effect in June 2004 when
Quebec amended its Labour Act to deal with psychological harassment in
the workplace. The Commision des norms du travail states “one in ten
Quebec workers has been the subject of harmful bullying, intimidation or
belittlement by a boss or co-worker”. (Canada Safety Council 2004)
This workshop will explore how to recognize bullying and its consequences.
We will discuss the nurses’ process of working through and recovering from
bullying and the impact on the workplace environment and nursing morale.
We will explore the tools required to conquer the ongoing detrimental
behaviour that continues through each generation of nurses.
Fatigue is the most prevalent symptom during cancer therapy and
many oncology patients experience post treatment chronic fatigue
for months or years following therapy. Case studies of typical
oncology patients will be discussed including their fatigue
presentation, interventions and outcomes. The first case discusses
the situation of a 45 year old female breast cancer patient on FEC
chemotherapy. This patient experienced excessive severe fatigue
during chemotherapy due to negative lifestyle changes, which
accompanied her reaction to her breast cancer diagnosis. The
second case presents a 53 year old male with chronic fatigue two
and a half years following allogeneic blood stem cell transplant for
diffuse large cell lymphoma. The third case profiles a 76 year old
female with multiple myeloma who had been unable to leave her
home for one year due to severe, debilitating fatigue. Symptom
screening tools, including the Brief Fatigue Inventory and the
Edmonton Symptom Assessment Tool, will be used to demonstrate
initial symptom assessments and outcomes. These cases illustrate
the variety of patient fatigue presentations and the severity of the
impact of fatigue for people with cancer. Patient reporting and the
use of symptom assessment tools, demonstrate the effectiveness
of nurse provided fatigue management education and strategies for
cancer patients.
WORKSHOP II (Abstract 2 of 3)
BUILDING TOWARDS THE FUTURE: A NURSE
FATIGUE CLINIC
RUN
WORKSHOP II (Abstract 3 of 3)
AND YOU THINK YOU’RE EXHAUSTED:
MANAGEMENT FOR CANCER PATIENTS
FATIGUE
Lois Dumenko-Russell, RN, BN, CON(C); Terry Kelly, RN, BScN,
CON(C); Tom Baker Cancer Centre, Calgary, Alberta
Lois Dumenko-Russell, RN, BN, CON(C); Terry Kelly, RN, BScN,
CON(C); Tom Baker Cancer Centre, Calgary, Alberta
For many years in oncology fatigue was accepted as a part of the
cancer experience. As more patients were cured, and cancer was
recognized as a chronic disease, improved symptom management
was crucial to quality of life. Comprehensive pain and symptom
control clinics have been developed over the last two decades but
until recently fatigue was the forgotten symptom. Fatigue has
been recognized as the most distressing symptom in people with
cancer impacting the physical, emotional, cognitive, financial and
social aspects of patients’ lives. Patients most affected include
those with excessive fatigue experienced with cancer treatments,
post treatment chronic fatigue and those with moderate to severe
symptoms contributing to fatigue such as anemia, insomnia,
depression and deconditioning. A nurse run Fatigue Management
Clinic has been developed to assist patients experiencing cancer
related fatigue to manage and minimize their fatigue by providing
comprehensive assessments, interventions and follow up care.
Our Fatigue Management Clinic will be presented including the
program purpose, the Nurse Coordinator role, referral pattern to
the program, patient statistics, areas of intervention and future
directions. Oncology nurses are the best health professionals to
utilize evidence-based practice to assist oncology patients to
manage fatigue, recover from cancer therapy and/or learn to live
with chronic disease.
Fatigue is now recognized as the leading symptom requiring
management in oncology care. Patients report fatigue to be the
most distressing symptom associated with cancer and it’s
treatment, more distressing even than pain or nausea and
vomiting, which, for most patients can be managed with
medication (Ashbury et al, 1998). Fatigue though remains a
symptom often unaddressed. The NCCN Practice Guidelines (2004)
defines cancer related fatigue as an unusual, persistent, subjective
sense of tiredness related to cancer or cancer treatment that
interferes with usual functioning. Fatigue is nearly a universal
symptom with cancer treatment and for patients the manifestations
of cancer related fatigue are numerous.
The Winningham
Psychobiological-Entropy Model of Functioning demonstrates the
complexity of fatigue in people with cancer. This presentation
discusses how cancer patients describe their fatigue, the impact on
patients, factors contributing to fatigue, a comprehensive fatigue
assessment and nursing interventions to assist patients to handle
their fatigue and maximize their wellness.
WORKSHOP III
CANO RESEARCH COMMITTEE WORKSHOP
WORKSHOP IV
SEXUAL HEALTH IN BMT
Learning how to read and appraise the value and clinical
significance of research for clinical practice
Joan Hamilton, MScN; Deborah McLeod, RN, MN, PhD; Capital
Health QEII Cancer Care Program, Halifax, Nova Scotia
Michelle Lobchuck1, RN, PhD; Natasha Murdoch2, RN, BSN,
CON(C); 1 Faculty of Nursing, University of Manitoba; 2 Nursing
Education Program of Saskatchewan, SIAST Kelsey Campus,
Saskatoon
Cancer and its treatment have the potential to severely impact how a
person experiences him or herself as a sexual being. Such changes may
have profound implications for physical and psychosocial wellbeing. One
treatment that commonly impacts all aspects of sexual health is blood
and marrow transplantation (BMT). Studies suggest that many patients
and their partners want help with this area of their experience but
hesitate to ask. Health professionals often do not raise the questions,
expecting that patients will raise the issues if they have concerns. The
result may be a conspiracy of silence with neither patients nor health
professions raising sexual health issues. Health professionals also
identify a sense of uncertainty and lack of skill in talking with patients
and their partners about their sexual relationship.
The purpose of this presentation is to provide oncology nurses
with beginning appraisal skills in reading research literature and
evaluating study recommendations for their value in changing
clinical practice. In particular, as part of evaluating research
studies, critical issues to address when considering the use of
study recommendations in clinical practice will be considered. For
example participants will consider whether the results are
impressive considering the risks and costs to patients, meaning
and value to patients, relevance to one’s own clinical population,
safe and effective use of the recommended change in practice, as
well as organizational, logical, financial, or time barriers. As a
basis for discussion, participants will be asked to read and
appraise both a quantitative and qualitative research article using
a reference provided by the facilitators.
WORKSHOP V (Abstract 1 of 2)
DEVELOPING AN INTRASPINAL ANALGESIA PROGRAM
FOR COMPLEX CANCER PAIN IN TERTIARY CARE AND
COMMUNITY SETTINGS
Cindy Shobbrook, RN, MN, ACNP, CON(C); Allyson Clarke,
RN, MSc(A); Princess Margaret Hospital, University Health
Network, Toronto, Ontario
Intraspinal analgesia (IA) is routinely used to manage procedural
pain in acute-care settings however, it is rarely used to manage
complex cancer pain in the home setting. An IA program was
established at a tertiary cancer center to enable patients to live at
home with acceptable pain control.
This workshop is designed to address some of these gaps. We plan to
focus on both content and skill development. Participants will have the
opportunity to discuss the current literature regarding the physical and
psychological sexual health changes that can occur with transplant,
along with the interventions that may be useful. Teaching guidelines
will be reviewed with copies provided to group participants. The second
half of the workshop will focus on skill development with dyadic and
small group exercises. Case examples will be presented for practice and
discussion. Topics addressed will include such issues as maintaining
intimacy and a satisfying sexual relationship in the face of physical and
psychosocial constraints, dealing with anxiety, lack of desire,
dyspareunia, menopausal symptoms and body image. The emphasis
will be placed on opening up conversations that allow assessment of
the difficulty to occur and providing sexual health education. A selected
bibliography for further reading list will be provided.
WORKSHOP V (Abstract 2 of 2)
LEARNING FROM TRAGEDY: PRACTICE RISK ISSUES FOR
INTRASPINAL LINES AND COMPLEX CANCER PAIN
Cindy Shobbrook, RN, MN, ACNP, CON(C); Princess Margaret
Hospital, Toronto, Ontario
This presentation examines the use of intraspinal analgesia as a
novel modality to control complex cancer pain and explores
challenges in achieving effective communication around patient
care between tertiary and community settings. Through
examination of a case study involving the untimely death of a
patient, this presentation explores critical issues in communication.
The IA program evolved in three stages. The first included
establishing identification criteria for patients with complex pain.
Admission to a tertiary cancer centre in Toronto facilitated
catheter insertion and adjustment of intraspinal medications. This
stage necessitated development of an IA education program for
nurses. The second stage involved developing and coordinating
community resources to monitor and support patients after
discharge. Liaison with community stakeholders involved
negotiating commitment from regional providers early in the
assessment process so that upon discharge, patients could access
specialized care in the home. The third stage arose from
increasing IA patients cared for in the community resulting in
regional dialogue with home health care, emergency medical
service and community hospital providers to respond to IA
complications.
In November 2004, a woman with metastatic cancer and
intractable pain was admitted to a large cancer center for insertion
of an intrathecal catheter to control pain. Following an uneventful
10-day admission, she was discharged home with support of skilled
nursing and medical personnel. Two weeks later, she died in her
local community hospital -- not from progressive disease or
complications with the catheter or infused medication, but from
misidentification of the intrathecal line. The autopsy report
disclosed cause of death to be from infusion of intravenous fluids
and anti-seizure medications into the intrathecal line. Clinical
documentation from community, emergency medical service, and
community hospital providers identified the intrathecal line to be
one of epidural, intravenous, and central venous, and intravenous
origin.
With planned coordinated teamwork, tertiary and community care
providers can achieve acceptable cancer pain control with IA in
the home setting and respond to complications as they arise.
In reviewing this case study, opportunities for enhancing systems
of communication, education and coordination of tertiary and
regional resources will be examined.
WORKSHOP VI
ACHIEVING QUALITY IN CANCER CARE: MEETING THE
CHALLENGES OF IMPLEMENTING CANO STANDARDS AND
COMPETENCIES IN NURSING PRACTICE
Doris Howell1, RN, PhD; Lynne Penton, RN, MN, CON(C); Shari
Moura, RN, MN, CON(C); 1University Health Network, Toronto,
Ontario
Standards of practice are increasingly viewed as important for
ensuring patients and their families receive consistent high quality
care. The Canadian Association of Nurses in Oncology Standards
of Care for Individuals and Their Families: Roles and
Competencies were found in an environmental scan conducted by
the Canadian Strategy for Cancer Control to meet all the principles
of the Alpha International Principles for Health Care Standards
(ISQua, 2004; Canadian Council on Health Services Accreditation,
2004). Yet, many cancer care organizations have not yet
implemented the CANO standards and competencies.
Implementing standards in organizations and facilitating their
application and uptake into practice can be extremely challenging.
This workshop will focus on pragmatic evidence-based strategies
for implementing change in practice settings using the standards
as a model for application of the techniques. At the end of the
workshop session learners will be able to: (1) demonstrate
increased knowledge of the CANO standards and their use in
facilitating high quality cancer care; (2) apply specific practical
and evidence-based strategies for implementing practice change
using the Standards as the model; (3) introduce a conceptual
model that allows participants to visualize how the standards and
competencies link to the roles of generalist, specialist and
advanced oncology nurses.
SCHERING / CANO LECTURE
TOUCHED BY A NURSE: THE IMPRINT OF EXEMPLARY
ONCOLOGY NURSING CARE
HELEN HUDSON LECTURE
LEAVING OUR IMPRINTS: AN EXPLORATION
THERAPEUTIC NURSE-PATIENT RELATIONSHIP
Beth Perry, RN, PhD; Athabasca University, Edmonton, Alberta
Cathy Kiteley1, RN, MSc, CON(C), CHPCN(C); Dorothy Vaitekunas2,
RN, MN, ACNP, CON(C), CHPCN(C); 1 Credit Valley Hospital,
Mississauga, Ontario; 2 Mount Sinai, Toronto, Ontario
This research based presentation examines the relationship
between exemplary oncology nursing practice and professional
fulfillment. What inspires nurses to choose oncology and
subsequently what gives them impetus to continue in this field?
To answer this question, oncology nurses were invited to recall
moments in their careers when they were satisfied that they had
chosen the “right” career. Data, in narrative form, were collected
through an innovative online research technique called web-based
narrative exchange. Submissions were analyzed using three
approaches, narrative analysis (Priest, Robert & Woods, 2003),
poetic interpretation (van Manen, 1990) and photovoice
(Woolrych, 2004). This multi-level analysis using stories, poems
and photographs furnishes evidence and provides a participatory
means of sharing intimate human experience.
Findings reveal that oncology nurses who provide excellent care,
and make strong connections with their patients, are also usually
very well satisfied with their careers. Specifically, nurses provide
exemplary care and report attaining professional fulfillment when
they achieve connection, affirm value, enable hope and help
patients finding meaning. These themes, along with the
overarching theme of joint transcendence are described in this
presentation. Perhaps this talk will reawaken memories of similar
experiences thus enhancing confidence, self-esteem and energy in
the nurses present affirming in them that they are unquestionably
leaving an imprint.
INTO THE
Oncology nursing aims to promote physical and psychosocial well-being
of individuals and families at risk for, or living with a life threatening
illness. A basic component of nursing practice is the nurse-patient
relationship (Canadian Nurses Association, 2002). This relationship has
been shown to have a positive impact on individuals’ wellbeing as they
journey through their cancer experience (Herth,1995).
While the nurse-patient therapeutic relationship is fundamental to
nursing care and may be quite subtle in its transaction, it is a complex
phenomena with every encounter being meaningful and impacting both
the patient and nurse. Reflecting on the nature of this relationship can
facilitate a richer and deeper awareness of the unique contribution
oncology nurses make in the lives we touch and are touched by.
This presentation will explore the therapeutic nurse patient relationship
in oncology nursing. The authors intend to facilitate self reflection and
increased awareness of both the art and science of the therapeutic
relationship. In particular, qualities of the nurse patient relationship, the
importance of communication, both verbal and nonverbal and the use
of silence will be explored. We will introduce the notion of coaching, an
intentional way of being with patients which in turn facilitates autonomy
and self efficacy. We will incorporate theory, evidence, experiential
learning along with story telling, music, poetry and video images to
convey our message.
I-01-A
FATIGUE: WHAT IT IS AND WHAT IT IS NOT
Karin Olson, RN, PhD; Faculty of Nursing, University of Alberta,
Edmonton, Alberta
Early work by our research group identified 4 behavioural patterns
that distinguish individuals who experience fatigue from those who do
not, despite common treatment and disease profiles. More recently
we reconceptualized fatigue by comparing the findings of studies of
fatigue in populations experiencing it due to illness (chronic fatigue
syndrome, depression, cancer), work (shift work), and leisure
activities (recreational distance runners). We are now completing
studies using ethnoscience and grounded theory designed to refine
our conceptualization of fatigue. This process has provided an
opportunity to distinguish fatigue from tiredness and exhaustion and
to create a framework that could facilitate the identification of
linkages between the behavioural markers of these three concepts
and potential physiological mechanisms. In this paper, I will present
our final definitions of tiredness, fatigue, and exhaustion and our
theoretical model, and outline work underway to link these concepts
to potential physiological markers. I will also outline the ways in
which we intend to use these behavioural and physiological markers
to develop and test nursing interventions.
I-01-B
CANCER-RELATED FATIGUE: WHAT IS A BREAST CANCER
SURVIVOR’S PERSPECTIVE?
Michelle Anglehart, RN, BN, MN (candidate), CON(C); South East
Health Care Authority, Moncton,
The experience of fatigue for breast cancer survivors is one of the
most common and debilitating symptoms of breast cancer
treatment. While debilitating fatigue during cancer treatment may
be expected, impairment of functional status beyond treatment is
often unexpected by the woman, her family and even health care
professionals. This study was undertaken to learn how this societal
taken-for-granted knowledge that cancer-related fatigue is timebound to cancer treatment, contributes to the phenomenon of
cancer-related fatigue following treatment.
Van Manen's (1997) hermeneutic phenomenological approach to
human science is used to describe the phenomenon and develop an
interpretation of the meaning of living with fatigue. Ten interviews
were completed with five breast cancer survivors with cancerrelated fatigue following the completion of treatment. This
interpretation is currently being developed and will be complete by
the summer of 2005.
The intent of phenomenological research is to develop an
interpretation that transforms our understanding of the
phenomena. Women’s stories will be used in the interpretation to
help us understand the taken-for-granted knowledge about the
experience of living with fatigue. Such an understanding may help
nurses become more empathic and supportive.
I-01-C
THE DEVELOPMENT OF A FATIGUE COLLABORATIVE CARE
PLAN
Kathy Coulson1, RN, MScN, ACNP, CHPCN(C); Diane Batchelor2, RN,
MScN, ACNP, CON(C); Elizabeth Jeffery1, RN, MSc; Sharon Preston3, RN;
1Kingston General Hospital, Kingston, Ontario; 2Diane Batchelor Advanced
Practice Nurse Cancer Care, Gananoque, Ontario; 3 Kingston, Frontenac,
Lennox & Addington Palliative Care Integration Project, Kingston, Ontario
Fatigue continues to be a prevalent and disruptive symptom for cancer
patients. There are multiple etiologies of cancer-related fatigue including
co-morbid conditions, the physical, psychological and spiritual distress of
cancer, and the consequences of cancer treatment.
When confronted with a multiplicity of issues, fatigue often becomes a
lesser priority. Frequently health care professionals view fatigue as a
“normal” consequence of treatment or the disease process. Failing to
address fatigue can have a major impact on quality of life. In a needs
survey of cancer patients in South Eastern Ontario, 19% stated that
fatigue was an under addressed issue.
Reducing the severity of fatigue requires a team approach that involves
adequate nutrition, correction of anaemia, pain and symptom
management, exercise, and counselling. The nurse, social worker,
nutritionist, physician and physical therapist should all play a role. Using an
interdisciplinary approach, a Collaborative Care Plan (CCP) for Fatigue is
under development based on current best practice and a review of the
literature. A representative group of health care professionals from across
the region, led by a CCP Consultant, Project Manager and Advanced
Practice Nurse work together to achieve consensus and make the plan
transferable to the practice setting. This presentation will address the
development and content of the CCP and plans for implementation.
I-02-A
CANCER PATIENT NAVIGATOR: AN INNOVATIVE NURSING
ROLE THAT ENHANCES INTEGRATION, COORDINATION
AND CONTINUITY OF CARE FOR CANCER PATIENTS
Charlene Porter1, RN, BScN, CON(C); Joanne Cumminger2, RN,
BScN, CON(C); Darolyn Walker3, RN, BScN, CON(C); 1St. Martha’s
Regional Hospital, Antigonish, Nova Scotia; 2Pictou County Health
Authority, New Glasgow, Nova Scotia; 3South West Health
Authority, Yarmouth, Nova Scotia
Cancer Patient Navigator is a multi skilled nursing role that guides,
supports and educates cancer patients, their families and health
professionals throughout the cancer continuum, facilitating timely
access to quality, standard cancer care in a culturally sensitive
manner.
Patients, families and health care professionals in Nova Scotia
identified the need for improved coordination, information and
support from the time of cancer diagnosis. Oncology Nurses are in
a position to identify the extensive range of physical, psychological,
social, emotional, and practical needs of cancer patients and with
the learned navigation skills, they can strive to ensure that cancer
patients have access to timely information, coordinated care and
community supports.
This presentation will discuss the key findings and conclusions of
the peer- reviewed evaluation conducted on the patient navigator
role. It will discuss how navigators have had a positive impact and
resulted in improved community cancer care. The presenters will
show how navigators have become an important source of support
in dealing with the emotional turmoil, educational needs and
logistical challenges associated with cancer.
I-02-B
TAKING A PILOT TO FLIGHT: IMPLEMENTATION OF NURSE
LED CHANGES TO OUR AMBULATORY CLINIC
I-02-C
NURSING DOCUMENTATION DILEMMAS IN AMBULATORY
CANCER CARE DELIVERY: CHANGE IS GOOD!
Aldyn Overend, RN, BSN, CON(C); Bev Seguna, RN, BSN; Sylvia
Baillie, RN, CON(C); Maureen Ryan, RN, BSN, BA, CON(C); BC Cancer
Agency, Centre for the Southern Interior, Kelowna, British Columbia
Grace I. Bradish, RN, MScN, ACNP, CON(C); Lyn Kligman, RN,
MN/ACNP(C), CON(C); Glenda Hayward, RN, MScN; Gwen Abdallah,
RN, CON(C); Tara Johnston, RN, BScN, CON(C); Sue Kudirka, RN,
CON(C); Jill Ross, RN, CON(C); London Regional Cancer Program,
London Health Sciences Centre, London, Ontario
In 2004, nurses at the Centre for the Southern Interior struggled with
how to best align nursing resources with patient needs. A growing
number of patient referrals, additional oncologists and limited nursing
resources continue to challenge us. Within our current care delivery
model nurses know that patient needs are often unmet as there is
limited time for comprehensive assessment and care planning for
patients and their families. Over the past year several organizational
initiatives have been implemented into our ambulatory care unit
(ACU) to help support nurses in their practice allowing them time to
provide quality patient care.
Nurses initiated an evidence based pilot project to help identify those
patients at greatest risk and with highest care needs. This
presentation will discuss the pilot project, challenges faced in its
implementation and changes which occurred. In doing so, we will
elaborate on change agents, nursing assessment tools utilized and the
provincial nursing liaisons that occurred. Finally, we will talk about our
current position in the quest to deliver a higher quality level of nursing
care.
A chart audit (2003) of patient self-reported cancer-related
symptoms using the Edmonton Symptom Assessment Scale (ESAS)
revealed significant deficiencies in existing out patient
documentation processes. These included incongruity between
patient and nurse assessment and an absence of documented
interventions such as referral of patients with significant selfreported symptoms or patient and family education. After two
years of persistence, new and revised documentation tools have
been pilot tested in one disease site group (Lung) with anticipated
centre-wide implementation imminent.
Formatting has been carefully considered to be ready for eventual
integration within an Electronic Patient Record, currently in
development. A nursing committee working in consultation with
interdisciplinary partners, has created tools that condenses a
cancer treatment summary, medication profile, patient problems
list, interventions including education, and patient outcomes in one
convenient location in the patient’s ambulatory chart.
A summary of this project will be presented with results compared
to previous chart audit as reported at CANO 2003.
I-03-A
INFLUENCE OF HOSPITAL CHARACTERISTICS ON NURSES’ RESEARCH
USE
Greta Cummings, RN, PhD; Carole A. Estabrooks, RN, PhD; William K.
Midozi, MSc; Lars Wallin, RN, PhD; University of Alberta, Edmonton,
Alberta
There is an increasing awareness that organizational influences are
important to research uptake by nurses in the goal to achieving evidencebased practice. Our study objectives were to develop a theoretical model
of hospital characteristics that predict nurses’ research use and estimate
this model using databases reflecting four different contexts defined by the
PARIHS research implementation framework.
The sample was drawn from a census of nurses working in acute care
hospitals in Alberta. Three variables that operationalized PARIHS
dimensions of “context” (culture, leadership, and evaluation) were used to
sort cases into four mutually exclusive databases reflecting different levels
of context. Our theoretical model was then estimated four times using
structural equation modeling and the four datasets.
Hospital characteristics that had a positive impact on nurses’ research use
were control over practice, nurse-to-nurse collaboration, support for
innovation, and facilitation of research use. Less time to nurse and greater
emotional exhaustion led to less reported research use. Nurses working in
contexts reflecting positive culture, leadership and evaluation also reported
significantly more research use than nurses working in any contexts that
lacked any of three dimensions.
Our findings highlight the combined importance of culture, leadership and
evaluation to increase research use when creating and supporting
professional practice environments. The PARIHS model also is an
appropriate guide to implementing research into practice by focusing on
hospital characteristics that improve the contexts in which nurses work.
I-03-B
APPLICATION OF A NURSING WORKLOAD MEASUREMENT
SYSTEM IN AN AMBULATORY ONCOLOGY SETTING
Mary Bennett1, RN, BN, CON(C); Cindy Cummings Winfield,
RN, BScN, CON(C); Miriam Dobson, RN, BScN, CHPCH(C); 1Tom
Baker Cancer Centre, Calgary, Alberta
The transition in oncology care from inpatient to outpatient
settings, coupled with increased complexity of cancer treatments
has significantly impacted nursing workload in ambulatory
oncology. The use of patient visits as a measure of nursing
workload is no longer sufficient to forecast staffing levels or
validate budget requirements.
Five years ago a provincial nursing initiative was undertaken to
develop a nursing workload measurement system that captured
direct and indirect nursing activities in our outpatient clinics and
chemotherapy units. The workload form was interfaced with our
electronic scheduling system, which resulted in minimal time
necessary for nurses to complete and simplified data entry.
Ongoing audits were incorporated to validate the accuracy and
completeness of the workload data. The workload system has now
been adapted for use in other nursing subspecialty areas including
radiation therapy, bone marrow transplant and fatigue clinics.
This presentation will describe the process of developing the
workload system and provide examples of the workload forms used
in various practice settings. The monthly, quarterly and annual
reports that are generated will be discussed including how they are
used to monitor the volume and complexity of nursing care. In
addition, future plans for validating our methodology and assigned
times for each workload unit will be presented.
I-03-C
INDUCED
PERSPECTIVE-TAKING:
ASSISTING
FAMILY
CAREGIVERS
TO
ACHIEVE
ENHANCED
PERCEPTUAL
ACCURACY
ON
LUNG
CANCER
PATIENT
SYMPTOM
EXPERIENCES
Michelle M. Lobchuk1, RN, PhD; Jacquie D. Vorauer2, PhD ; Lesley F.
Degner1, RN, PhD; Dan Chateau 3, PhD; Donna Hewitt1, RN ; 1Faculty of
Nursing, University of Manitoba, Winnipeg, Manitoba; 2Department of
Psychology, University of Manitoba, Winnipeg, Manitoba; 3Biostatistics,
Community Health Sciences, Faculty of Medicine, University of Manitoba,
Winnipeg, Manitoba
In response comparability literature it is inferred that family caregivers are
reasonably good at “stepping inside the patient’s shoes” in order to
accurately respond to patient symptoms. To test this assumption, the
authors examined the effects of different perspective-taking instructions
that prompted 98 family caregivers to think about lung cancer patients’
symptoms in different ways. The two main aims were: (1) to estimate the
effects of a randomized, counterbalanced sequence of perspective-taking
instructional sets on caregiver accuracy scores for patient symptom
experiences and (2) to examine the influence of gender, the caregiver’s
personal history with a cancer diagnosis, and aspects of the ‘caregiving
relationship’ on caregiver judgment accuracy. There were no order effects
for four perspective-taking instructional sets on caregiver accuracy scores.
Findings suggested a superiority of instructions for caregivers to imagine
the patient’s perspective over imagining their own perspective in relation
to promoting caregiver responses that more closely approximated patient
self-reports. Self-oriented instructions produced caregiver responses that
were most discrepant from patient self-reports. While gender had no
significant effects on discrepancy scores, the degree of patient-caregiver
communication had a positive impact on decreasing the amount of
discrepancy by caregivers on patient symptom experiences.
I-04-C
BLAZING A TRAIL: INNOVATION IN NURSING PRACTICE
Colleen Valente, RN(EC), MN(C), CON(C), CHPCN(C); Thunder Bay
Regional Health Sciences Centre, Integrated Cancer Program,
Thunder Bay, Ontario
The provision of high quality health care for Canadian residents is the
primary focus of nursing in this country.
The demographics of Canada are changing. As Canadian residents
age, they will develop the diseases of aging, including cancer. Those
suffering from a cancer diagnosis in this country, represent a growing
number of patients with specialized, complex needs. There are not
enough oncology specialists to ensure that all the needs of cancer
patients are met, nor is it appropriate to invest the time of oncologists
in the more routine aspects of patient care. The provision of cancer
care requires the coordinated, collaborative approach that is the
strength of nursing practice. Nurse practitioners in oncology are
capable of improving the care of cancer patients and facilitating the
journey of cancer patients through the continuum of care. This
presentation will discuss the innovative application of the nurse
practitioner role in the provision of high quality cancer care.
I-04-A
EFFECT OF SPECIALIZED ONCOLOGY NURSES ON
CONTINUITY OF CARE, UNMET NEEDS AND QUALITY OF
LIFE IN COMMUNITY CANCER PATIENTS
Doris Howell1, RN, MScN, PhD; Jonathan Sussman2, MD; Kevin
Brazil 2, PhD; Tim Whalen2, MD; Nancy Pyette2, MSc; Daryl
Bainbridge2, MSc (candidate); 1 University Health Network, Toronto,
Ontario; 2Supportive Care Cancer Research Unit, Juravinski Cancer
Centre, Hamilton, Ontario
Individuals with cancer/families continue to report unmet needs
and difficulty accessing supportive care in the community. Research
has demonstrated that supportive care is fragmented resulting
problems in care coordination, psychosocial distress and poor
quality of life. Specialized oncology nurse models using theorydriven evaluation methods have demonstrated performance
objectives of care coordination. There is a need to evaluate if these
models improve health status outcomes. The focus of this paper is
to present the findings of a cohort longitudinal study designed to
examine the effect of specialized oncology nursing care on patientfocused outcomes. Outcomes measured in this community-based
sample of cancer patients were: care continuity, unmet needs,
therapeutic self-care, and quality of life. Patterns of health care
utilization in this patient population of community-based cancer
patients were also explored. Study results will be presented and
discussion will focus on health care policy implications and the
challenges of conducting community-based research in a seriously
ill cancer patient population.
I-05-A (Abstract 1 of 2)
A PHASED APPROACH TO DEVELOP NURSING INDICATORS
IN CANCER CARE
Esther Green1, RN, MSc(T), MScN(T); Janet Rush2, RN, PhD;
Margaret Fitch3, RN, PhD; 1 Cancer Care Ontario, Toronto, Ontario;
2
McMaster University, Hamilton, Ontario; 3Toronto-Sunnybrook
Cancer Program, Toronto, Ontario
With increasing demand for professional and financial accountability,
nurses have been challenged to delineate their contributions within the
system and in particular, demonstrate that the care is of high quality.
Nurses work within multi-disciplinary teams and outcomes directly
related to nursing interventions are often problematic to define. There is
a growing body of evidence that suggests that nursing contributions to
patient and health outcomes are identifiable. Much of this work is in
relation to hospital care, for example, the relationship of nurse staffing
and staff mix to patient safety and outcomes. However, there is
minimal work that has been completed to date in relation to the
identification of outcomes related to cancer patients in the ambulatory
environment.
Cancer Care Ontario has developed a framework and undertaken to
define beginning indicators through a process that involves systematic
review of the evidence. In March 2005, an Expert Panel consisting of
oncology nurses involved in practice, education and research came
together to begin the first phase of work in developing nursing
indicators in cancer care.
The purpose of this presentation will be to report on the first phase of
work, the results of the Expert Panel discussions and subsequent
consensus on the indicators and outline the next phases of work. We
believe that this work is meaningful for oncology nurses across Canada
and may provide impetus for inter-provincial discussion and
collaboration.
I-05-A (Abstract 2 of 2)
PARTICIPATIVE REGIONAL PLANNING: NURSES AS KEY
STAKEHOLDERS
I-05-B
ARE THERE QUALITY WORK
CANADIAN ONCOLOGY NURSES?
Esther Green1, RN, MSc(T), MScN(T); Janet Rush2, RN, PhD; Harry
Milne3, RN, MScN; 1Cancer Care Ontario, Toronto, Ontario; 2McMaster
University, Hamilton, Ontario; 3 London Regional Cancer Program,
London, Ontario
Debra Bakker1, RN, PhD; Michael Conlon2, MSc, PhD; Karin
Olson3, RN, PhD; Greta Cummings 3, RN, PhD; Lorna Butler4, RN,
PhD; Margaret Fitch5, RN, PhD; Esther Green6, RN, MSc(T); 1School
of Nursing, Laurentian University, Sudbury, Ontario; 2Northeastern
Ontario Regional Cancer Program, Sudbury Ontario; 3Faculty of
Nursing, University of Alberta, Edmonton, Alberta; 4School of
Nursing, Dalhousie University, Halifax, Nova Scotia; 5Cancer Care
Ontario, Toronto, Ontario
In January 2004, Regional Cancer Centres were integrated into host
hospitals. This, among other service delivery strategies, represented
a major shift in the model of cancer care in Ontario. Stakeholder
participation in shaping care that fit the provincial vision and goals
was central to the planning framework.
In the Southwest Region, nursing input was an essential element of
planning. A survey to obtain opinion about proposed changes was
conducted among attendees of an oncology nursing retreat on
professional practice (n = 63). A pre-retreat, 10-item survey was
distributed that asked nurses to rank and provide comments on key
issues. The response rate was 41/63 (65%).
The results were presented at the practice retreat, to stimulate
discussion, refine and validate the findings. There was a high level of
support for proposed regional strategies such as a one-number-tocall for oncology information, teamwork, partnerships, a
single oncology health record, and best practice guidelines.
This participative approach to planning demonstrated solid respect for
oncology nurses’ opinion, motivated these key stakeholders for
impending change, and fostered collaboration in the strategic
initiatives. The results of this work, including the Participative
Planning Framework, provide valuable information about process
engagement of oncology nurses that can be used by nursing leaders
and policy makers in building and sustaining a model of integration.
I-05-C (Abstract 1 of 4)
PROFESSIONAL
AUTONOMY
AND
DEVELOPMENT FOR ONCOLOGY NURSES
PROFESSIONAL
Dauna Crooks1, RN, DNSc, PhD; Esther Green2, RN, MHSc; Mary
Fergeson-Pare3, RN, PhD; Doris Howell3, RN, PhD; Debra Bakker4, RN,
PhD; Joan Tranmer5, RN, PhD; Pat Sevean6, RN, PhD (candidate);
Margaret Fitch 7, RN, PhD; Laurel Plewes7, BScN; Shirley Sharkey8,
RN; Nancy Lefevre8, RN, MScN; 1Hospital for Sick Children, Toronto,
Ontario; 2 Cancer Care Ontario, Toronto, Ontario; 3 University Health
Network, Toronto, Ontario; 4Laurentian University, Sudbury, Ontario;
5
Queen’s University, Kingston, Ontario; 6 Lakehead University,
Thunder Bay, Ontario; 7Toronto-Sunnybrook Regional Cancer Centre,
Toronto, Ontario; 8Saint Elizabeth Health Care, Markham, Ontario
Compounding the problem for oncology nursing development is the
lack of available educational programs and incentives for completion
of specialized education by employing agencies. This is especially
important when one considers that new technologies, complex
treatment protocols, telephone triage and management, as examples,
require greater educational input, expertise, autonomy and skill than
has previously been needed in acute and community based oncology
care.
This presentation focuses on the survey data from oncology nurses
about their present professional development practice and where
oncology nurses seek to develop themselves and their profession.
Categories of discussion include: evidenced based education and
application, research involvement, presentation, and leadership.
ENVIRONMENTS
FOR
Improving the work lives of nurses has been identified by the Canadian
Nursing Advisory Committee as the key focus for addressing the nursing
shortage and widespread job dissatisfaction across the country. Recent
qualitative work by our research team suggests that healthcare
restructuring over the past decade has created challenges and
sometimes conflicts for Canadian oncology nurses in providing
comprehensive care to meet the needs of cancer patients and their
families. Therefore, to more fully examine the quality of oncology
nurses’ working lives, over 600 oncology nurses were surveyed across
Canada for the purpose of collecting information about their work
environment and professional practice. This presentation will describe
the findings of this survey by identifying workforce management,
professional practice and knowledge transition factors present in
oncology settings and the linkages among these factors and their
relationship to organizational climate and professional well-being. In
addition, the study findings describe the quality of oncology work
environments as perceived by groups of oncology nurses based on age,
education, clinical setting, and geographical region. The results of this
study provide valuable information about the current state of oncology
nursing in Canada that can be used by nursing leaders and policy
makers in building and sustaining a quality oncology nursing workforce
in the future.
I-05-C (Abstract 2 of 4)
ONCOLOGY NURSE DEMOGRAPHICS:
“KNOW” ABOUT THE ONTARIO GROUP?
WHAT
DO
WE
Dauna Crooks1, RN, DNSc; Esther Green2, RN, MHSc; Mary Fergeson-Pare3,
RN, PhD; Doris Howell3, RN, PhD; Debra Bakker4, RN, PhD; Joan Tranmer5,
RN PhD; Pat Sevean6, RN, PhD (candidate); Margaret Fitch7, RN, PhD; Laurel
Plewes7, BScN; Shirley Sharkey8, RN, Nancy Lefevre8, RN, MScN; 1 Hospital
for Sick Children, Toronto, Ontario; 2 Cancer Care Ontario, Toronto, Ontario;
3
University Health Network, Toronto, Ontario; 4Laurentian University,
Sudbury, Ontario; 5Queen’s University, Kingston Ontario; 6 Lakehead
University, Thunder Bay, Ontario; 7Toronto-Sunnybrook Regional Cancer
Centre, Toronto, Ontario; 8 Saint Elizabeth Health Care, Markham Ontario.
Despite increasing needs from the growing sector of individuals
with cancer or at risk for the disease, there is no database to assist
in health human resource planning for the next decade. Secondly,
even if a resource plan existed, there is no research evidence to
support the requirements for the level of registered nursing practice
relative to patient/family needs or differentiation of clinical activities
between generalized, specialized or advanced levels of oncology
nursing practice.
This presentation describes who is practicing in oncology in Ontario
at the specialized and advanced categories as defined by CANO.
The study group surveyed nurses in all health care sectors in
Ontario providing care to oncology patients in adult and pediatric
settings. We will present ideas for a comprehensive data base and
will compare our results with published CIHI and CNA data. Data
presented will include: level of expertise in oncology, retirement
data, years in oncology service, proportion of oncology in practice
as examples. Finally, we will propose strategies for cancer care
human resource planning.
I-05-C (Abstract 3 of 4)
ONCOLOGY NURSING IN ONTARIO: A SYNTHESIS OF SURVEY
DATA TO PLAN OUR PROFESSIONAL FUTURE
Dauna Crook 1, RN, DNSc; Esther Gree 2, RN, MHSc; Mary Fergeson-Par3, RN,
PhD; Doris Howell3, RN, PhD; Debra Bakker4, RN, PhD; Joan Tranmer5, RN PhD;
Pat Sevean6, RN, PhD (candidate); Margaret Fitch7, RN, PhD; Laurel Plewes7,
BScN; Shirley Sharkey8, RN, Nancy Lefevre8, RN, MScN; 1 Hospital for Sick
Children, Toronto, Ontario, 2 Cancer Care Ontario, Toronto, Ontario; 3University
Health Network, Toronto, Ontario; 4Laurentian University, Sudbury, Ontario;
5
Queen’s University, Kingston Ontario; 6 Lakehead University, Thunder Bay,
Ontario; 7Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario; 8Saint
Elizabeth Health Care, Markham Ontario.
This presentation will synthesize the results of a survey of oncology
nurses in a variety of settings in Ontario. The survey captured the
thoughts of specialized and advanced oncology nurses about where
they work, what they do, who they collaborate with and how
independent they are in their practice. Results disclose areas of
concern for development of oncology roles and future leadership. The
presentation will focus on the larger picture of demographic issues
and challenges to come in retirements, expertise, educational levels,
and help us to begin to define Human Health Resource planning
issues for the oncology nurse group.
The presentation also highlights the ambiguity, role overlap and lack
of clarity in deciphering and enacting oncology nursing roles at the
specialized and advanced practice levels. In addition, the issues and
differences by context of practice and geographic area will be
highlighted.
I-05-C (Abstract 4 of 4)
THE FUTURE OF ONCOLOGY NURSING: WHERE DO WE
WANT TO GO AND WHAT BARRIERS OR PROMOTERS EXIST
FOR FUTURE ROLE DEVELOPMENT
Dauna Crooks1, RN, DNSc; Esther Green2, RN, MHSc; Mary
Fergeson-Pare3, RN, PhD; Doris Howell3, RN, PhD; Debra Bakker4,
RN, PhD; Joan Tranmer5, RN PhD; Pat Sevean6, RN, PhD
(candidate); Margaret Fitch7, RN, PhD; Laurel Plewes7, BScN;
Shirley Sharkey 8, RN, Nancy Lefevre8, RN, MScN; 1 Hospital for Sick
Children, Toronto, Ontario, 2Cancer Care Ontario, Toronto, Ontario;
3
University Health Network, Toronto, Ontario; 4Laurentian
University, Sudbury, Ontario; 5Queen’s University, Kingston Ontario;
6
Lakehead University, Thunder Bay, Ontario; 7Toronto-Sunnybrook
Regional Cancer Centre, Toronto, Ontario; 8Saint Elizabeth Health
Care, Markham Ontario.
Minimal research has been undertaken to discover the impact on
care delivery of oncology nursing roles in Canada. This presentation
will focus on survey results examining the clinical role functions of
oncology nurses at the specialized and advanced levels of practice
with specific reference to the expectations oncology nurses have
for their future scope of practice. Oncology nurse perceptions of
barriers to role change will be addressed. We will present potential
solutions to overcome barriers, allowing oncology nurses to work to
full scope of practice and evolve in their roles as patient care needs
change
Finally, issues for educational preparation and support will be
addressed and a strategy for the future will be put forward.
I-06-A
FOSTERING PROFESSIONAL NURSING PRACTICE ON A TERTIARY
CARE INPATIENT PEDIATRIC ONCOLOGY UNIT
I-06-B
TUMORS OF GLIAL ORIGIN: CONFINED COMPLEXITY
Patricia McCarthy, MScN; Children’s Hospital of Eastern Ontario, Ottawa,
Ontario
Cindy Cummings-Winfield, RN, BScN, CON(C); Susan King,
RN, BScN, CON(C); Cross Cancer Institute, Edmonton, Alberta
The realities faced by oncology nurses today, such as the ever increasing
acuity of oncology patients, staffing, safety and workload issues challenges
the focus and spirit of even the most seasoned oncology nurse. The
nursing staff on the inpatient pediatric oncology unit at this hospital are
very junior. There are 28/40 nurses under the age of 29 years. We need to
develop strategies and systems aimed at developing the skill and
confidence of junior nurses to face the complex realities of everyday
practice.
Tumors of the central nervous system (CNS) are a diverse group of
heterogeneous, benign and malignant, primary neoplasms and
metastatic tumors. There are over 100 histologic classifications of
primary brain tumors alone. Gliomas are the most commonly
occurring primary brain tumor.
The purpose of this poster will be to share the learning and outcomes of
an RNAO advanced clinical fellowship, undertaken by the oncology APN at
this pediatric hospital in the fall of 2004. The goals of the fellowship were
1) to examine the factors and processes that foster professional nursing
practice on a tertiary care pediatric oncology unit, and 2) to develop an
understanding of the leadership skills and strategies that create positive
change within a nursing system.
The candidate utilized multiple methods to immerse herself into the culture
of the inpatient unit. She conducted literature reviews on practice models
and empowerment of nurses. She conducted focus groups with nurses,
utilized observation and informal discussions with patients /families and
hospital nursing leaders and maintained a reflective journal. She discussed
ideas and progress with her mentoring team regularly and consulted with
nursing experts during a site visit to a center of nursing excellence.
An integrated plan for fostering the growth and development of junior
oncology nurses was developed. This plan includes implications for nursing
practice, education and research, and addresses sustainability of outcomes
from the fellowship.
Even though glial tumors are confined to the CNS they can result in
a multitude of disabling sequelae. Patients and their families are
faced with difficult treatment decisions.
This complexity is
compounded with ethical considerations when patients experience
cognitive and perception problems.
Excellence in oncology nursing care requires the nurse to be
knowledgeable about treatment modalities for brain tumors,
anticipated symptoms specific to this patient population, and
appreciation of the impact this disease has on the patient and their
family.
This presentation will review the anatomy of the CNS, and
epidemiology, etiology, and classification and staging of glial
tumors. Clinical presentation, diagnosis and treatment of glial
tumors will be discussed. The presentation will conclude with a
review of the unique complications experienced by the patient with
a glial tumor and their family, quality of like issues and nursing
interventions.
I-06-C
UPDATE ON ACUTE MYELOID LEUKEMIA
Gail Macartney, RN, MSc(A), ACNP, CON(C); Ottawa Hospital,
Ottawa, Ontario
The overall incidence of acute leukemia is approximately 4/100,000
individuals. The incidence in people aged 60 or over rises to about
10/10,000 individuals. Acute myeloid leukemia (AML) refers to a series
of relatively well-defined hematopoietic neoplasms involving cells
committed to the myeloid cell line.
Individuals diagnosed with acute leukemia need to become informed
about this potentially life threatening disease, generally within a very
short period of time. This presentation will review the clinical features,
diagnosis and prognosis of AML. The pathobiology of AML will be
reviewed with a focus on cytogentic and molecular genetic diagnostic
tools. This presentation will empower nurses working with AML
patients to better understand the pathogenesis of this disease and
rationale for therapy. Consequently, their ability to provide
comprehensive care will be enhanced.
II-01-E
EXAMINING THE CONTRIBUTION OF LEADERSHIP STYLES TO
30-DAY PATIENT MORTALITY IN ALBERTA HOSPITALS
Greta Cummings, RN, PhD; William K. Midodzi, MSc; Carole A.
Estabrooks, RN, PhD; University of Alberta, Edmonton, Alberta
Background: Emotionally intelligent (resonant) nursing leadership has
been shown to mitigate the negative effects of hospital restructuring on
nurses’ health and wellbeing, thereby supporting the nurses’ ability to
provide quality care to patients. The purpose of this study was to
examine the contribution of resonant nursing leadership, as reported by
nurses in acute care hospitals in Alberta, to one outcome ─ 30-day patient
mortality.
Method: Data for 18,142 adult medical patients discharged from 49
hospitals in Alberta in 1999 were used to measure patient demographics,
co-morbidities and outcomes. The responses of registered nurses working
in these same hospitals to the Revised Nursing Work Index (NWI-R) were
used to measure the predominant nursing leadership styles (resonant,
dissonant or mixed) in each hospital.
Analysis: We used a two level hierarchical linear model (patients at level
1 and hospitals at level 2) to determine the contribution of patient
demographics, co-morbidities, hospital characteristics and nursing
leadership styles to patient mortality. The level 1 model consisted of
patient demographic, co-morbidity and outcome variables. The level 2
model consisted of variables measuring hospital characteristics and nursing
leadership styles.
Results: Nursing leadership styles significantly contributed to differences
in mortality of medical patients across hospitals, after adjusting for patient
co-morbidities, demographic factors, and hospital characteristics. Hospitals
with resonant leadership had significantly lower patient mortality than
those with dissonant or mixed (neither completely resonant nor dissonant)
leadership.
II-01-D
SUPPORTING PATIENTS BETWEEN DIAGNOSIS AND REFERRAL FOR
TREATMENT: INFORMATION & SUPPORT NEEDS OF PATIENTS
DIAGNOSED WITH HEAD & NECK CANCERS
Maurene McQuestion1, RN, BScN, APN, CON(C), MSc (candidate);
Doris Howell2, RN, PhD; David Wan3, BSc; 1 Princess Margaret Hospital,
University Health Network; 2RBC Financial Group Chair in Oncology
Nursing Research, University Health Network, University of Toronto;
3University of Toronto School of Medicine; Toronto, Ontario.
Supportive care has been defined as meeting the needs of those
affected by cancer in the domains of physical, informational,
psychosocial, emotional, practical and spiritual needs across the cancer
experience (Fitch, 1994). Most research in the area of head and neck
(H&N) cancer has focused on the efficacy of treatment modalities and
the assessment and management of treatment side effects and
toxicities. While there has been a focus of understanding the needs of
other patient populations in the early diagnostic phase, little or no
attention has been directed toward understanding the information and
support needs of this group of patients. Their needs may be particularly
unique in light of social and demographic factors, lifestyle risks for
cancer, difficulties with eating / swallowing, and the potential for
disfiguring surgery or challenging treatments. Understanding the needs
of patients newly diagnosed with H&N cancer is important for
developing nursing care measures and delivery models as well as
integrating supportive care measures early in the continuum that extend
into the survivorship period.A research project was developed to assess
the needs of this patient population between diagnosis and referral for
treatment. Focus groups were held with 12 participants to explore the
informational and support needs of patients with head & neck cancer
during the transition period between diagnosis and referral to the
treatment centre. The presentation will review the literature on
supportive care, share themes derived from the focus groups and offer
recommendations to better support patients in the community and at
the treatment centre.
II-01-F
“I’D RATHER DIE THAN GO TO EMERG”: PATIENT’S
PERSPECTIVES ON EMERGENCY ROOM VISITS FOR
FEBRILE NEUTROPENIA
Arlene Court, RN, BScN, CON(C); Sharon Lemon, RN, BScN,
CON(C); Grace Sangle, RN, CON(C); Sunnybrook & Women’s
Health Sciences Centre, Toronto, Ontario
Febrile neutropenia is the number one oncological emergency
experienced by most cancer patients. A chart review at this cancer
centre showed 122 patients visited the institution’s emergency
room for chemotherapy induced febrile neutropenia in a twelvemonth period. Patients frequently verbalize distress about waiting
times, triage processes and inconsistent management by the
hospital team at emergency room visits. Nurses question the
effectiveness of patient teaching that prepares patients for self-care
regarding fevers.
A retrospective randomized telephone survey was conducted with
twenty breast cancer patients who attended the emergency room
for febrile neutropenia.
The telephone interviews utilized a
questionnaire, which addressed areas of patient concern and the
nurses’ questions regarding patient teaching.
The findings of the telephone survey will be shared with resulting
recommendations. New tools for patient management approaches
are required to effectively support patients with febrile neutropenia.
By listening to our patients and implementing new strategies, the
oncological emergency of febrile neutropenia can be managed. We
can do better.
II-02-D
SHAPING THE FUTURE OF PALLIATIVE CARE NURSING: THE
DEVELOPMENT OF SPECIALITY COMPETENCIES
Deborah Gavelle, BScN, MHS (candidate); Lillian Locke, BScN, MPA;
SCO Health Services, Ottawa, Ontario
To be effective at relieving suffering and improving quality of life,
caregivers including nurses must be able to identify and respond to
complex/multiple issues that patients and families face. (CHPCA,
2002)
Competencies are the skills, knowledge, personal attributes
and judgments expected of nurses to provide safe, ethical and
effective care (CNO, 1999). Nursing competencies are defined as
statements which describe expected performance, behaviours and
reflect the professional attributes required in a given role, situation
and practice setting (College of Nurses of Ontario, 1999).
Specialty nursing competencies represent the specific knowledge,
skills and personal attributes required for a nurse to care for a
particular patient population. The goal of the Specialty Nursing
Competency program is to provide exemplary care to patients and
their families receiving care through nursing excellence. The specific
objectives of the program are: to promote reflective practice,
articulate practice expectations and plan and implement learning
opportunities to facilitate nurses maintaining and gaining knowledge,
skills and ability within their practice context.
This presentation will describe the components of the program, the
speciality competencies required by palliative care nurses, the
integration of the competencies with a professional practice model,
and the impact on patients and families.
II-02-F
IMPLEMENTING BEST PRACTICE GUIDELINES FOR PALLIATIVE
CARE WITHIN A CANCER CENTRE
Kathy Coulson1, RN, MScN, ACNP, CHPCN(C); Elizabeth Jeffrey1, RN,
MSc; Diane Batchelor2, RN, MScN, ACNP, CON(C); Sharon Preston3, RN;
1Kingston General Hospital, Kingston, Ontario; 2 Diane Batchelor Advanced
Practice Nurse Cancer Care, Gananoque, Ontario; 3Kingston, Frontenac,
Lennox & Addington Palliative Care Integration Project, Kingston, Ontario
This presentation will outline how a cancer center participated in the
development and implementation of best practice guidelines for palliative
patients through its involvement in a regional palliative care project. The
Palliative Care Integration Project is an exciting initiative with the goal of
attaining the best quality of life for patients and families for whom curative
therapies are no longer possible. Discontinuity of care, inconsistent pain
and symptom management, few assessment tools, little evidence based
practice, variable knowledge and under-utilization of resources were
identified through regional research as persistent problems in palliative
care. A unique regional strategy to integrate palliative care was developed.
Over 100 individuals representing 25 organizations were involved in the
project. The key objectives were to facilitate easy, uncomplicated access to
palliative care by implementing validated assessment tools, care plans and
supporting guidelines. Individuals from the participating organizations
were divided into teams for development of three evidence based generic
care plans for stable, transitional and end-of-life patients, as well as, two
symptom focused care plans for pain and dyspnea. Other teams focused
on implementation (education and documentation). The broad based
interdisciplinary consultation used in developing the project resulted in a
network of contacts and a ground swell of enthusiasm. The strategies as
well as the successes and challenges of implementation within a cancer
centre will be highlighted.
II-02-E
PROGRAM PLANNING AND EVALUATION: ENHANCING
ONCOLOGY PALLIATIVE CARE THROUGH INTEGRATION OF
BEST PRACTICES
Vicki Lejambe, RN, BScN, CON(C); Saint Elizabeth Health Care,
Markham, Ontario
Best practice guidelines (BPG’s) as defined by the Registered Nurses
Association of Ontario, “are systematically developed statements (based
on best available evidence) to assist practitioners' and clients' decisions
about appropriate health care. Guidelines are a resource tool, to be
used in assessing current practices, developing policies, procedures,
protocols, educational programs, quality standards, and assessment and
documentation tools, within a practice setting”.
This presentation will describe a program planning process that
integrated BPG’s to enrich our oncology palliative care program. The
innovative enhancements include :

Adopting Client Palliative Performance Scale scores to identify level
of care provider;

Creation of ‘Smarter’ documentation tools to enhance and cue
practice from an evidence base; and

Creation of client educational material and records to fully support
informed decision making and participation in planning and
delivery of care.
The audience will learn about the framework and tools used to guide
program planning. They will be introduced to our documentation tools
that enhance and cue evidence based practice, and will share in the
evaluation results to date. Although conducted in a community setting,
the strategies used to enhance nursing practice have broad application
in a wide range of clinical settings.
II-03-D
DECISION-MAKING AMONG WOMEN DIAGNOSED WITH
STAGE I & II BREAST CANCER: A NOVA SCOTIA
PERSPECTIVE
Brenda Sabo 1, RN, MA, PhD Student; Carman Giacomantonio 2,3,
MD; Daniel Rayson 2,3, MD; Maureen Nolan 2,3, MD; 1 QE II Health
Sciences Centre, Halifax, Nova Scotia; 2 Capital District Health
Authority, Nova Scotia; 3 Nova Scotia Cancer Centre
How clients within the healthcare system make decisions about
their treatment(s) has been an important focus of healthcare
delivery since the early 1990’s. As health professionals we need to
understand how clients make decisions, support their approach and
provide the necessary resources for the client (based on their
suggestions) to make a fully informed decision about the care they
desire. A province-wide initiative was undertaken using a mixedmethod (survey, interviews and focus groups) approach to explore
how women diagnosed with stage I & II breast cancer made their
decision choices about treatment, how satisfied they were with
their choices, and what changes are necessary to improve or
enhance their ability to make decisions consistent with their beliefs,
values and style.
The survey resulted in a 57% positive response rate. Fifty-one
percent of the respondents preferred an active decision making role
(based on the definition by Degner & Sloane, 1992). Age was the
only variable to be significantly associated with decision satisfaction
The findings from this project will be presented along with
implications for research and practice
II-03-E
DEVELOPMENT AND EVALUATION OF AN INFORMATION AND
TEACHING PACKAGE FOR OLDER ADOLESCENTS AND YOUNG
ADULTS WITH CANCER
Andréa Maria Laizner, N, PhD; Emily Ingram, BA; David Wright, BSc;
Nancy Hutchison, N, MScA, CON(C); Christine Leblanc, N, BScN,
CON(C); McGill University Health Centre (RVH), Montreal, Quebec
Literacy and health are connected. Nurses contribute to better health or
learning outcomes for individuals by using plain language health
information. The term “health literacy” refers to an individual’s capacity to
read and comprehend medical information and instructions. More recently,
it refers to facilitating access to information that enables individuals to
make informed choices, influence events, and exert greater control over
their lives.
Given that approximately 20 to 30 percent of Canadian youth are not
completing high school and that anxiety as well as cancer related fatigue
could interfere with comprehension, it is extremely important that health
information be written using clear health communication and plain
language. A team of nurses, graphic artists, translators, and volunteers
worked together to prepare information materials for the Older Adolescent
and Young Adult Program in Oncology. These materials, English and
French versions, would serve to orient new patients and their families to
the program. Nurses could use these materials as a teaching package with
this target group when talking about disease, chemotherapy treatment,
side effect management and use of resources.
This presentation describes the process used to develop the materials and
to evaluate their content and usefulness for a target group of patients.
Guided by the work of The Centre for Literacy of Quebec and others,
specific emphasis in the evaluation of the materials was placed on layout
(appearance and appeal), readability, and client satisfaction.
II-04-D
HEALING TOUCH AS AN ADJUVANT HOLISTIC APPROACH
INTEGRATED WITH ALLOPATHIC MEDICINE FOR ONCOLOGY
PATIENTS
Jeanne Balcom, RN, HTP; Beauséjour Regional Health Authority,
Moncton, New Brunswick
Focusing on true self-care and personal healing through your own
inner process is an important focal point in this presentation. As
stated in Healing Touch a Guidebook for Practitioners: "The first part
of our life is spent finding our identity, and the second part of our life
is moving into our greater identity as spiritual beings. This maturing is
called individuation and it differentiates from the achievementorientated nature of our early life's work. Anyone who is serious about
helping others needs to individuate-to be less dependant on outside
opinions and be able to hear the inner guidance that is available
through daily, committed practice". What is Healing Touch? Healing
Touch is a nursing continuing education multi-level program in
energy-based therapy. It uses touch to influence the human energy
field centers to bring balance and alignment to individuals. Body,
mind, emotion, and spirit, are touched through this therapeutic
process. Some benefits of Healing Touch as an adjuvant therapy with
oncology patients are: relieving pain, promoting relaxation, improving
energy level and supporting the dying process. This presentation
explores an oncology nurse's vision, with the support and help of
others, the integration of Healing Touch within the health care system
in a community.
II-03-F
MY CARE SOURCE-EMPOWERING PATIENT MANAGED CARE
Claudette DeLeonardo, RN, BScN, MSN(C), CAE; Grand River
Hospital, Kitchener, Ontario
My CARE Source is an innovative web-based, patient-centric application
that assists patients to navigate their way through the confusing and
complex system of cancer care. My Care Source, a personalized support
and disease management tool actively engages patients in their health.
Patients become their own “project manager” by engaging in proactive
and informed management of their journey through treatment.
Patients have identified gaps in cancer services specifically in
dissemination of information, provision of supportive care and delivery
of services (CCS, 2003). Barriers to obtaining information include
knowing how and where to obtain specific information and accessing a
health care provider. A coordinated strategy that provides evidencebased health information is essential in meeting the needs of patients
with cancer.
Other patient portals exist in healthcare however; My CARE Source is
the first to our knowledge that delivers fully integrated treatment plans
that provide patients with a personalized plan of care including links to
relevant patient education along with the ability to document, track and
monitor symptoms and/or side effects of treatment. Evidence-based
sources are used to develop treatment protocols and build the content
library. Two surveys have been conducted to evaluate the functionality
and content of the application. All participants stated they found the
application easy to navigate and to read. All participants stated they
would recommend the portal to others.
II-04-E
THERAPEUTIC
TOUCH™:
AN
EXTENSION
OF
PROFESSIONAL SKILLS IN CLINICAL ONCOLOGY NURSING
Caroline Merritt, RN, CON(C); Atlantic
Corporation, Hampton, New Brunswick
Health
Sciences
Therapeutic Touch is a modern version of several ancient healing
practices. It is a process of energy exchange. The practitioner uses
his/her hands as a focus for promoting healing in the patient.
Therapeutic Touch was developed in the early 1970’s through the
pioneering work of Dolores Krieger, Ph.D., R.N., a professor at New
York University, and Dora Kunz, a natural healer. Research has
shown that Therapeutic Touch can promote relaxation and provide
a sense of comfort and well being, by readily eliciting the relaxation
response. It has been shown to be helpful for symptom
management for cancer patients, and those journeying toward end
of life. Canada’s national accreditation committee for Cancer Care
Centers recommends that nursing staff offer Therapeutic Touch to
inpatients to assist in pain control and enhance the patients’ sense
of well being. Therapeutic Touch blends the art and science of
nursing. Nurse Healers- Professional Associates International, Inc.
and the Therapeutic Touch Network of Canada are the professional
governing bodies whose mission it is to lead, inspire, and advance
excellence in Krieger- Kunz Therapeutic Touch. This presentation
will provide an introduction to Therapeutic Touch for Oncology
nurses, focusing on its principles and practical applications, and will
offer experiential exercises for the participants.
II-04-F
SPIRITUAL ASSESSMENT: REFLECTIONS FROM YESTERDAY,
IMPRINT FOR TOMORROW
Brenda Caldwell, RN, BScN, CON(C); Margaret Baker, RN, BSN,
CON(C), CHPCN(C); Stephanie Burlein-Hall, RN, BScN, MEd,
CON(C); Interlink Community Cancer Nurses, Toronto, Ontario
Spiritual care is important to patients who are suffering form a lifethreatening illness such as cancer (Schnoll, Harlow, & Bower, 2000)
and an important aspect of holistic nursing care. (Musgrave,
McFarlane, 2004).
Previously, no framework was used to guide patient/family discussion
regarding spiritual care issues by a group of specialized community
oncology nurses.
During the development of a comprehensive patient/family
assessment tool, the nurses identified the need to incorporate the
spiritual domain into the new assessment tool. After reviewing the
literature, Pulchalski’s FICA spiritual assessment tool (Pulchalski,
Romer 2000) was chosen for implementation. The presentation will
provide an overview of spiritual care within a supportive care
framework. Results of a chart review evaluating the use of the FICA
tool, and a peer survey highlighting the challenges in getting at issues
of meaning for patients living with cancer, will be featured.
Nurses are uniquely positioned to be available when patients
experience spiritual distress. Providing oncology nurses with practical
frameworks that can facilitate the assessment of spiritual needs is
important in providing the holistic care needed to leave an imprint for
tomorrow.
II-05-D (French)
PROBABILITÉ
DE
PARTICIPATION
D’UNE
POPULATION
QUÉBÉCOISE ASYMPTOMATIQUE À UN PROGRAMME DE
DÉPISTAGE DU CANCER COLORECTAL
Louise Bouchard1, inf., PhD; Johanne Roy2, inf., MSc; Geneviève Baron2,
MD, MSc, FRCPC; 1 Université de Montréal; 2 Direction de la Santé Publique
de la Montérégie.
Au Canada, le cancer colorectal représente la deuxième forme de cancer la
plus meurtrière. Des groupes canadiens recommandent un programme de
dépistage de ce cancer dans un proche avenir. L’objectif de cette étude
qualitative était d’explorer les perceptions d’une population québécoise
asymptomatique sur le cancer colorectal et sa prévention et leur opinion
sur trois tests de dépistage après avoir reçu une information détaillée sur
ces derniers. Six focus group (n =58 participants) ont été formés. Les
résultats révèlent que les participants peuvent nommer plusieurs mesures
de prévention primaire du cancer colorectal, ses symptômes et facteurs de
risque, mais certaines croyances persistent sur son étiologie, son évolution
et la fréquence du « sac » de colostomie. Le quart des participants, surtout
des femmes, connaissent certains tests pour les avoir déjà passés dans un
contexte symptomatique. Selon les résultats, il est peu probable que ces
individus participeraient au dépistage du cancer colorectal s’il était
implanté dans un proche futur. Ces derniers sous-estiment leur risque
personnel à contracter ce cancer et sont peu renseignés sur son histoire
pré-cancéreuse naturelle. Leur notion de dépistage est inscrite dans un
contexte symptomatique. Ils subiraient certains tests de dépistage si leur
médecin traitant les leur recommandait fortement. Ils se sont cependant
montré prêts à recevoir plus d’information sur le sujet. Les participants ont
livré des opinions critiques à l’égard du système de santé invitant les
chercheurs à une réflexion quant à l’approche éducative à déployer pour
favoriser leur participation au programme de dépistage colorectal.
II-05-D (English)
PROBABILITY OF PARTICIPATION OF AN ASYMPTOMATIC
QUEBEC POPULATION TO A COLORECTAL CANCER SCREENING
PROGRAM
Louise Bouchard1, PhD; Johanne Roy2, MSc; Geneviève Baron2, MD,
MSc, FRCPC; 1Université de Montréal; 2Direction de la Santé Publique de
la Montérégie
In Canada, colorectal cancer represents the second deadliest form of
cancer. Canadian groups have recommended implementing a screening
program for this form of cancer in the near future. The objective of this
qualitative study was to explore the perceptions of an asymptomatic
Quebec population on colorectal cancer and its prevention as well as
their opinions on three screening tests after receiving detailed
information about these tests. Six focus groups (n=58 participants)
were formed. The results reveal that the participants were able to name
the symptoms and risk factors of colorectal cancer as well as many
primary prevention measures, but certain beliefs persist about its
etiology, evolution and the frequency of the colostomy bag. One quarter
of the participants, mostly women, know some of these tests by having
experienced them in a symptomatic context. According to the results, it
is unlikely that these individuals would participate in colorectal screening
if it was implemented in the near future. These subjects underestimate
their personal risk of contracting this form of cancer and are not well
informed about the disease’s natural history. Their notion of screening
comes from a symptomatic perspective. They would undergo certain
screening tests if their attending physician strongly recommended them.
However, they are willing to receive more information on the subject.
The participants gave critical opinions on the health care system thus
making researchers think about which educational approach to use to
encourage participation in the colorectal cancer-screening program.
II-05-E
EARLY-STAGE
PROSTATE
CANCER
TREATED
BRACHYTHERAPY: NAVIGATING IN A GREY ZONE
BY
Robert Roy, BSc; Dr. Leon Richard Oncology Centre, Moncton,
New Brunswick
Prostate cancer affects approximately 20,000 Canadians every year.
When a man is diagnosed with this form of cancer, he is confronted
with difficult decisions regarding the available treatments. It is also
common for men with prostate cancer and their families to be
concerned about the disease. However, the majority of people
become less worried once they have learned more about the
disease and after the treatments have begun. Having a contact
person, with whom the patient can establish a trusting relationship
and receive guidance in terms of care, are some of the functions of
a brachytherapy nurse case manager. Since long-term posttreatment follow-ups will be required and brachytherapy treatment
centres are far apart, local follow-up, which is often desired by the
patient, is possible. In these cases, follow-up is safely ensured by
the local general practitioner, in collaboration with the nurse case
manager and the brachytherapy centre’s team. The purpose of this
presentation is to examine the implementation of the role of
brachytherapy nurse case manager from a treatment centre that
serves the population of the Atlantic provinces.
II-05-E (French)
CANCER PRÉCOCE DE LA PROSTRATE TRAITÉ
CURIETHÉRAPIE; NAVIGUER DANS UNE ZONE GRISE
PAR
II-05-F (English)
UNACCEPTABLE DELAYS IN THE DIAGNOSIS AND
TREATMENT OF BREAST CANCER: A FRANCOPHONE
COMMUNITY ENSURES BETTER COORDINATION
Robert Roy, BSc; Dr. Leon Richard Oncology Centre, Moncton, New
Brunswick
Linda Varner, BScN, CSIO(C); Dr. Leon Richard Oncology Centre,
Moncton, New Brunswick
Le cancer de la prostate touche environ 20 000 canadiens chaque
année. Lorsqu’un homme est diagnostiqué avec ce type de cancer, il
est confronté à des décisions difficiles quant aux traitements offerts.
Il est également commun de voir que les hommes atteints d’un cancer
de la prostate et leurs proches soient inquiets face à cette maladie.
Toutefois, la plupart d’entre eux constatent que leurs préoccupations
diminuent une fois qu’ils comprennent mieux la maladie et que le
traitement débute. Avoir une personne contact avec qui le patient
peut établir un climat de confiance, lui permettant d’être guidé vers
une prise en charge, est une des fonctions d’un infirmier gestionnaire
de cas en curiethérapie. Puisque un suivi à long terme post
traitement s’impose, et que les centres de traitements en
curiethérapie sont situés à distance; un suivi local, souhaité par le
patient, est souvent possible. Lorsque c’est le cas, un suivi est assuré
en toute sécurité par l’omnipraticien local, en collaboration avec
l’infirmier gestionnaire de cas et l’équipe de curiethérapie du centre.
Cette présentation aura pour but de faire un retour sur l’implantation
du rôle d’un infirmier gestionnaire de cas en curiethérapie à partir
d’un centre de traitement qui désert la population des provinces
Atlantique.
According to the Cancer Advocacy Coalition of Canada (2000), a
woman living in one of the Atlantic Provinces has fewer chances of
surviving breast cancer than if she lived in British Columbia or
Ontario. It has been documented that delays have an influence on
the stage of disease at the time of diagnosis and consequently, the
prognosis. Survivors, who are assisting newly diagnosed women,
reported significant delays in the diagnosis and treatment of breast
cancer in New Brunswick as well as the lack of support for these
women during the investigation period. These observations (2000 –
2002) were confirmed by a retrospective study of breast cancer
cases referred to an oncology centre in New Brunswick. A breast
clinic was created to improve access to services. Thanks to the
services of an oncology navigator nurse, in collaboration with
committed partners, those unacceptable delays were reduced by 58
% (2003 – 2004). In addition, ad hoc and continuous support was
provided to the women who were referred to the clinic. Algorithms
for the diagnosis and follow-up were developed. These measures
did not create additional costs to the health care system. The
objective of this presentation is to explain this innovative model,
the role of the navigator nurse and the transferability potential of
this model to other communities.
II-05-F (French)
DÉLAIS INACCEPTABLES DANS LE DIAGNOSTIC ET LE
TRAITMENT DU CANCER DU SEIN; UNE COMMUNAUTÉ
FRANCOPHONE ASSURE UNE MEILLURE COORDINATION
III-01-A
SUPPORTING HOPE IN PALLIATIVE CARE PATIENTS AND
FAMILIES: THE CHALLENGES AND BENEFITS FOR
ONCOLOGY NURSES
Linda Varner, inf. BSc Inf., CSIO(C); Centre d’oncologie Dr-LéonRichard, Moncton, N.B.
Allyson Clarke, RN, MSc; Princess Margaret Hospital, University
Health Network, Toronto Ontario
Selon le Cancer Advocacy Coalition of Canada (2000),une femme
vivant dans les provinces Atlantiques, a moins de chance de survivre
un cancer du sein que si elle habite en Colombie-Britannique ou en
Ontario. Il est bien documenté que les délais influent le stade de la
maladie au moment du diagnostic et par le fait même, le pronostic.
Des survivantes, accompagnant des femmes nouvellement
diagnostiquées, ont rapporté des délais considérables lors du
diagnostic et du traitement du cancer du sein au N.-B. ainsi que le
manque de soutien pour ces femmes
pendant la période
d’investigation. Une étude rétrospective des cas de cancer du sein
référés à un centre d’oncologie au N.-B. a confirmé ces constats
(2000-2002). Une clinique du sein fut mise sur pied afin d’améliorer
l’accès aux services. Grâce à la présence d’une infirmière navigatrice
en oncologie, en collaboration avec des partenaires engagés, ces
délais inacceptables furent réduits de 58% (2003-2004). De plus, du
soutien ponctuel et continu aux femmes référées fut assuré. Des
algorithmes pour le diagnostic et le suivi furent élaborés. Ces
démarches n’ont pas été plus onéreuses pour le système de santé.
Cette présentation a pour objectif d’expliquer ce modèle novateur, le
rôle de l’infirmière navigatrice et le potentiel de transférabilité de ce
modèle aux autres communautés.
Hope has been identified as playing a critical role in effective coping
and quality of life for all individuals.
Oncology nurses work with their patient’s hope every day.
Research has begun to show the impact nurses have in this area
and the key role they can play in supporting their patient’s hopes.
Most definitions describe hope as directly linked to the individual’s
desires for the future. Both patients and nurses struggle with the
challenge this creates when an individual becomes palliative and is
unable to be cured. Many health care professionals describe the
difficult balance between false hope and hopelessness. This
presentation will discuss the concept of hope and how this can be
promoted in palliative care patients.
It will present current
research around hope and will discuss strategies for oncology
nurses to assist patients both with their transition into the palliative
stage of care and throughout their palliative care experience. The
focus will be on case scenarios that discuss the challenges of
supporting transitions around some of oncology patient’s common
hopes, such as “hope for a cure”.
III-01-B
CARING FOR THE DYING PATIENT AND CAREGIVERS
DEVELOPMENT OF A BROCHURE: SHARING PRACTICAL
ADVICE ON HOW TO MANAGE POTENTIAL PHYSICAL
CHANGES AT THE END OF LIFE
Patty McQuinn, RN, MSc(A), CHPCN(C); Eleanor Nicholson, RN;
South Regional Health Authority, Moncton, New Brunswick
A recent poll indicated that 90% of Canadians wish to remain in their
own homes during the final stages of life; yet only 6% of informal
caregivers feel they could adequately care of their loved ones without
hospice palliative care support. Our teams are part of a provincial
home care program that has been involved in palliative care for over
24 years. Our community-based program uses a multidisciplinary
team approach in delivering care.
The home care teams have utilized several information sheets in the
past to assist caregivers by explaining what to anticipate when a
death is expected to occur at home. We have been working to
develop and implement a concise family friendly information brochure
for the teams to use. The brochure will not replace explanations to
the families. It is to help provide guidance, practical advice and
support when families of home palliative patients are asking questions
related to end of life. The information brochure was trialed and the
results documented.
This presentation will highlight the developmental
effectiveness and content of the end of life brochure.
process,
References

2004 January, Canadian Hospice Palliative Care Association
information fact sheet

Ferrell, R.B. & Coyle, N. (Eds). (2001). Textbook of
Palliative Nursing, New York: Oxford University Press
III-02-A
“EVEN LONGER LENGTHS OF STAY…”
Pamela J. West, RN, MSc, ACNP, CON(C), CHPCN(C); Rouge Valley
Health System, Centenary Site, Toronto, Ontario
Cancer care is changing rapidly (and for the better). In days gone by,
the end point for all clinical trials was ‘survival’. In the mid nineties,
quality of life and instruments to measure this phenomenon were
introduced, and both survival and the quality inherent in those extra
few weeks/months became the valued outcome.
However, it is a new century: a new millennium. There is an
emerging and significant concept that will have incredible impact on
care provided generally, and more specifically on patients with a
cancer diagnosis receiving that care. This concept is “stable disease”.
The chronicity of treated disease is becoming more of a reality, and
prognostication and ever-increasing guessing game.
This paper will review the literature on prognostication, the concept of
stable disease and explore how oncology practice is beginning to
measure this phenomenon. Stable disease opens the door for other
new and evolving concepts such as cancer rehabilitation. Ideally
patients will have longer and
better illness trajectories and nurses will have longer journeys
accompanying them in their illness experience.
III-01-C
HOSPICE PALLIATIVE CARE TELEPHONE PROTOCOLS FOR
WESTERN CANADA CALL CENTRE PROGRAMS: A TELENURSING
INNOVATION
Carolyn Tayler, RN, BN, MSA, CON(C); V. Clark, RN; M. Aherne,
BComm, MEd; J. Béasse, MA; C. Brenneis, RN, MHSA; A. Einsiedel, PhD;
L. McManus, RN, BN, MPA; M.J. Paquin, RN, MSc; A. Syme, RN, MN; C.
Taylor, RN. BSN, MS; The Pallium Project – Phase II
Background: Within the last ten years, call centre programs were
launched in Alberta (AB), British Columbia (BC), Manitoba (MB), and
Saskatchewan (SK), with start dates ranging from 1994 (MB) to 2003
(SK). This service is a creative approach to the principle of primary
health care and the potential for collaborative work among health
disciplines and sectors.
Project Goal: To provide palliative patients, caregivers and the public
living in Western Canada 24/7 Hospice Palliative Care (HPC) telenursing
access to HPC assessment, information and referral to appropriate
existing resources.
Project Description: This nursing project meets the needs expressed
by Canadians in a national HPC survey. In fact, 50% of respondents
indicated that they would use a provincial telephone or telehealth
service for HPC information (Ipsos-Reid, 2004).The project supports the
development and integration of HPC telephone protocols for Western
Canada call centre programs by March 31, 2006. This has a potential for
ramification across Canada.
Focus of the Presentation: This presentation will detail the
development of the project, its status and outcomes as of September
2005.
Conclusion: This telenursing innovation has the potential to affect the
lives of many cancer patients and their families and improve primary
care access to specialized services through an already existing and
validated infrastructure of the provincial Call Centre Programs.
III-02-B
A DEMONSTRATION OF TEAM EFFORT: MANAGING AN
OUTBREAK OF VANCOMYCIN RESISTANCE ENTEROCOCCI
ON A MEDICAL AND RADIATION ONCOLOGY UNIT
Eleanor Miller, RN, BScN, MEd; Catie Challoner, RN; Mena
Carengi, RN, BScN; Dr. Richard Fralick, MD, CCFP; Carmen Gosselin
RN; Sunnybrook and Women’s College Health Sciences Centre,
Toronto, Ontario
The impact of an outbreak of Vancomycin Resistant Enterococci
(VRE) poses a challenge and risks for patients and staff. The
application of effective teamwork, collaboration and strategic focus
are essential for managing the outbreak that had the potential of
sabotaging the effective function of a patient care unit.
From August 2004 to November 2004 a total of 9 confirmed cases
of VRE were identified on the unit. Following several meetings with
key players within the organization, an out-break was confirmed.
As a team, we acted quickly to abort this outbreak. Various
measures were implemented to control the outbreak including,
80% increase in staff core competency training and certification in
infection control. Other interventions include placement of patients
with VRE in private rooms, cohorting of patients and nursing staff,
strict surveillance of all patients admitted and discharged from the
unit and the re-training of support staff that clean the patients’
rooms. Further strategies include daily double cleaning of patient’s
rooms, and several measures of designated equipment to each
patient. With such aggressive measures the outbreak was
eventually controlled. This presentation will highlight the cooperative effort of the team, strategies implemented and lessons
learned from this crisis.
III-02-C
PRIMARY NURSING IN RADIATION ONCOLOGY: THE PAST,
THE PRESENT AND THE FUTURE
III-03-A
IMPLEMENTING THE WCCNR STOMATITIS STAGING
SYSTEM
Gail Monk, RN, CON(C); Donna Gies, RN, CON(C); Tom Baker
Cancer Centre, Calgary, Alberta.
Karin Olson1, RN, PhD; Cindy Cummings-Winfield2, RN, BScN,
CON(C); 1 Univeristy of Alberta; 2Cross Cancer Institute, Edmonton,
Alberta
The Radiation Oncology Nurse is a specialist in the care of individuals
receiving radiation therapy as a primary or adjuvant treatment for
cancer. The nurse must be experienced in all aspects of cancer care
and work with many members of the healthcare team to coordinate
services and ensure quality patient care. The role of the nurse is
multidimensional and has evolved in response to the escalating
number and complexity of patients.
In the past the role of the RT nurse was not well defined and was
basically one of trouble shooting and support.
The patient
experiencing significant radiation toxicity was often admitted to the
hospital for symptom management until completion of their
treatment. Today most symptoms and concerns can be effectively
managed on an outpatient basis. As patients continue to present with
more complex problems, knowledge and ingenuity will be key in
meeting their needs.
In previous studies, Canadian oncology nurses identified the need
for a valid and reliable stomatitis severity assessment tool. A tool
developed from interviews with nurses, dentists and physicians was
developed to meet this need, tested for reliability and validity and
published in the August 2004 issue of the Canadian Oncology
Nursing Journal.
We are now in the process of implementing this tool as a
component of standard nursing care in our hospital.
This paper will outline our implementation protocol, plans for
evaluation and future directions for stomatitis interventions.
In this presentation, we will share programs we have implemented,
including the Patient Care Model and describe how the Primary Nurse
functions as part of the multidisciplinary team in the RT department at
our Cancer Centre.
We will discuss how the development of
collaborative approaches to patient care enhances the quality of care
and improves job satisfaction for all disciplines. We will present ideas
for future goals of nursing in Radiation Oncology.
III-03-B
DEVELOPMENT OF AN EVIDENCE-BASED ORAL CARE GUIDE
FOR HEMATOLOGY/ONCOLOGY PATIENTS
III-03-C
RISK PERCEPTION AND NATURAL HEALTH PRODUCTS IN
PEOPLE LIVING WITH CANCER
Prisco Salvador, RN, MScN; Lillian Martinez, RN; Kiing Eng Chan,
RN; Princess Margaret Hospital, Toronto, Ontario
Lynda G. Balneaves 1, RN, PhD; M.J. Verhoef; H. Boon; J. Carey.
1
School of Nursing, University of British Columbia
This project describes one inpatient unit’s experience in developing
and managing oral mucositis in patients diagnosed with hematological
malignancies.
The purpose of this study was to explore the risk perceptions of
people with cancer using natural health products (NHPs). This
study was a secondary analysis of three qualitative studies
exploring NHP utilization across diverse cancer populations. Indepth, open-ended questions were conducted with over 30
individuals with cancer. The analysis focused on participants’
perceptions of risk related to NHPs and how risk perceptions
influence treatment decisions. Participants reported taking part in a
“balancing” process as they made decisions about NHPs. Therapies
perceived to “do no harm” were considered to be safe and
appropriate choices. NHPs were perceived to hold fewer safety risks
than conventional treatments and were described as “natural” and
“supportive”. Risks that were commonly mentioned included loss of
support from physicians, cost, false hope, and interactions with
conventional cancer therapies. Risk perceptions about NHPs were
influenced by the degree of trust held in those giving advice and
information sources used and by participants’ previous experiences
with NHPs. Anecdotal stories from cancer survivors were
particularly influential in participants’ treatment decisions.
Individuals with cancer have relatively low risk perceptions about
NHPs and rely on lay sources of information for treatment
decisions. The findings raise concerns about the safe and informed
use of NHPs and highlight the need for educational strategies that
support accurate risk perceptions in people living with cancer.
Oncology nurses have identified oral mucositis as a primary concern
that adversely affects hematology/oncology patients undergoing
chemotherapy. Despite improvements in treatment protocols (e.g.,
use of growth colony stimulating factors and therapeutic doses of
antibiotics) over the last decade, the incidence and severity of oral
mucositis remain significant. Cognizant of the impact of oral mucositis
on a patient’s psychological well-being and quality of life, a core group
of oncology nurses took a leadership role to better manage oral
mucositis leading to the development of a unit-based oral care guide
that can be used in any oncology settings. The group selected the
Neuman systems model (Neuman & Fawcett, 2002) as a conceptual
framework and synthesized information derived from the literature
and from their clinical practice experiences. An oral care flowchart was
also developed to ensure coordinated and continuous delivery of oral
care and other services to the patients. Educational presentations for
staff RNs and other healthcare providers were conducted to familiarize
them about the oral care guide. The implementation of an oral care
guide as a primary preventive intervention has the potential to
minimize the occurrence or reduce the severity of oral mucositis after
chemotherapy.
III-04-A
WEB-BASED LEARNING – IS IT THE NEXT STEP IN ONCOLOGY
PALLIATIVE CARE EDUCATION?
III-04-B
REGISTERED NURSES 2005 LEARNING NEEDS SURVEY
ACROSS THE CONTINUUM OF CANCER CARE-PRELIMINARY
RESULTS
Vicki Lejambe, RN, BScN, CON(C); Saint Elizabeth Health Care,
Markham, Ontario
Linda Robb Blenderman, RN, BNSc, MSc, CON (C); 2Margareth
Santos Zanchetta, PhD, DN, MNSc; 3Brenda Weir, RN, BScN, MBA;
4Linda Morgan, RN, BNSc., CON(C); 5Jane Warner, RN, BNSc, MSc,
CON(C), 2 Ena Howse, RN, PhD; 1Cancer Centre of Southeastern
Ontario at Kingston General Hospital, 2Queen’s University, 4 All Care
Health Services and 5Hotel Dieu Hospital-Kingston, Ontario, 3
Northumberland Hills Hospital, Cobourg, Ontario
Creating an environment of continuous learning and delivering
standardized, evidence based oncology palliative care education
presents unique challenges in today’s health care environment. Highly
mobile, geographically dispersed clinicians combined with complex
care requirements and an increased body of knowledge, have resulted
in the need to transform oncology palliative care education. We have
harnessed the power of the intranet to provide nurses’ access to
evidence based education, on line resources, and opportunities for
synergistic learning about oncology palliative care. This innovative
approach provides an “anytime and anywhere” environment of
knowledge creation. Built on the principles of adult education, and
collaborative learning, our interactive web-based solution supports
nurses in advancing their knowledge and practice in oncology
palliative care.
This presentation will describe the online learning environment, the
educational content, and the knowledge resources within the webbased education program. Evaluation results will be shared and linked
to enhancements required for the further development and
improvement of this program. Lessons learned will be shared
regarding implementation and change management strategies, along
with the identified supports required for successful transformation of
professional development and learning in oncology palliative care for
health care professionals.
In Ontario, cancer is recognized as a major health problem.
Assisting individuals to live well with cancer is a challenge that
nurses in cancer care can meet when they are educated and apply
standards of care. Inconsistencies in levels of oncology nursing
knowledge and expertise were identified as a priority for the
Regional Oncology Nursing Council of Southeastern Ontario. The
council will contribute to the improvement of regional cancer care
with the results of a needs based education program. A Learning
Needs Survey of nurses across the care continuum working with
individuals and families with or at risk for cancer will provide the
basis. The goals of the survey are to establish a profile of nurses in
cancer care, identify their education needs, current education
resources and preferred modes of learning.
The survey instrument used was a modified version of the “Nurses
Needs Assessment in Cancer Care Education” developed by Cancer
Care Nova Scotia (CCNS) in collaboration with the Canadian
Association of Nurses in Oncology (CANO). The presentation will
share preliminary results and how they may provide direction in
furthering education in cancer care for Southeastern Ontario.
III-04-C
IMPLEMENTING REGIONAL STRATEGIES TO STRENGTHEN
KNOWLEDGE TRANSLATION FOR ONCOLOGY NURSES
III-05-A (English) – refer to page 73 for French
PREOPERATIVE INFORMATION SESSION FOR WOMEN
WITH GYNAEOLOGICAL CANCER
1
Joanne Brodeur, BSc; Thérèse Vincent, BSc; Nicole Tremblay,
MSc, CSIO(C); Lucie Bédard, BSc, MBA; Jacinthe Brodeur, BSc,
CSIO(C); Chantal Bélanger, BSc; Josée Beaudoin, Dt.P. clinicienne;
Centre Hospitalier de l’Université de Montréal.
Linda Robb Blenderman, RN, BNSc, MSc. CON(C); 2Brenda Bass,
RN, HBSc. (Zoology), BScN, MBA; 3Brenda Weir, RN, BScN, MBA; 4
Jane Warner, RN, BNSc, MSc.; Dorothy Broeders-Morin5, RN, DHA;
1
Cancer Centre of Southeastern Ontario at Kingston General Hospital;
2
Ontario Breast Screening Program-Southeast Region; 4Hotel Dieu
Hospital and 5St. Elizabeth’s Health Care-Kingston, Ontario;
3
Northumberland Hills Hospital, Cobourg, Ontario
Access to timely oncology nursing knowledge is increasingly complex
across a variety of settings and environments resulting in barriers to
care coordination and evidence-based practices.
To create an effective and supportive professional environment while
addressing contextual barriers the Regional Oncology Nursing Council
of Southeastern Ontario lobbied and received resources to implement
a regional Website. The Website will act as a knowledge translation
vehicle for enhanced information dissemination and implementation of
regional evidence-based cancer care.
This presentation will outline the steps involved in planning,
implementing, marketing the Website and illustrate its usefulness to
direct care nurses, students, educators, administrators and
researchers. This presentation will contribute knowledge on how
websites can assist nurses in accessing current information in their
daily practice.
In recent years, the development of the role of a nurse navigator
and the creation of a continuous quality improvement team for
gynaecological oncology care allow for the identification of areas
for improvement in the care provided. Among these, the need to
better plan for the return home of women who have had gynecooncology surgery was earmarked as a priority. Even though a lot of
significant effort was made by the team to prepare these patients’
release, many problems surfaced only once the patient returned
home. Fatigue, difficulty to care for oneself, various worries
associated with surgery and anxiety were identified as frequent
problems. At the beginning of 2005, following this study, a project
of information and preoperative education sessions intended for
these patients was started. The purpose of these sessions is to
better inform the patients about the surgery and detect problem
situations before admission so that they can be corrected
beforehand. The project leaders will present the contents of the
program and various resulting observations.
IS NOW THE TIME
REGARDING EXERCISE?
III-05-B
TO MAKE
RECOMMENDATIONS
Nicole Temblay, MSc, CSIO(C); Hôpital Notre-Dame
For many years, the number of articles on the benefits of exercise has
been multiplying. The effects of exercise have also been studied in
oncology, particularly as a means of decreasing fatigue associated
with cancer. The findings are that exercise is definitely an effective
means. Consequently, in various oncology centres, many nurses are
encouraging cancer patients to exercise in order to fight fatigue.
However, at what frequency, at what intensity, for how long and over
what period of time? Does research data now allow us to answer
these questions? After reviewing the literature, the author will discuss
the various research results in order to guide this aspect of practice.
SOMMES NOUS À L’HEURE DES RECOMMANDATIONS EN
MATIÈRE D’EXERCICE?
Depuis de nombreuses années, les écrits sur les bienfaits de l’exercice
sur la santé se multiplient. Dans le domaine de l’oncologie, l’exercice a
été également étudié, notamment comme intervention pour diminuer
la fatigue reliée au cancer. Il en est ressorti que l’exercice est bel et
bien un moyen efficace en ce sens. Il s’ensuit que, dans les divers
centres d’oncologie, de nombreuses infirmières incitent maintenant les
personnes atteintes de cancer à faire de l’exercice afin de mieux lutter
contre la fatigue. Mais à quelle fréquence le faire, à quelle intensité,
quelle doit en être la durée et pour combien de temps ? Les données
de recherche permettent-elles, d’ores et déjà, de répondre à ces
questions ? L’auteure, s’inspirant de revues des écrits sur le sujet,
discutera des divers résultats de recherche afin de guider la pratique
en ce sens.
III-05-C (French)
LA VIE APRÈS LES TRAITEMENTS POUR UN CANCER:
QUELQUES PISTES D’ACTION POUR MIEUX PRÉPARER LES
PATIENTS AUX DIFFICULTÉS DE L’APRÈS-TRAITEMENT.
Le cancer provoque un bouleversement chez la personne atteinte et
ses proches. La fin des traitements à visée curative est habituellement
perçue comme un soulagement et le début du retour à la « vie
normale ». Cependant, pour beaucoup de personnes, cette étape de
l’après-traitement est lourde de difficultés et elles réalisent alors que
la vie ne sera plus jamais pareille à ce qu’elle était avant le cancer.
Tant sur le plan physique que psychologique, social et spirituel, la
maladie a laissé des traces. Comment vivre maintenant avec
l’incertitude et la crainte de la récidive à apprivoiser, le sentiment
d’être abandonné par l’équipe traitante, la lenteur de la récupération
physique et la persistance de la fatigue, les changements de l’image
corporelle, etc. À partir de la littérature et de la clinique, cet atelier
abordera les principales difficultés vécues par les patients dans
l’après-traitement et les moyens élaborés par notre équipe pour mieux
préparer les patients à cette étape.
III-05-C (English)
LIFE AFTER CANCER TREATMENTS: A FEW COURSES OF
ACTION TO BETTER PREPARE PATIENTS FOR POSTTREATMENT PROBLEMS
Nathalie Gravel, inf. BSc; Marie de Serres, MSc inf., CSIO(C);
Geneviève Lambert, Travailleuse Social; Centre Hospitalier
Universitaire de Québec, Québec City, Québec
Cancer deeply affects an individual and their loved ones. The end
of curative treatments is usually seen as a relief and the beginning
of a return to a “normal life”. However, for many people, this posttreatment stage has many problems and they realize that life will
never be the same as it was prior to the cancer. From physical,
psychological, social or spiritual perspectives, the disease leaves
deep marks: how to live with the uncertainty, and fear that the
cancer will recur, the feeling of being abandoned by the treatment
team, the slow rate of physical recovery and persistent fatigue, the
change in body image, etc. Based on literature and clinical practice,
this workshop will address the main problems confronting patients
once the treatments are complete and the means developed by our
team to better prepare patients for this phase.
IV-01-D
CLINICAL TRIAL ONCOLOGY NURSING – PART OF THE
CANCER CARE TEAM
Florence Kronstal, RN, BSN; Nancy Hartt, RN, BSN; Karn WilkieBoyd, RN, BSN; British Columbia Cancer Agency – Centre for the
Souther Interior, Kelowna, British Columbia
Medical decision making rests on evidence-based practice which is
largely the result of clinical trials. The role of the Clinical Trials
Nurse (CTN) is an added dimension to the specialty of oncology
nursing. There is a need to have comprehensive knowledge of
research methodology as well as standards of nursing practice to
ensure safe and ethical patient care. The CTN coordinates all
aspects of clinical trials including assessing patients and
coordinating their care with other members of the cancer care team
and a wide range of administrative and regulatory processes.
Clinical trials are available for all tumor groups in the settings of
curative, supportive and palliative care. Participating in a clinical
trial is a unique experience for a patient. At our centre, the CTN is
the primary oncology nurse for the trial participant and is therefore
closely involved with the patient’s experience. A focus of patient
care, education and advocacy is combined with data collection and
protocol compliance requirements.
This presentation will focus on the CTN as an integral member of
the cancer care team. We will outline the unique highlights and
challenges within this role as we seek to improve patient outcomes
using the most advanced cancer treatments available.
IV-01-F
MEASURING OUTCOMES OF NURSE-LED CARE: IMPLICATIONS
FOR PATIENTS, NURSES AND THE INTERDISCIPLINARY TEAM
IV-02-D
STATE OF THE SCIENCE REVIEW: DIAGNOSIS AND
MANAGEMENT OF EPIDURAL SPINAL CORD COMPRESSION
Tracy Truant, RN, MSN; Susan Bartnik, RN, BSN; Patti Devon, RN,
CON(C); Mary Scott, RN; Joy Bunsko, RN, BSN, CON(C); Brenda Ross, RN,
BSN, CON(C); British Columbia Cancer Agency, Vancouver and Surrey,
British Columbia
Milena Segatore, RN, MScN, MNI-PG; Karen Lock, RN, MN, CON(C);
North York General Hospital, Toronto, Ontario
A growing body of research based evidence is pointing toward improved
outcomes for ambulatory patients receiving care within nurse-led clinics
(Corner, 2003; Loftus & Weston, 2001). At one Provincial Cancer Agency,
revisions to the ambulatory care delivery model included nurse-led Patient
Support Clinics (PSCs) as an integral component which maximally aligns
nursing resources with patient needs and complements the existing
medically oriented clinics.
Within the PSCs, Registered Nurses practice to their full scope to deliver
care to patients and families that meet their expressed needs (e.g.
symptom management; education; treatment decision making support,
referral to resources; navigation of cancer care system, etc). Through
implementation of PSCs, it is anticipated that patients will receive timely,
professional nursing care that enhances satisfaction with nursing care,
enables treatment to be completed on time, enhances self care ability, and
improves quality of life. To ensure these outcomes were achieved through
the implementation of nurse-led PSCs, a rigorous evaluation plan was
articulated and implemented. Written surveys, interviews, and focus
groups were utilized to gather data at baseline, three months and one year
post implementation.
This presentation outlines the plan and process used to evaluate the
implementation of PSCs in the ambulatory setting, identifying outcomes for
patients, nurses and the interdisciplinary team. Recommendations for
future implementation and evaluation of nurse-led PSCs will be
summarized.
IV-02-E
INDUCTION
CHEMOTHERAPY
FOR
ACUTE
MYELOID
LEUKEMIA:
A
CASE
STUDY
FOR
UNDERSTANDING
ONCOLOGICAL EMERGENCIES
Gail Macartney, RN, MSc(A), ACNP, CON(C), The Ottawa Hospital,
Ottawa, Ontario
About 3,900 new cases of leukemia are diagnosed each year in
Canada. As the population ages, the incidence of acute myeloid
leukemia (AML) appears to be rising, particularly in the population
over the age of 60 years. Treatment-related myelodysplasia and
leukemia in survivors of cancers diagnosed in childhood and young
adulthood also appears to be rising.
The goal of remission induction chemotherapy in AML is the rapid
restoration of normal bone marrow function. This presentation will
review the most standard remission induction regimen for AML. A case
study will be used to highlight the possible complications that can
occur as a result of this treatment. Oncologic emergencies related to
this treatment will be reviewed including tumor lysis syndrome,
disseminated intravascular coagulation and febrile neutropenia with a
focus on nursing assessment and intervention.
Epidural spinal cord compression (ESCC) is a neuro-oncologic
emergency, which, if not diagnosed promptly, carries significant
morbidity. History is often the key to diagnosis: Patients can often
literally pinpoint the site of their lesion.
However, radiologic
investigation is critical to definition of the lesion and surgical planning.
Magnetic resonance imaging modalities have revolutionized the
evaluation of spinal cord and roots; computerized tomography (CT)
remains invaluable for surgical planning especially when the architecture
or stability of the spine is affected by the lesion. Plain X-rays, though
frequently used, have a minimal role in the diagnosis of ESCC
The goal of treatment – be it medical, radiologic and/or surgical - is
preservation of existing neurological function and quality of life through
aggressive pain control, decompression of neural elements and recreation or preservation of spinal stability. Definitive treatment is
directed at eradicating or controlling the underlying malignancy. Even
in the setting of aggressive disease, aggressive surgical palliation of
cord compression may be appropriate to preserve quality of life.
This session will review the emergency management of the patient once
the diagnosis of ESCC is suspected: Following a discussion of
investigative imaging modalities, surgical approaches to the spine will
be discussed and illustrated. The session will conclude with a review of
the current role of radiotherapy and adjunctive therapies.
IV-02-F
UNBLOCKING THE MYSTERY – THE
MALIGNANT BOWEL OBSTRUCTIONS
MANAGEMENT
OF
Shari Moura, RN, MN; CON(C), Sunnybrook and Women’s College
Health Sciences Centre – Toronto Sunnybrook Regional Cancer Centre,
Toronto, Ontario
There are multiple factors that contribute to the suffering experienced
by patients with advanced or end-stage cancer. Malignant bowel
obstruction (MBO) is a frequent clinical complication for patients with
advanced gastrointestinal cancer, gynecological cancer, or metastatic
disease to the peritoneal cavity. The prevalence of MBOs in patients
with gynecological or gastrointestinal cancers is generally unknown
(Feuer & Broadley, 2003). Recent descriptive research suggests that the
incidence of bowel obstructions ranges from 5% to 51% in patients with
ovarian cancer and from 10% to 28% in patients with gastrointestinal
cancer (Hardy, et al., 1998 & Jolicoeur & Faught, 2003).
When patients and family members are dealing with the diagnosis of a
MBO, the options explored with them include medical and surgical
interventions to reduce or relieve MBO related symptoms. An
understanding of the management of MBO is integral to the care of
patients and their families in the midst crisis and the possibility of
impending death.
The paper will explore, appraise, and summarize evidence from
scientific and descriptive research regarding the use of surgical and
non-surgical interventions for MBOs for patients with advanced or end
stage gynecological and gastrointestinal cancer. Knowledge gained in
this presentation will strengthen cancer nurses understanding of the
common symptoms experienced by patients who present with MBO,
possible treatments and, nursing assessments required to evaluate the
effectiveness of the treatment.
IV-03-D
OVARIAN
CANCER
AWARENESS:
CHALLENGES
AND
FACILITATING
FACTORS
IN
THE
DEVELOPMENT
AND
DISSEMINATION OF INFORMATION PRODUCTS FOR CANADIAN
WOMEN
Fran Turner1, MS; Margaret I. Fitch2, RN, PhD; Elisabeth Ross3, MHSc;
1Ovarian Cancer Information Project; 2Toronto Sunnybrook Regional
Cancer Centre; 3National Ovarian Cancer Association; Toronto, Ontario
Although ovarian cancer is the fourth leading cause of cancer-related
death in women and leading cause of death in gynecological malignancies,
most women know little about this disease—many believe it is detected
with a Pap smear. Developing and disseminating information about ovarian
cancer to a range of audiences, including well women, has been the
mandate of a three-year Canada-wide initiative.
A needs assessment was conducted with women and health care
professionals using phone interviews, focus groups and surveys to identify
information gaps about ovarian cancer as a basis for new product
development. A variety of strategies were also employed in the
development and dissemination of awareness materials in English and
French as well as in other languages (Portuguese, Chinese, Tamil and
Punjabi). Collaboration with community agencies was essential in
designing information materials for diverse cultural groups. Following the
recommendations of a wide range of stakeholders (N=380), efforts at
dissemination are directed toward going where the women are, integrating
with existing initiatives, and using multiple approaches.
This presentation will profile the awareness materials and describe
approaches utilized to develop, disseminate and evaluate them. It will also
address the challenges of creating information materials in different
languages and of ensuring that they reach the intended audiences.
IV-03-F
NURSE-LED CHEMOTHERAPY ASSESSMENT CLINICS: A PILOT
PROJECT INVOLVING ADJUVANT BREAST CANCER PATIENTS
Patricia Bieronski, RN, BScN, CON(C); Margaret Samide, RN,
CON(C); Maureen Watt-Smith, RN, CNCC(C); Donna Van Allen, RN,
BHScN, CON(C); Grand River Regional Cancer Centre, Kitchener,
Ontario
At this fast paced Community Cancer Centre the medical oncologists
spend an average of 4.8 hours per day doing assessments for patients
on active chemotherapy. These oncologists see 230 new patients per
year providing primary care for both hospitalized and ambulatory
cancer patients. This pilot project of nurse-led assessment clinics
considers the use of expert oncology nurses to assess a patient’s
readiness for his/her next chemotherapy cycle.
The pilot project was 6 months long. The first 3 months was devoted
to development, orientation, education and early implementation of a
nurse-led assess clinic. The final three months were considered
‘steady state’ and indicators were measured to evaluate the outcome.
The purpose of this pilot was to establish if the use of expert oncology
nurses to assess readiness for chemotherapy would improve patient
access, management of current patient volumes, and ensure ongoing
quality of care. Our presentation will introduce the evidence based
assessment tool, algorithms for each potential area of concern, and
the medical directives to support nursing practice. The results of the
evaluation will be shared to establish this exciting new role for expert
oncology nurses.
IV-03-E
THE JOURNEY BEYOND BREAST CANCER: EMPOWERING
BREAST CANCER SURVIVOR;S WITH WELLNESS STRATEGIES
Carole Beals, RN, BScN, CON(C); Tracey Keighley-Clarke, RN, BA,
MScH (in progress), CON(C); Royal Victoria Hospital, Barrie, Ontario
“Survivorship begins with diagnosis and continues for the rest of your
life”. (Muller, 1990).
Quality of life is gaining importance for breast cancer patients as
treatment advances increase survivorship. Breast cancer survivors
experience many demands of illness across the physical, psychological,
social, and spiritual domains.
Research has shown that once breast cancer patients end their active
treatment, links to support are often ended.
In 2002, the Royal Victoria Hospital, (RVH) Barrie received a grant from
the Canadian Breast Cancer Foundation to develop a breast cancer
retreat. The goal of the retreat was to “increase breast cancer survivor’s
knowledge of wellness and health strategies post breast cancer
treatment through a weekend retreat experience”, and “to provide
survivor’s with life-long health strategies and a network of peers which
could evolve into a healing community model”. Results obtained from
the surveys and focus groups demonstrated that the information and
education strategies utilized at the retreat improved the quality of life of
the survivors.
This presentation will examine how the Cancer Care Program at RVH
used the results of the retreat findings to develop a survivorship model
to provide information, education, and wellness strategies for all breast
cancer survivors within our community.
PSYCHOLOGICAL
EXPERIENCE IN
PATIENTS
IV-04-D
DISTRESS AND
POST-SURGICAL
PHYSICAL SYMPTOM
COLORECTAL CANCER
Vanessa Buduhan, RN, MN; University of Manitoba, Winnipeg,
Manitoba
Colorectal cancer (CRC) is the second most frequent cause of cancerrelated deaths among Canadians (NCIC, 2003).
Patients often
experience several physical and psychological symptoms from their
cancer or related treatment (Zaza & Baine, 2002). The purpose of this
study was to ascertain the prevalence rates of psychological distress
(PD), physical symptom experience (PSE), and the relationship between
these variables in post-surgical CRC patients. The Theory of Unpleasant
Symptoms (Lenz et al., 1997) guided this descriptive, correlational
study. PD was measured by the Hospital Anxiety and Depression Scale
(Zigmond & Snaith, 1983), and PSE was measured by the Memorial
Symptom Assessment Scale (Portenoy et al., 1994) in a convenience
sample (n = 35). In this sample, the prevalence of PD post-surgically
was 43%. The most prevalent physical symptoms reported were lack of
energy (89%), pain (83%), and dry mouth (83%). There was a
significant relationship between PD and the PSE (r = 0.573, p < 0.001).
Open-ended questions revealed that many patients (~50%) had no
concerns about hospital discharge. These findings suggest that many
patients are experiencing significant psychological and physical
symptoms post-operatively prior to hospital discharge. Furthermore,
patients are unaware of potential problems that can occur once
discharged home.
Standardized screening and patient education
emphasizing psychosocial care, symptom management, and about what
to expect after surgery is necessary to ensure a successful transition
from hospital to home.
IV-04-E
EXPLORING FAMILY NURSING PRACTICES IN ADULT ONCOLOGY
SETTINGS
Deborah L. McLeod1,2, RN, PhD; Dianne Tapp3, RN, PhD; Mary
Campbell1, RN, MScN; Nancy Moules3, RN, PhD; Teri Crawford2, RN, MN; 1
QE II Health Science Centre; 2 Dalhousie University; 3 University of Calgary
The experience of cancer is often devastating, affecting many aspects of a
family’s life. Families clearly desire competent care, understandable
information, involvement in decision-making about treatment and
compassionate recognition of both patient and family members’ distress.
However, there are many barriers that make it difficult for nurses to
provide family nursing in our individually focused health care systems.
Even in the face of such barriers however, nurses find ways to respond to
the needs of families but how that care is lived out in practice is poorly
understood and often invisible. Family nursing practices in oncology
settings have rarely been studied and consequently are not well described
in the literature.
In this presentation, we report on the first phase of a three phase study
designed to explore, describe, and interpret family nursing practices in an
adult ambulatory care oncology setting. The purpose of the project is to
understand more about how nurses care for families. Specifically, how do
they support the involvement of families and address their concerns and
distress given the limitations of the system. In the first phase, participant
observations and interviews were completed with 10 nurses and 10
families. The interviews and field notes were transcribed and interpreted in
the hermeneutic tradition. Exemplars of excellence as well as identified
barriers to family care will be discussed. Giving voice and visibility to
excellence in family nursing practices opens up possibilities to strengthen
this aspect of oncology nursing practice and education.
IV-05-D
BENEFITS AND LIMITATIONS OF TELEPHONE TRIAGE IN ONCOLOGY
Nicole Tremblay1, MSc inf. CSIO(C); Jacinthe Brodeur, BSc inf., CSIO(C); Julie
Piché, BSc inf., CSIO(C); 1 Hôpital Notre-Dame
In Canada, telephone triage or telephone consultation service in oncology care
will soon celebrate its tenth anniversary. Even though the telephone is the
fastest and most effective way to use professional expertise between two
appointments1, does this method, which was implemented in numerous
oncology centres, meet the needs of cancer patients? The authors will review
Canadian experiences in this area and present a report on the two years of
operation of a Quebec telephone consultation service. They will also address the
legal and training issues. Various data regarding the accessibility and continuity
of care as well as the prevention of certain complications and the reinforcement
of the educational aspects will be presented. The possibilities and the limitations
of such a service as an alternative to the emergency room will also be
discussed.
Stacey, D. & Fawcett, L. (1997). Telephone triage: An important role for
oncology nurses. Canadian Oncology Nursing Journal, July 1997, 178-179.
BENFAITS ET LIMITES DU TRIAGE TÉLÉPHONIQUE EN ONCOLOGIE
Au Canada, dans les milieux de soins oncologiques, le triage téléphonique ou
service de consultation téléphonique fêtera sous peu son dixième anniversaire.
Bien que le téléphone constitue le moyen le plus efficace et rapide de recourir à
une expertise professionnelle entre deux rendez-vous1, ce moyen mis en place,
dans bon nombre de centres d’oncologie, répond-il aux besoins des personnes
atteintes de cancer ? Les auteures feront un retour sur les expériences
canadiennes à cet égard et présenteront le bilan de deux années de
fonctionnement d’un service québécois de consultation téléphonique. Elles
aborderont aussi les enjeux de la formation et les aspects légaux. Diverses
données concernant l’accessibilité et la continuité des soins ainsi que la
prévention de certaines complications et le renforcement d’aspects éducatifs
seront présentées. Les possibilités et les limites d’un tel service en tant
qu’alternative à l’urgence seront également discutées.
1
Stacey, D. et Fawcett, L. ( 1997 ). Telephone triage : An important role for
oncology nurses. Canadian Oncology Nursing Journal, juillet 97, 178-179.
IV-04-F
EFFECTIVE COMMUNICATION IN ACUTE CANCER CARE:
PERSPECTIVES OF PATIENTS, FAMILY MEMBERS AND
NURSES
Fay J. Strohschein1, MSc (candidate); Sarah Thirlwell1, 2, RN,
MSc; Shona Hutton2, RN, BSc (candidate); Antoinette Ehrler2, RN,
BSc; Hélène Ezer1, RN, PhD; 1 McGill University; 2 Sir Mortimer B.
Davis Jewish Hospital; Montreal, Quebec
Effective communication is a core element of a quality cancer care
environment and has been identified as a priority in cancer nursing
research. Communication can directly impact on health and
functional outcomes for patients, influence coping and adjustment
to illness for patients and their family members, and affect the
work-related stress experienced by nurses. However, there is little
recent empirical evidence of what comprises effective
communication in acute cancer care.
This presentation will
describe the results of a qualitative research study that examined
experiences of effective communication in acute cancer care from
the perspectives of patients, family members and nurses. Data
were obtained through semi-structured interviews and were
analyzed using grounded theory methodology. The findings of this
study may be used to guide nurses in developing evidence-based
strategies to facilitate effective communication in acute cancer
care. In addition, the findings of this study may be used to guide
nurse administrators’ interventions in promoting an environment
conducive to effective communication between patients, family
members and nurses, thus contributing to quality cancer care.
IV-05-E (English)
THE POSITIVE EFFECTS OF THE USE BY NURSES OF A
SIMPLE DELIRIUM SCREENING TOOLS WITH PATIENTS IN
ONCOLOGY AND PALLIATIVE CARE
Marie de Serres, MSc inf., CSIO(C); Pierre Gagnon, MD, FRCP;
Jean-David Gaudreau, PhD; Centre Hospitalier Universitaire de
Québec, Québec City, Québec
Delirium is a complication that occurs occasionally with patients in
oncology and frequently with palliative care patients. As delirium
fluctuates, it is only through constant surveillance that it is possible
to detect it early and prevent it from getting worse.
This workshop will present the experiments in the use of a delirium
screening instrument in two institutions: a palliative care home and
an hemato-oncology and bone-marrow transplant unit. In palliative
care, the Confusion Rating Scale (CRS), a small and simple tool,
has been used by nurses since 1997 (Gagnon, Allard, Masse et al.,
2000). An improved version of the CRS was later validated for
oncology and bone-marrow transplant patients. This new scale has
been used for three years and is called “Échelle de dépistage du
délirium” [Delirium Screening Scale] (Gaudreau, Gagnon, Tremblay
et al., publication pending). Caregivers observed concrete results
after using these tools: decrease in the number of patients having
severe delirium, decrease in the number of patients needing
constant surveillance, reduction in the use of restraints. The
screening tool and the results of its use will be presented in this
workshop.
IV-05-E (French)
LES EFFETS POSITIFS DE L’UTILISATION PAR LES
INFIRMIÈRES D’UN OUTIL SIMPLE DE DÉPISTAGE DU
DÉLIRIUM CHEZ LES PATIENTS EN ONCOLOGIE ET EN SOINS
PALLIATIFS
Marie de Serres, MSc inf., CSIO(C); Pierre Gagnon, MD, FRCP; JeanDavid Gaudreau, PhD; Centre Hospitalier Universitaire de Québec,
Québec City, Québec
Le delirium est une complication qui se présente occasionnellement
chez les patients en oncologie et fréquemment en soins palliatifs. Le
delirium étant fluctuant, c’est par une surveillance constante qu’il peut
être possible de le dépister précocement et d’éviter que le problème
s’aggrave.
IV-05-F (English)
LITERATURE REVIEW TO DEVELOP AN EVIDENCE-BASED
TOOL FOR THE INITIAL ASSESSMENT OF ONCOLOGY
PATIENTS
France Robert1, inf. BSc, CSIO(C); Johanne Gagnon2, inf. PhD;
1
Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec;
2
Faculté des Sciences Infirmières, Université Laval, Québec
Our approach is part of a research internship at the Bureau de
transfert et d’échange de connaissances (BETC) [Office of
knowledge transfer and exchange] that involves a partnership
between Laval University’s Faculty of Nursing and a teaching
hospital with a supraregional focus in oncology. The objective was
an evidence-based improvement of the initial assessment.
Cet atelier présentera les expériences d’utilisation d’un instrument de
dépistage du delirium dans deux établissements: une maison de soins
palliatifs et une unité d’hémato-oncologie et greffe de moelle. En
soins palliatifs, le Confusion Rating Scale (CRS), un outil bref et
simple, est utilisé par les infirmières depuis 1997 (Gagnon, Allard,
Masse et al., 2000). Une version améliorée du CRS a ensuite été
validée auprès d’une clientèle d’oncologie et de greffe de moelle.
Cette nouvelle grille est utilisée depuis trois ans et est appelée Échelle
de dépistage du délirium (Gaudreau, Gagnon, Tremblay et al., sous
presse).
L’utilisation de ces outils a apporté des résultats
concrets observés par les soignants: diminution des patients qui
présentent un délirium sévère, diminution du nombre de patients
nécessitant une surveillance constante, réduction des contentions . On
présentera dans cet atelier l’outil de dépistage et les résultats de son
utilisation.
Method: databases such as Current Contents, CINAHL, Medline,
Cochrane Library and Psyclit were consulted for the period 1990 to
2004. This presentation examines work proposals that emerge from
the literature review. The following elements are available to
structure the collection tool: extensive knowledge of the patients’
needs, selection of a conceptual framework, use of practice
standards such as NIC, NANDA or CONEP, the use of a theoretical
model on change management, an implementation procedure using
a quality improvement approach, selection of a compatible format
with electronic health records.
IV-05-F (French)
RECENSION DES ÉCRITS POUR L’ÉLABORATION D’UN OUTIL
D’ÉVALUATION INITIALE DU PATIENT EN ONCOLOGIE À
PARTIR DE RÉSULTANTS PROBANTS
IV-06-D (Abstract 1 of 2)
WORKLOAD MEASUREMENT FOR ONCOLOGY ADVANCED
PRACTICE NURSES: HOW CAN THE IMPRINT TO PRACTICE
BE EVALUATED WITHOUT IT?
France Robert1, inf. BSc, CSIO(C); Johanne Gagnon2, inf. PhD;
1
Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec;
2
Faculté des Sciences Infirmières, Université Laval, Québec
J. Colleen Johnson, RN, MN, CON(C); Cindy Murray, RN, MN;
Princess Margaret Hospital, University Health Network, Toronto,
Ontario
Notre démarche se situe dans le cadre d’un stage de recherche au
Bureau de transfert et d'échange de connaissances (BTEC) qui
implique un partenariat entre la Faculté des sciences infirmières de
l’Université Laval et un centre hospitalier universitaire à vocation
suprarégionale en oncologie. L’objectif visait l’amélioration de
l’évaluation initiale basée sur des résultats probants. MÉTHODE: Les
banques de données telles Current Contents, CINAHL, Medline,
Cochrane Library et Psyclit ont été consultées de 1990 à 2004. Cette
communication présente des propositions de travail émergentes de la
recension des écrits. Pour structurer l’outil de collecte on retrouve les
éléments suivants : la connaissance approfondie des besoins de la
clientèle, le choix d’un cadre conceptuel, l’utilisation de standards de
pratique comme le NIC, le NANDA ou le CONEP, l’utilisation d’un
modèle théorique sur la gestion du changement, un mode
d’implantation qui respecte une démarche d’amélioration de la qualité,
la sélection d’un format compatible avec l’informatisation du dossier
médical. DISCUSSION: La recension des écrits a démontré un manque
d'études scientifiques avec des méthodes rigoureuses permettant de
produire des résultats probants sur l'efficacité des outils de collecte de
données en oncologie.
Workload measurement should be an expectation for every
oncology advanced practice nurse.
In an environment of
continuous fiscal restraint advanced practice nurses have an
obligation to demonstrate their value. Workload measurement is
one strategy that can be used to communicate the importance of
their contributions to the administrative members of the healthcare
team. However, measuring the activities of advanced practice
nurses is a complex and intimidating process.
The role
expectations for advanced practice nurses involve both clinical and
non-clinical activities therefore consideration to both areas must be
included. The clinical component for advanced practice nurses
involves the time and/or activities related to patient care including
interviewing, assessments, interventions and telephone contacts.
The non-clinical component for advanced practice nurses includes
the leadership, teaching, research and professional activity domains
of practice. This presentation will review the literature regarding
workload measurement for APNs as well as the experience of
advanced practice nurses from one oncology tertiary centre that
have been using a variety of measurement tools for the past four
years.
Discussion: the literature review reveals a lack of scientific studies
with rigorous methods producing conclusive results on the
effectiveness of data collection tools in oncology.
IV-06-D (Abstract 2 of 2)
ADVANCED PRACTICE NURSING IN ONCOLOGY: SHARING
THE EXPERIENCES OF YESTERDAY AND TODAY TO SHAPE THE
PRACTICE FOR TOMORROW
Cindy Murray, RN, MN; J. Colleen Johnson, RN, MN, CON(C);
Princess Margaret Hospital, University Health Network, Toronto,
Ontario
Advanced practice nurses specializing in oncology are practicing in
many provinces across Canada. The roles and issues for oncology
advance practice nursing are constantly evolving and there are
numerous similarities and differences depending on provincial
legislation, political environments and health care institutions. In
many cases advanced practice nurses are practicing in healthcare
settings as the solitary advanced practice nurse. In larger settings,
with multiple oncology advanced practice nurses, busy daily practices
leave them little time left to share their experiences, issues or
concerns with fellow advanced practice nurses. This workshop is an
opportunity for advanced practice nurses to come together to share
experiences and discuss issues relevant to advanced practice nursing
such as medical directives, role responsibilities, practice patterns,
collaborative relationships, and credentialing. From novice to expert,
this workshop will provide a learning opportunity for currently
practicing oncology advanced practice nurses, nurses considering a
future as an advanced practice nurse and/or administrators wanting
to learn more about the issues that affect the role. Sharing past and
present experiences may help to enhance the future role of advanced
practice nurses in oncology.
V-01-B
AN
EXPLORATORY
STUDY
OF
ONCOLOGY
HEALTH
PROFESSIONAL’S KNOWLEDGE, EXPERIENCES AND ATTITUDES
OF BEST PRACTICE USE OF ADVANCE DIRECTIVES WITHIN AN
ADVANCED CARE PLANNING PROCESS
Janice Wright, RN, MS, ACNP; Susan Robinson RN, MN; Princess
Margaret Hospital, Toronto, Ontario
Advance care planning refers to the process of preparing for likely
scenarios near the end of life and includes identification of a person’s
knowledge of their medical history, condition, values, preferences,
and personal and family resources. An advance care directive (ACD) is
a document that describes an individuals future preferences for
medical treatment. It is done prior to an event that would render one
unable to express those preferences.
There is a growing societal expectation that personal wishes will be
respected. At the same time there is a need for improved clinical
processes whereby an incompetent person’s prior wishes about end of
life decision making are known and there is clarity in communication
at the time that critical decisions need to be made.
Prior to considering implementation of an institutional process of best
practice use of advanced care directives it was essential to explore
Oncology Health Professional’s knowledge, attitudes, experiences with
Advance Directives and Advance Care Planning.
The knowledge, attitude and experiences with Advance Directives of
Oncology Health Professionals at a major comprehensive cancer
centre has been examined using the KAESAD or Knowledge,
Attitudinal, Experiential Survey on Advance Directives (Jezewski).
Analysis of the survey responses in the four essential study objectives
will be presented.
V-01-A
PROFESSIONAL ACCOUNTABILITY: A SURGICAL ONCOLOGY
UNIT EXPERIENCE
Mary Glavassevich, RN, BA, MN; Suman Iqbal, RN, CON(C); Anita
Long, RN; Sunnybrook and Women’s College Health Sciences Centre –
Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario
The challenge for nurses to practice in a decentralized model, in which
they are accountable for their practice, is well documented Porter
O’Grady, 1992. A professional model of nursing is described as one in
which the nurses are accountable for decisions about their practice and
one that enhances stag satisfaction.
Since 1997, staff nurses on a surgical oncology unit have been
accountable for assessing and evaluating their nursing practice through
the development of a unit-based nursing council. Nurses assume
leadership roles as chair and co-chair of the unit council and are
members of the hospital-wide nursing council. The patient care
manager, Advanced Practice Nurse, and educator provide support,
however, it is the nurses themselves who take the lead in addressing
the nursing practice issues identified on the unit within the outlined
terms of reference for the unit council. Nurses at unit based meetings
focus on the standards of nursing practice developed within the
organization, the College of Nurses of Ontario and the current national
oncology nursing standards. The goal of focusing on nursing issues
rather than operational issues requires particular skills and focus.
The nurses are positive about this approach and have been pleased
with the patients’ satisfaction survey results. Nurses feel that the council
has contributed to the high quality care they are providing to their
patients. This presentation will focus on the development of the unit
council, challenges encountered and strategies utilized by the nurses to
maintain momentum.
TO “BSN” OR NOT TO “BSN”
V-01-C
Patti Devion1, RN, CON(C); Elizabeth Cooper1, RN, CON(C); Laurel
Nicholson1, RN; Susan Hirowatari2, Student Nurse; Tracy Truant1, MSN;
1British Columbia Cancer Agency, Fraser Valley Centre, Surrey, British
Columbia; 2 Kwantlen University College, British Columbia
As of January 2005, a baccalaureate degree in nursing is the entry to
practice standard for Registered Nurses in Canada (CNA, 2004). Many
questions arise for diploma prepared nurses who have been working in
the profession of nursing for many, many years and have a wealth of
experience,
expertise
and
knowledge.
What
about diploma
prepared expert oncology nurses? How will this new CNA standard
affect their practice and/or their views on returning to complete their
BSN? How can employers and universities support diploma prepared
nurses to return to school to attain their BSN? These are some of the
questions that were asked of diploma and BSN prepared nurses.
This issue was investigated by diploma prepared nurses employed at a
Provincial Cancer Agency who have returned to university to attain their
BSN. In collaboration with two University Schools of Nursing they
undertook this project as part of their community development
course. Using a variety of data collection techniques, common
themes were identified by working nurses, employers and faculty
members surrounding the struggles and frustration that returning RN’s
experience in pursuit of higher education. This presentation will discuss
some of the barriers and enabling factors identified by RN's along with
some strategies to help employers and universities facilitate diploma
prepared nurses to receive their BSN.
V-02-A
PATIENT
FOLLOW-UP
VIA
VIDEOCONFERENCING:
ADVANTAGES AND CHALLENGES TO PATIENTS AND HEALTHCARE PROFESSIONALS
Nicole McDonald, RN; Audrey Oliver, RN; Terry Koski, RN, CON(C);
Carolle Thibeault; Northeastern Ontario Regional Cancer Centre of the
Hôpital Régional de Sudbury Regional Hospital, Sudbury, Ontario
The long-term follow-up of oncology patients in a large geographical
area creates many challenges. Barriers to patient adherence for
follow-up often stems from the inconvenience of travel, especially in
the winter months. Videoconferencing technology in Northern Ontario
has provided the capability to connect to our patients in many
communities for follow-up care. The utilization of this technology in
our ambulatory oncology setting has increased dramatically over the
last 2 years from a few cases to approximately 180 cases per month.
With the increased use of this technology, primary nurses face
increased responsibilities in managing patients. For example, as the
primary nurse is not physically attending the patient, her assessment
and interviewing skills must be enhanced to ensure the patient’s
needs are being met. In addition to seeing well follow-up patients,
physicians and nurses share test results, monitor side effects and
address palliative care issues such as pain control. This presentation
will outline the advantages for the patient, and also the challenges
faced by the health-care team in managing such a large number of
patients via this technology. Information collected from interviews of
patients, physicians, nurses and clerical support will be reported and
the perceived advantages and disadvantages will be discussed.
V-02-C
THE EFFECTIVENESS AND EFFICIENCY OF AN INDIVIDUALIZED
TELEPHONE COUNSELING INTERVENTION FOR PEOPLE WITH
CANCER
Lynn Coulter 1, RN, MN; Barbara Downe-Wamboldt 2, RN, PhD; Lorna Butler 2,
EN, PhD; Patricia Melanson 2, RN, MN; Janice Keefe 3, PhD; Jerome Singleton 4,
PhD; David Bell 5, MD; Gina Browne 6, RN, PhD; Teri Crawford 2, RN, MN,
Research Coordinator; 1 Queen Elizabeth II Health Sciences Centre, Halifax,
Nova Scotia; 2 Dalhousie University, School of Nursing, Halifax, Nova Scotia; 3
Mount Saint Vincent University, Family Studies Gerontology, Halifax, Nova
Scotia; 4 Dalhousie University, School of Health and Human Performance; 5
Dalhousie University, Faculty of Medicine; 6 McMaster University, Hamilton,
Ontario
Extensive evidence indicates that cancer patients suffer considerable
emotional distress as a result of their disease and treatment. Psychological
factors such as difficulty coping and poor adjustment to illness influences
both quality of life and the use of health resources. Current literature
clearly indicates a need to provide evidence-based interventions to
increase the patient’s ability to cope successfully with their personal cancer
experience. The aim of this study was to determine the effectiveness and
efficiency of individualized problem solving counseling provided by
registered nurses over the telephone for persons with cancer and to
determine for whom and with what characteristics the intervention was
most acceptable, effective and efficient. This study used a longitudinal,
randomized controlled design to assess the effect and expense of usual
clinic care (control group, n = 75) versus individualized problem solving
counseling intervention (experimental group, n = 76) for patients
diagnosed with breast, lung or prostate cancer. The intervention group, in
addition to the usual follow-up care, was provided telephone problem
solving counseling sessions over a 4 month period following surgery.
Measures of adjustment to illness, depression, coping, and health resource
expenditure were completed at baseline, post intervention (4 months) and
at 8 months. The finding from this study and implications for practice will
be the focus of this presentation.
.
V-02-B
ONCOLOGY TELEPHONE PRACTICE GUIDELINES & ONLINE
DOCUMENTATION: THE PERMANENT IMPRINT
Patti Marchand, RN, MN, CON(C); Linda Klich, RPN; R.S. McLaughlin
Durham Regional Cancer Centre, Oshawa, Ontario
The past year has seen the introduction of telephone practice guidelines
in our ambulatory oncology clinic. Consistency, continuity and
confidence have not always been the hallmark of telephone practice in
our institution. An education manual containing telephone nursing
practice standards and symptom management guidelines and an
interactive presentation including case studies were developed
externally and shared with staff to launch their usage in our clinic. In
addition, our center incorporated the guidelines into a pocket guide to
ensure easy accessibility. The next necessary step was the inclusion of
the guidelines into the current online documentation system.
In collaboration with the information technology department,
documentation screens were built, piloted and moved to “live.” Staff
nurses addressing telephone calls in the middle of busy clinics, found
that the user-friendly screens facilitated complete and efficient
documentation, consistent with nursing standards.
This presentation will enable nurses to view the documentation screens
that were created and are now being utilized in the ambulatory
oncology setting. An audit captured the details of the guidelines’
application and highlighted situations when the guidelines were not
used, but should have been. These situations were further explored
through interviews with individual nurses. Information gathered
identified gaps in telephone practice, evident in both symptom
recognition and management. These lessons learned will be shared to
positively influence the imprint of documentation excellence.
V-03-A
BREAST CANCER INFORMATION DISSEMINATION STRATEGIES
– FINDING OUT WHAT WORKS
Margaret I. Fitch 1, PhD; Irene Nicoll 2, MBA; Sue-Keller-Olaman 3,
PhD; 1 Sunnybrook and Women’s Health Sciences Centre; 2 Ontario
Breast Cancer Information Exchange Partnership; 3 Ontario Breast
Cancer Community Research Intiative; Toronto, Ontario
Information about breast cancer is more available now than ever
before, yet women still report that they received "no information" at the
time of their diagnosis or treatment for breast cancer. The aim of this
project was to help groups and individuals engaged in the dissemination
of information about breast cancer learn the best strategies to use so all
women will have easy access to that information. The qualitative
research was conducted in two phases from November 2003 to August
2004. First, 28 breast cancer survivors were interviewed. Three themes
emerged from these discussions: the shock of diagnosis; the onus
being on the patient to search for information; and the different types
of information that breast cancer survivors want. Interviewees also
shared their negative and positive experiences in the cancer care
system. Secondly, to learn multiple viewpoints, focus groups were held
with breast cancer survivors in nine locations in Ontario (n=127) and
three focus groups were conducted with information providers (n=25)
using the three themes as a framework to guide the discussions.
Participants validated the themes and identified two programs using
“best practices” to provide information for women: a structured breast
health centre in eastern Ontario and a peer support program operating
in rural southwestern Ontario. The presentation will highlight the study
findings that include implications for practice, education, and research.
V-03-B
NURSING SUPPORT PROGRAM TO DECREASE OR PREVENT SIDE
EFFECTS OF CAELYX (PEGYLATED LIPOSOMAL DOXORUBICIN) IN
PATIENTS WITH RECURRENT EPITHELIAL OVARIAN CANCER (REOC)
Veronique. Lebel 1, RN; Nathalie Grenier 1, RN;; M. Gill 2, RN; T. Mullen 3, RN;
K. Mitchinson 4, RN; M. Foster 5, RN; S. Lewis 6, RN; K. Seborn 7, RN; A.
Rodgers 8, BSc; J-F. Pouliot 8, PhD; CHUM – 1 Hôpital Notre-Dame, Montreal,
Quebec; 2 Tom Baker Cancer Centre, Calgary, Alberta; 3 Juravinski Cancer
Centre, Hamilton, Ontario; 4 Royal Victoria Hospital, Barrie, Ontario; 5 Lakeridge
Health Centre, Oshawa, Ontario; 6 Peel Memorial Hospital, Brampton, Ontario; 7
London Regional Cancer Centre, London, Ontario; 8 Schering Canada Inc.,
Pointe-Claire, Quebec
Background: A significant long-term survival with Caelyx compared to
topotecan was recently reported in a phase III randomized study of
women with REOC (Gordon Gyn. Oncol. 2004). Caelyx is known to be
relatively less toxic than topotecan and conventional doxorubicin, however
side effects may lead to sub-optimal drug exposure and treatment
discontinuation. Methods: A nursing support program was created to
determine if patient education through proactive nursing intervention could
decrease the occurrence and/or severity of side effects. Patients were
educated about potential toxicities of Caelyx and received instructions on
the prevention and management of side effects. Results: Caelyx was
administered to 112 ovarian cancer patients as 2nd, 3rd and 4th line
therapy in 51%, 34% and 15% of patients, respectively. The average dose
of Caelyx was 40.4 mg/m2 (35-50) every 28 days for an average of 4.01
cycles (1-23). Clinical symptoms and/or radiological evaluation stabilized or
improved in 69% of patients. Overall the frequency of adverse events, in
these heavily pretreated patients, was similar to that observed in a
previous phase III clinical trial (Gordon JCO 2001) where patients had
received only one prior therapy. However, the incidence of grade 3/4
palmar-plantar erythrodysesthesia and mucositis were reduced from 21%
to 4% and 8% to 3%, respectively. Conclusion: The nursing support
program helped to reduce the severity of PPE and mucositis in patients
receiving Caelyx for REOC.
V-03-C
MOVING PRACTICE FORWARD AT PRINCESS MARGARET
HOSPITAL:
NURSES
TRANSFUSING
AUTOLOGOUS
PERIPHERAL BLOOD STEM CELLS
Katherine Trip, RN, MN (ACNP); Norman A. Franke, MD; Princess
Margaret Hospital, Toronto, Ontario
The infusion of autologous peripheral blood stem cells has long
been the domain of physicians.
Building on literature from Australia, the physicians and nurses at
our hospital developed a procedure that would enable Registered
Nurses to transfuse thawed stem cells rather than having this
remain a physician only responsibility.
It was hoped that patients would tolerate the new method of
infusion as well as or better than reinfusion by IV push.
Engraftment data are routinely collected and show there is no delay
in engraftment when stem cells are transfused rather than pushed
into the circulation.
This presentation will focus on the process of moving practice from
a physician only responsibility to a shared responsibility between
physicians and nurses. Outcome data regarding patient side effects
and engraftment will be shared, as will the protocol utilized by our
nurses.
V-04-A
SHOULD ONCOLOGY NURSES ACCEPT PRIVATE INDUSTRY
SPONSORSHIP; IT IS ETHICAL WEIGHING, THE ODDS?
V-04-B
A CELEBRATION – RAINBOWS: THE MANY COLOURS OF
ONCOLOGY NURSING
Janis Stewart 1, BScN, CON(C); Shelagh Knight 2, RN; 1 Princess
Margaret Hospital, Toronto, Ontario; 2 Astra Zeneca, Toronto, Ontario
Cathy Doyle, RN, CON(C); Vicki Barton, RN; Marge Blokker, RN,
BA, CON(C); Susan Collins, RN, MScN, ACNP, CON(C); Wendy Gillis,
RN, MScN, ACNP, CON(C); Susan Ludlow, RN, BA; Gloria Murdoch,
RN, MScN, ACNP, CON(C); Patricia Stalker, RN, BScN, CON(C);
Angela Vinet, RN; London Health Sciences Centre, London, Ontario
Oncology nurses have the luxury of often being in a situation where
they can access paid education/financial support from pharmaceutical
companies or they are offered an honorarium to give educational
sessions on behalf of pharmaceutical companies. Should this practice
exist and how do nurses draw the line and ensure they are not being
unduly influenced? This presentation will inform the attendees about
the currently published guidelines related to the sponsorship and
marketing practices. The current Canada’s Research-Based
Pharmaceutical Companies (Rx &D) have regulations regarding private
industry sponsorship of health care professionals. The Oncology
Nursing Society (ONS) and its affiliates have a set of policies that
guide decision-making with regard to sponsorship and the National
Institutes of Health (NIH) published an extensive report concerning
conflict of interest for health care professionals. Two nurses who
have had the unique experience to have worked in both the hospital
sector and the pharmaceutical sector will present a selection of the
currently published recommendations and guidelines. Having a clear
understanding of these regulations will provide nurses with a
framework to guide decision-making around accepting private
sponsorship. A case study model will be used to present situations;
the models will be based on real situations recounted by oncology
nursing colleagues.
In planning our 2004 cancer nursing conference, it was our goal to
end the day with a celebration of oncology nursing using an
audio/visual presentation format.
Wanting to capture the experiences of nurses, we asked them what
brings them joy, what gives them rewards and why they remain in
such a demanding speciality. We then set about to videotape and
photograph oncology nurses and patients. The overwhelming
responses reflected their compassion, the importance of coworkers,
the value of humour, and their unique relationships with patients. A
physician and the daughter of one of the nurses also volunteered to
provide their insights.
Together with the interviews, photographs of nurses and patients,
and a thoughtful selection of music, we created a 22 minute movie
presentation titled: Rainbows: The Many Colours of Oncology
Nursing. This movie exceeded our expectation. It not only invoked
a celebration, but also laughter and tears leaving a lasting imprint
as it touched nurses in a very personal way. It inspired a renewed
awareness that together we share beliefs, values and passion in
our relationships with our patients and with each other.
The purpose of this presentation is to share the video depicting a
glimpse into oncology nursing.
V-04-C
WHAT DO ONCOLOGY NURSES DO?
Dauna Crooks1, RN, DNSc; Esther Green2, RN, MHSc; Mary
Fergeson-Pare3, RN, PhD; Doris Howell3, RN, PhD; Debra Bakker4, RN,
PhD; Joan Tranmer5, RN, PhD; Pat Sevean6, RN, PhD (candidate);
Margaret Fitch7, RN, PhD; Laurel Plewes7, BScN; Shirley Sharkey8, RN;
Nancy Lefevre8, RN, MScN; 1Hospital for Sick Children, Toronto,
Ontario; 2Cancer Care Ontario, Toronto, Ontario; 3University Health
Network, Toronto, Ontario; 4Laurentian University, Sudbury, Ontario;
5
Queen’s University, Kingston, Ontario; 6Lakehead University, Thunder
Bay, Ontario; 7Toronto-Sunnybrook Regional Cancer Centre, Toronto,
Ontario; 8Saint Elizabeth Health Care, Markham, Ontario
The Ontario Role Function Study group, using survey techniques,
examined the full scope of clinical role functions for clinical oncology
nursing practice. Role functions included the following: assessment,
prevention, medical directives, counseling, education, psychosocial
support, evaluation and palliative care. Nurses were asked to self
identify as specialized or advanced practitioners as per CANO
descriptions. They noted what role functions they performed, if they
did not perform the role function themselves, who did it. Finally, they
identified the degree of independence in performing each function.
We will present the data for selected role function categories as
illustrations of the scope of practice of oncology nurses, identify areas
of role overlap and clarify specifics of each role category, Survey
results will be of value to educators and administrators in assessing
and defining role parameters, and role definitions. In addition it will
guide educators in nursing to create useful educational programming
and clinical administrators to identify areas where nurses are
underutilized in oncology care.
V-05-B
PREPARING ONCOLOGY NURSES: ORIENTATION REALITY IN
2005
Beverley Page1, RN, BScN, CON(C); Margaret Fitch, RN, PhD; Laurel
Plewes, RN, BScN; 1Toronto Sunnybrook Regional Cancer Centre,
Toronto, Ontario
A worldwide shortage of nurses, altered hiring practices, shorter
inpatient stays and increased patient acuity has contributed to
changing orientation needs for ambulatory oncology nurses.
Preparation of specialty oncology nurses is being challenged in various
ways. Newly hired nurses must be prepared quickly to function
competently in new roles and units and feel pressure from
performance expectations.
In one ambulatory cancer centre, nurses starting employment during
2003 and 2004 (n=21) were invited to participate in an intensive
evaluation of their own orientation, identify pressures, strengths and
weaknesses and make suggestions for improvement. Interviews were
accomplished through focus groups and via telephone (n=16,
76.17%) and centred around questions designed by educator, clinical
practice leader and managers.
Results of the interviews yielded themes and key pressures for new
nurses. They identified system weaknesses and educational needs and
suggested creative educational approaches. These data are being
integrated into the cancer centre’s revised nursing orientation
program. New challenges in nursing practice frequently lead to
identification of education needs and developing new strategies and
innovations in nursing education. Sharing strategies and innovations
allows oncology nurse educators to meet challenges, support new
nurses and address the crisis of inadequate preparation for oncology
specialty practice.
V-05-A
LEAVING OUR IMPRINT: A COLLABORATIVE ONCOLOGY
NURSING EDUCATION PROGRAM INVOLVING THE CROSS
CANCER INSTITUTE AND THE AGA KHAN UNIVERSITY
HOSPITAL
Tayreez Mushani-Kanji, RN, BScN, CON(C), CHPCH(C); Cindy
Cummings-Winfield, RN, BScN, CON(C); Khurshid Khowaja, PhD; Cross
Cancer Institute, Edmonton, Alberta
The opportunity to collaborate with an institution in another continent
has the potential to forge a long term relationship especially as it relates
to the sharing of oncology nursing knowledge that will ultimately lead to
enhanced patient care.
The department of Nursing Education at the Cross Cancer Institute
(CCI) had the unique occasion to partner with Nursing Education at the
Aga Khan University Hospital (AKUH) in Karachi, Pakistan. The
recognition of oncology nursing as a specialty at the AKUH was
instrumental in establishing contact between the two institutions and
the subsequent development of an oncology nursing education
program.
This presentation will begin by describing the events that lead to this
unique collaborative educational endeavor. This will be followed by
outlining key considerations such as culture, distance and lack of
available oncology nursing resources in Karachi that impacted course
design in Canada. The challenges inherent in teaching oncology nursing
to practicing nurses whose first language is not English, coupled with
the challenges encountered in a third world country will also be shared.
The course was evaluated to ascertain participants’ self-perceptions,
views on oncology nursing, theory assimilation and clinical application.
The results of this evaluation will be presented.
Finally, we will discuss how such an experience left an imprint on both
sides of the oncology nursing world and planted the seeds for future
collaboration.
V-05-C
CLINICAL LEADERSHIP IN ACTION – AN EVALUATION
STUDY OF THE IMPACT OF CLINICAL LEADERSHIP
DEVELOPMENT FOR ONCOLOGY STAFF NURSES
Lynne Penton1, RN, MN, CON(C); Janet Rush2, RN, PhD; Sandra
McFarlane2, RN, MHSc 3Juravinski Cancer Centre, Hamilton,
Ontario; 1Registered Nurses Association of Ontario; 3McMaster
University, Hamilton, Ontario
Leadership can be found throughout an organization. Leadership is
not limited to one person in any work setting. It is based on
relationships and actions, not on positions. (Buzzotta et al. 1996)
In the oncology nursing milieu as in other practice areas there has
been renewed interest in the notion that every nurse has the ability
to provide leadership in some way. There is also some evidence to
suggest that previous beliefs about leadership as an inherent trait
are untrue and that all nurses, given opportunity and
understanding, can demonstrate leadership behaviours. This in turn
may strengthen clinical practice, improve job satisfaction and
create positive results in patient care outcomes while fostering
nursing retention. Kouzes and Posner (2002) have identified the
five measurable components of leadership behaviour; they can be
measured using a valid and reliable tool.
To explore these notions, a funded, approved study is underway in
a Regional, Cancer Centre.
This presentation will involve a
discussion of the underlying values driving the project, the concept
of leadership among oncology staff nurses, the study maneuver,
and the methods for measuring leadership attributes.
V-06-A (Abstract 1 of 2)
A FIFTEEN- MINUTE FAMILY CENTRED NURSE ASSESSMENT
IN ONCOLOGY
Anne Plante, MSC inf.; Christiane Salée; Lucie Laporte, BSc inf.;
Hôpital Charles LeMoyne, Greenfield Park, Québec
Theme: family centred care, family nursing interventions, oncology
assessment for new patients.
Nursing Faculties and nursing directions of all institutions are investing
a lot of efforts to promote family centred care in various settings.
Those initiatives have improved results in care settings. Our regional
hospital has worked in partnership with eight local oncology clinics to
implement family centred care and family nursing interventions ``way
of doing``. In the context of limited human and financial resources, it
was quite a challenge. We structured a nursing assessment tool to
evaluate all new patients in the oncology program. It is based on the
``15-minute family interview`` model from Wright and Leahey. The
15-minute family interview is not a strategic decontextual nursing
tool. In fact, it is a flexible interview guide that is embedded in family
nursing practice. It enhances the relationship between nurses and
family. It promotes the nurse’s philosophical assumptions and
obligations to relate adequately with families, especially in oncology.
The use of this tool has changed not only nursing practices, but the
whole team practice.
VI-01-D
A CONCEPT ANALYSIS OF SUFFERING LEADS TO THE
HEALING
AND
TRANSFORMATION
MODEL
FOR
MULTIDISCIPLINARY PSYCHOLOGICAL INTERVENTION
Lynn Hryniuk1, RN, MSN; Wm. Hryniuk2, MD; 1CarePath Inc.,
Dundas, Ontario; 2Cancer Advocacy Coalition of Canada, Toronto,
Ontario
Psychosocial and spiritual interventions lack a coherent model for
assessing needs of cancer patients and families, and multi-disciplinary
care is frequently not sharply focused on meeting these needs. A
concept analysis of Suffering yielded the “Transformation and
Healing” model allowing for a more logical approach. The analysis
determined how Suffering is defined, its causes, what are its
preconditions, its natural history, and its positive and negative
consequences: Suffering can end or lead to turmoil without resolve.
With this sequence defined, (i.e. suffering exists, has a beginning, a
process and an end), after careful interview each individual’s personal
sources of Suffering can be understood, required interventions and
care disciplines identified, and outcomes evaluated. Moreover, the
points of entry for interventions can be defined more precisely and
logically.
Interventions can come from the individual’s own resources, or from
health care professionals, spiritual and psychological counselors,
family and friends. The informed patient can choose interventions
from these according to need, interest, and ability. With insight and
assistance, the Suffering can end more rapidly. At that end point
“Healing” occurs and usually a different life views are acquired which
is “Transformation”.
V-06-A (Abstract 2 of 2)
ONCOLOGY INTERDISCIPLINARY TEAM MEETING
Anne Plante, MSc inf.; Christine Mimeault, BSc inf.; Hôpital
Charles LeMoyne, Greenfield Park, Québec
Themes: Health care teams, oncology team work, quality
improvement
Nurses, physicians and all other health care professionals are being
asked to work on a team model in delivering their care. The
knowledge that each health professional brings from their practice
discipline, coupled with the theory of ``team working`` (methods
to organize interdisciplinary clinical meetings) can greatly
accelerate the opportunities for improvement in the quality of care
and the quality of life for all oncology patients. A thirty minute
video explains the process followed to implement such a vision.
Support was given to all professionals in using new habits, working
in teams, and approaching the work environment as a system. The
nurse’s role in this interdisciplinary, patient, family centred care
model is essential and central. It will be well illustrated throughout
the video presentation.
VI-01-E
FACTORS ASSOCIATED WITH FUNCTIONAL WELL BEING IN
OLDER PERSONS LIVING WITH CANCER
Joan Tranmer1, RN, PhD; Linda Robb Blenderman2, RN, MScN;
Esther Green3, RN, MSc(T); et al; 1 Kingston General Hospital,
Kingston, Ontario; 2Cancer Centre of Southeastern Ontario; 3Cancer
Care Ontario
The purpose of this prospective cohort study was to obtain a profile
of personal health and social factors associated with functional well
being in older persons diagnosed with cancer. Three hundred and
fifty patients, greater than 65 years of age, diagnosed with cancer
at the Southeastern Ontario Cancer Centre participated in the
study. At baseline and 3 months following enrollment, the following
validated measures were collected via written questionnaire or
telephone interview: (1) health related quality of life using the MOS
SF12 and the EORTC QLQ – C30; (2) symptom distress using the
Memorial Symptom Assessment Scale (MSAS); (3) physical activity
using the Physical Activity Scale for the Elderly (PASE) and (4)
informal social support using the Medical Outcome Social Support
Survey. Data collection and analysis is in progress. We will report
on the personal, health and social support factors that are
correlated to functional well being. It is anticipated that the
information gained from this study will enhance nurses’
understanding of, and care in regard to age related issues.
RN
VI-02-D
THE IMPRINT OF MRS. L: A UNIQUE CLINICAL JOURNEY WITH
PAGET’S DISEASE OF THE VULVA
Jennifer Parkins, RN, BScN, CON(C); Pat Bieronski, RN, BScN,
CON(C); Gloria Hasenpflug, RN, CON(C); Grand River Regional Cancer
Centre, Kitchener, Ontario
Gwendolyn D. Bourdon, RN, BScN, MEd; Stephanie Burlein-Hall, RN,
BScN, MEd, CON(C); Interlink Community Cancer Nurses, Toronto,
Ontario
A MULTIDISCIPLINARY
LEADERSHIP
VI-01-F
LUNG
CANCER
CLINIC:
Registered Nurses are innovative leaders in the implementation of a
multidisciplinary lung cancer clinic at a regional cancer centre.
Registered Nurses specialized in lung cancer triage all new lung
cancer cases coming into the centre in collaboration with the medical
team. Thus, there is a process of prioritization leading to the delivery
of prompt and appropriate care for the lung cancer clients. Decisionmaking and clinical judgements are essential components to the
Registered Nurse’s planning for the clinic. “The literature identifies
two distinct phases in nursing and medical decision-making: (a) a
diagnostic phase in which observation of a patient situation, data
collection, and data processing lead to the identification of problems
or decisions about diagnosis, and (b) a management phase in which
plans of action and treatment options lead to interventions. In this
kind of process nurses and physicians make decisions on the basis of
the information processing theory” (Salantera, & Erikson, & Junnola,
& Salminen, & Lauri, 2002, p. 280). Therefore, newly diagnosed lung
cancer clients are seen for initial consultation by a medical oncology
and a radiation oncology multidisciplinary team. On consultation, an
individualized plan of care is developed for each client. Registered
Nurses act as key contacts for the clients offering ongoing educational
and holistic support. This presentation/poster will focus on the RN’s
role for this clinic and ongoing evaluation of this pilot project.
VI-02-E
CREATIVE PARTNERSHIPS IN ACTION: RECOMMENDATIONS FOR
A REGIONAL STRATEGY TO MANAGE BREAST CANCER RELATED
LYMPHEDEMA
Cathy DeGrasse 1, RN, MScN; Lisa Bitonti 2, BScN, RN, CON(C); Dr.
Audley Bodurtha 3, MB, BS, FRCSC, FACS; 1 The Ottawa Regional Women’s
Breast Health Centre; 2 The Ottawa Regional Cancer Centre; 3 The Ottawa
Hospital; Ottawa, Ontario
Women suffering from lymphedema and other stakeholders who have
been helping women to cope with their breast cancer diagnosis and
treatment have expressed two main challenges related to lymphedema:
inconsistent acknowledgement by some health practitioners of
lymphedema existence; and the overall coordination of lymphedema
services within the community.
An innovative multi-stakeholder process was used to determine a regional,
evidence-based strategy to manage breast cancer-related lymphedema. A
multi-stakeholder steering committee informed the process and developed
a foundation document for a regional workshop. The purpose of the
workshop was to make specific recommendations for a regional strategy.
The workshop framework was based on the following five major themes
identified by the steering committee: clinical pathways; communication
strategies; education of women; education and training of health
professionals; and research and quality improvement. Through large and
small group facilitated dialogues, workshop participants adopted a working
definition of lymphedema, provided feedback on the foundation document,
and, identified the main priorities related to each theme. This project is
consistent with a provincial cancer plan to improve access, measurement
and reporting, evidence-based decision making, effective use of resources,
and outcomes. This presentation will focus on the recommendations for a
regional plan which was submitted to a palliative care consortium (the
project funding body) and the Regional Cancer Centre for implementation.
While many nurses may be familiar with Paget’s disease of the bone,
extramammary Paget’s disease of the vulva is a rare non-squamous cell
cutaneous adenocarcinoma with the true incidence and cause unknown.
Challenges related to the rarity of this disease include limited knowledge
and information about the disease, and inappropriate or unclear
management guidelines, including those related to nursing care.
Typical symptoms are non-specific and may include pruritis, irritation
and pain, but occasionally patients may appear asymptomatic. Delay in
diagnosis and treatment may be long, range 2-8 years (Tulchinsky,
Zmora, Brazowski, Goldman, and Rabau, 2004) as the disease is often
treated with topical preparations in the belief it is a benign dermatologic
condition, such as dermatitis or eczema.
Surgery is the most common treatment, however repeat excisions are
often necessary due to the high incidence of local recurrence. To date,
chemotherapy has not been effective for this population of
predominately postmenopausal Caucasian women.
Through the journey of Mrs. L, the author shares the ‘imprint’ of this
patient on her practice and the clinical challenges in caring for one with
a rare cancer. Sharing this experience will help other oncology nurses
provide holistic and individualized nursing care through a review of this
disease from past and present knowledge.
VI-02-F
NURSING’S IMPRINT ON PATIENT CARE: AN EVALUATION OF
PATIENT SATISFACTION IN A RADIATION NURSING CLINIC
Maurene McQuestion, RN, BA, BScN, CON(C), MSc (candidate); Barbara
Willson, RN, BN, MS, CON(C); Sandra Chapman, RN, CON(C); Princess
Margaret Hospital, University Health Network, Toronto, Ontario
Patient satisfaction has been shown to be a nurse sensitive outcome as well
as a measure of quality care provided by the multidisciplinary team (Spence
Laschinger & Almost, 2003). In the ambulatory oncology setting, care is
provided in several areas including new patient clinics, treatment review
clinics, radiation treatment units, drop-in radiation nursing clinics, and in
inpatient settings for overnight chemotherapy treatments. Existing patient
satisfaction studies have focused on informational needs and information
provision, satisfaction with physical and psychosocial adjustment, medical
care, waiting times, technical competence of personnel, communication,
access to care, and satisfaction with follow-up care, etc. (Frost, et. al., 1999;
Goodwin, 2000; Gourdji, et. al., 2003; Hagedoorn, et. al., 2003). To date no
studies have assessed patient satisfaction of care in an ambulatory radiation
oncology setting.
A pilot study assessing patient satisfaction based on the Picker Institute’s
eight dimensions of patient centred care (PCC) was conducted with patients
receiving care in a radiation nursing clinic (RNC). The RNC provides a setting
where patients can be assessed by a registered nurse for new or ongoing
problems or have procedures carried out in the period between their weekly
review appointments with the radiation oncologist and RN Case Manager.
Surveys were conducted with 57 patients who received care in the radiationnursing clinic. 10 patients also participated in a one-hour indepth interview
about their experience in the clinic setting. This presentation will provide a
brief overview of the model of PCC and share findings from the patient
satisfaction survey and patient interviews. Results of this survey may serve
as a model for the evaluation of patient satisfaction in other radiation
treatment facilities.
VI-03-D
EMPOWERED CHOICES: NAVIGATING THE CONTINUUM OF CARE
FOR WOMEN WITH BREAST CANCER
Sally Turco, RN, CON(C); Misericordia Community Hospital, Edmonton,
Alberta
In July 2003, a funding grant from the Canadian Breast Cancer
Foundation, Alberta/NWT chapter allowed the development a Nurse
Navigator role, aimed at providing education and support to women at the
time of diagnosis of breast cancer. The Nurse Navigator meets with
women at the time of diagnosis and facilitates access to information and
support in their decision making through surgery and in preparation for
long-term treatment at the Tertiary Cancer Center.
In addition, the Misericordia Community Hospital developed an innovative,
quality program for women newly diagnosed with breast cancer. The
purpose of the program, called Healing Connections, is the assessment,
follow up, support and education of program participants and to provide a
bridge from diagnosis to the long-term treatment programs at the Cancer
Center. Patients are referred to the 5-week program as part of their preand post-operative care. Although the concept of such a program may be
seen as basic, it is unique to the Capital Health Region.
Participants come into the program after diagnosis of breast cancer and
prior to surgery, and are followed by a team of health professionals until
initial consultation at the Cancer Center, or until they decide to exit the
program, knowing that they can return at any time. Outcomes reveal a
high success rate of program participants in mobility, increased function,
adaptability and a sense of well-being.
Through these two initiatives, women with a diagnosis of breast cancer are
well informed, well supported, and well prepared to adjust to life in the
context of breast cancer.
This presentation will outline the structure of the Healing Connections
Program and the Role of the Nurse
Navigator, and will present research
VI-03-F
investigating
patient satisfaction
and preparedness
long termWITH
cancer A
DAY
SURGERY
AND RECOVERY
IN for
WOMEN
care, as well as future
directions LESION:
for this uniqueEVALUATION
program..
SUSPICIOUS
BREAST
OF
A
PSYCHOEDUCATIONAL NURSING INTERVENTION
Nicole Allard, RN, PhD (candidate); Université du Québec a
Rimouski, Québec
This study assessed whether a nursing intervention based on selfregulation theory, the Attentional Focus and Symptom Management
Intervention (AFSMI) could help women who underwent day surgery
for breast cancer to achieve better health outcomes. The sample
consisted of 117 patients with breast cancer who were outpatients
and undergoing surgery as part of the initial treatment for their
cancer. The outcomes were the subjects' symptomatology, emotional
distress and functional status. Results showed significant differences
between the experimental and control group at post-test on disruption
in home management activities, total mood disturbance, confusion
and tension scores implying that the intervention was effective in
achieving these outcomes. As for symptom management, the
intervention had no statistically significant effect. Future research
should consider individualized intervention to help each woman cope
with the healthcare situation and allow different ways to reach
unexpressed needs in order to intervene more effectively. Findings
from the present research have illustrated that a nursing intervention
applied during immediate recovery of breast cancer surgery is quite
clinically relevant to reduce emotional distress and usual functioning,
the ultimate outcomes of coping. Self-regulation theory could
effectively be used as a guide in developing nursing intervention
programs in practice for patients with cancer undergoing day surgery
as a primary treatment.
VI-03-E
IMPROVING WAIT-TIMES: THE ROLE OF THE NURSE
NAVIGATOR IN BREAST HEALTH ASSESSMENT AND CANCER
DETECTION
Anne Matte, RN; Carole Mayber, MSW, RSW; Denise Gauthier-Frohlick,
MA, Bed; Carolyn Jackson, RN; Sudbury Regional Breast Health
Program, Supportive Care Oncology Research Unit, Hôpital Régional de
Sudbury, Sudbury, Ontario
As the Canadian health care system struggles to provide patients with
timely access to medical care and treatment, more attention is focused
on the role of the Nurse Navigator to effectively coordinate services and
provide the necessary support to patients. This presentation will focus
on the role of the Primary Nurse Navigator (PNN) developed at a
regional breast health program that has contributed to reducing time to
diagnosis for women and men who are investigated for a breast
detected abnormality. Data will demonstrate that time to diagnosis has
significantly decreased. The presenter will also share her experience
working as a PNN and how it has changed her nursing practice.
The regional breast health program opened in January 2000 and offers
comprehensive services to women and men of all ages undergoing
investigations for a breast abnormality. Examples demonstrating how
the PNN is effective at reducing time to diagnosis are:

Track breast detected abnormalities identified in Diagnostic
Imaging

Assess patient referrals based on a priority system

Bridge dialogue within the interdisciplinary team (e.g.
radiologists, pathologists, surgeons, oncologists, family
physicians, social workers, and community partners).
Participants attending will have a good understanding of how the Nurse
Navigator role can be implemented to provide optimum care, reduce
wait times, and the implication for nursing practice.
VI-04-D
FROM INPATIENTS TO OUTPATIENTS AND BEYOND
Deborah Sanfelice, RN. OCN; Darlene Priestman, RN, CON(C); Susan
Coffey, RN; Jeanie Son, BScN; Mari Dumbrell, RN; Princess Margaret
Hospital, University Health Network, Toronto, Ontario
The Transfusion Center was developed as an outpatient unit to provide
blood transfusions, boluses and antibiotic therapy for solid tumor and
hematology patients. As well, it supports other outpatient clinics by
providing central line blood draws for their patients.
The decreased availability of inpatient resources over the last five years
has affected the volume of patients seen in The Transfusion Center, as
well as the types of treatments administered there. The Transfusion
Center frequently acts as a drop-in center for neutropenic patients,
providing daily antibiotics, antifungal treatments and chemotherapy.
The increased volume and variety of treatments have forced The
Transfusion Center to make changes to cope with several issues such as
staffing, space, time, budget and patient satisfaction. Working with
advanced practice nurses, limiting the number of chemotherapies per
week and alternating patient visits, The Transfusion Center has evolved
into a highly skilled and functioning unit.
While the future of health care remains uncertain, treatment and
mortality for leukemia patients continue to improve. It is expected that
the transfusion unit will continue to see an increasing number patients
requiring complex care. The transfusion unit will continue to adapt and
improve to provide a high level of care to these patients.
V1-04-E
PAIN POINTERS: WEB-BASED INNOVATION IN KNOWLEDGE
TRANSFER
Cindy Shobbrook, RN, MN, ACNP, CON(C); Princess Margaret
Hospital, Toronto, Ontario
Continuing education of health care professionals on the principles
behind pain assessment and management is central to successful pain
management. Literature suggests that a lack of interdisciplinary pain
education contributes to ineffective pain management (McCaffrey &
Pasero, 1999). Innovations in information technology create
opportunities for creative education delivery including electronic
learning that provides health care professionals access to convenient
web-based education.
A 3-site tertiary hospital in Toronto embraced an opportunity to
disseminate consistent interdisciplinary pain management education
organization wide. One nursing strategy initiated several years ago is
“Pain Pointers”, a monthly one-page newsletter exploring topics in
pain management. Previously distributed via hardcopy and email to
targeted staff, Pain Pointers evolved into an electronic format
distributed to team members through the corporate intranet. In
addition to traditional text, Pain Pointers contains an embedded video
relaying visual and audio reinforcement of pain assessment and
management principles. Maintaining an electronic archive enables
interdisciplinary team members to revisit previous issues. In 2004,
twelve Pain Pointers issues averaged 500 viewings monthly. The
accompanying video was viewed approximately 320 times. Further
work is required to evaluate the impact of this method of knowledge
transfer on practice and patient outcomes related to pain
management.
This presentation will explore Pain Pointers’ design and examples of
VI-05-D
the interactive format.
THE ROLE OF THE CLINICAL NURSE SPECIALIST AND RESEARCH
NURSE IN THE MCGILL UNIVERSITY CANCER NUTRITION AND
REHABILITATION PROGRAM FOR PATIENTS WITH CACHEXIA
Michelle Dumas1, 2, RN, MSc; Nancy Lee Brown2, 3 , GPL, MSc(A), Neil
MacDonald1, 2, MD; Nelda Swinton1, 2, RD, MA; Sarah Thirlwell1, 2, RN, MSc;
Mary-Ann Dalzell, PT, MSc(A)2, PT, MSc(A); 1 SMBD Jewish General
Hospital, Montreal, Quebec; 2Cancer Nutrition-Rehabilitation Program,
McGill University, Montreal, Quebec; 3McGill University Health Centre,
Monreal General Hospital, Montreal, Quebec
Patients with advanced cancer commonly lose their appetites, lose weight
and become profoundly weak and tired. These symptoms are the
hallmarks of cachexia, which impairs quality of life and contributes to
morbidity and mortality in one-half of all cancer patients. The McGill
University Cancer Nutrition and Rehabilitation Program (CNR) was
instituted in 2002 to provide a multi-site, interdisciplinary approach to the
management of cachexia and cachexia research. The CNR team consists of
physicians, physiotherapists, clinical nurse specialists, nutritionists and a
research nurse who offer a comprehensive approach to managing cachexia
through sophisticated nutritional counseling, drug therapies, tailored
exercise programs, and psychosocial interventions. Within the
interdisciplinary team, the clinical nurse specialist and research nurse fulfill
key roles. Both identify patients at risk for cachexia and assess the impact
of cachexia on patients and their families. The clinical nurse specialist
offers evidenced-based strategies for symptom management and assists
patients, families and healthcare professionals to integrate the CNR
interventions into the patient’s care plan. The research nurse oversees the
quality of research protocols, biologic samples collection, and data
management. This presentation will focus on the unique expertise that
these nurses bring to the CNR program and on how that expertise
translates into improved quality of care for the patients and their families,
while making a significant contribution to cachexia research.
VI-04-F
THE ROAD LESS TRAVELED – CONTINUOUS LIDOCAINE
INFUSIONS FOR THE TREATMENT OF NEUROPATHIC
CANCER PAIN
Virginia M. Jarvis, RN, RM, BScN, MPC, OCN; The Ottawa
Hospital Regional Cancer Centre, Ottawa, Ontario
Approximately 30-90% of patients with a diagnosis of cancer will
experience pain at some time during their illness, with more
advanced cancers exhibiting more severe and complex pain
syndromes. Of these patients, approximately 34% will develop pain
of neuropathic origin. While the treatment of nociceptive pain has
improved substantially over the last 20 years, effective treatment
for neuropathic pain remains elusive (Portenoy & Lesage 1999).
Bolus doses of intravenous (IV) Lidocaine have been used for the
treatment of neuropathic pain for many years. However, the use of
continuous IV infusions for the treatment of severe cancer pain is
an emerging treatment modality.
This presentation will review two cases where a continuous infusion
of IV Lidocaine was used to control severe neuropathic cancer pain.
The discussion will address some of the issues that were of concern
to pharmacy, senior administration as well as the problems
encountered by the nurses who were caring for the patients in both
the inpatient and community settings.
VI-05-E
CREATING A VISION FOR ONCOLOGY NURSES: THE ROLE OF
ADVANCED PRACTICE NURSES
Debbie Miller, RN, MN, ACNP, ET; Shari Moura, RN, MN, CON(C);
Rosemary Cashman, RN, MA, MSc(A), ACNP; Barbara Fitzgerald, RN,
MSN; Angela Boudrean, RN, MN, CON(C); Sunnybrook and Women’s
College Health Sciences Centre – Toronto Sunnybrook Regional Cancer
Centre, Toronto, Ontario
Advanced Practice Nurses (APN) fulfill various domains of practice,
which may include direct care, education, research, publication and
professional leadership, and systems support (Ackerman et. al, 1996).
In a large tertiary health care centre, APNs working in the oncology
program have varied clinical roles, but all work towards supporting,
advancing and influencing the professional growth of oncology nurses.
The Canadian Nurses Association (CNA, 2002) describes competencies
related to advanced nursing practice, which includes nursing leadership.
Strategies to advance oncology nursing practice includes the leadership
role of APNs in the specialized care of oncology patients, as well as their
work on various intra-and interdisciplinary committees and program
councils. The APN vision for oncology nursing has been a driving force
for nursing leadership and has
influenced nursing practice and
education in our cancer centre.
This presentation will provide participants with an overview of the
various APN roles at a leading cancer centre. The involvement of the
APN in creating a vision for oncology nursing, the implementation of
nursing practice standards, the provision of nursing education through
formal and informal professional development activities, and specific
committee/council work will also be highlighted.
VI-05-F
PROMOTING THE FUTURE OF ADVANCED PRACTICE NURSES
(APN) IN PALLIATIVE CARE: A NURSING FELLOWSHIP PROGRAM
Deborah Gravelle1, BScN, MHS (candidate); Lillian Locke1, BScN, MPA;
Frances Fothergill Bourbonnais2, RN, PhD Full Professor; 1SCO Health
Services; 2School of Nursing, University of Ottawa; Ottawa, Ontario
While completion of a graduate degree is currently considered the most
effective means of acquiring the competencies for an APN, it is also
essential that novice advance nurse practitioners have additional
opportunities to integrate previous clinical experience and education in the
specialty setting. Programs currently exist in Australia, Great Britain and
the United States. This program is the only one available presently in
Canada.
The Palliative Care Nursing Fellowship is a 12 month program for
Registered Nurses completing the Masters of Nursing Program at the
University of Ottawa. The program is tailored depending on the experience
and learning needs of the fellow. There are time allotments for course
work, clinical work, research endeavours and education. The nursing
fellowship provides clinical and academic preparation for a nurse who
would like to pursue a position as an Advanced Practice Nurse in
Palliative/End of Life care, this occurs through a collaborative relationship
between the Palliative Care Program of SCO Health Services and the
University Of Ottawa School Of Nursing. Leadership and learning are
indispensable to each other. - John F. Kennedy . To develop leaders in
palliative care nursing one must contribute to the education of those
leaders. This presentation will describe the collaboration between clinical
and academia settings in the development of a speciality fellowship. It will
describe the components of the fellowship including the logic model,
objectives, and outcomes of the program.
VI-06-E
THE ABZ’S OF A ZEVALIN PROGRAM
Nancy Hutchinson, RN, BPHE, BA, MScN, CON(C); McGill University
Health Centre – Royal Victoria site, Montreal, Quebec
The future of malignant hematology and oncology care will involve the
administration of medications beyond the current chemotherapies and
monoclonal antibodies. Diseases, such as Non-Hodgkin’s lymphoma
can now be treated by radioimmunotherapy. In October of 2004, we
administered our first infusion of Zevalin in our outpatient oncology
day centre. As the treatment requires considerable coordination
between the multi-disciplinary radioimmunotherapy team as well as
the pharmaceutical company, a Zevalin coordinator was designated.
The ABZ’s of Zevalin coordination is presented here. Implications for
nursing practice including treatment side effects, transfusional and
supportive care needs, patient/family education and staff
development are discussed. Radioimmunotherapy is a promising
modality and can be safely administered in oncology settings.
.
VI-06-D
“DOES IT MAKE YOUR MOUTH WATER?”: A PATIENT
FOCUSED METHOD OF EVALUATING THE BEST PRODUCT TO
INDUCE SALIVATION IN PATIENTS RECEIVING I-131
DRINK FOR THE TREATMENT OF THYROID CANCER
Monique Levesque King, BN, RN, MN, CON(C); Elizabeth
Mabey, RN; Atlantic Health Sciences Corporation, Saint John, New
Brunswick
Radioiodine is a radiation therapy in which radioactive iodine (I131) is administered to destroy or ablate thyroid cancer.
Radioiodine is absorbed not only by thyroid tissue but also by other
tissues, including the salivary glands. This can result in salivary
gland pain, swelling and subsequent dry mouth (xerostomia). The
goal of this treatment is to deliver enough radiation to destroy the
thyroid tissue, with every effort made to minimize damage to the
salivary glands. Patients are encouraged to drink fluids frequently
and to suck on lollipops or candies to induce salivation during
treatment. Salivation helps flush the excess radiation out of the
salivary glands and can help reduce the occurrence and/or severity
of these side effects.
Increasing patient complaints of throat pain and swelling was the
impetus to investigate whether other products might improve
patient outcomes in relation to these side effects. This presentation
will focus on the processes one unit undertook to involve their
patient population in determining the best product to induce
salivation following radioiodine ablation. Preliminary survey results
will be discussed. Samples of the four products evaluated will be
available.
VI-06-F
PERMANENT BREAST SEED IMPLANT IN EARLY STAGE BREAST
CANCER: AN EXPANDED ROLE FOR ONCOLOGY NURSES
Lisa A. Verity, RN, BScN, CON(C); Nancy Hurst, RN, CON(C); Tanya
Holownych, RN, BScN; Barb Nayler, RPN, CRA; Barbara Fitzgerald, RN,
MSN, Clinical Practice Leader/Advance Practice Nurse
Breast Cancer is the most commonly diagnosed cancer in Canadian
women. A large portion of women who undergo breast conserving
surgery (BCS) will receive adjuvant external radiation (XRT).
Conventional adjuvant radiation treatment can be associated with skin
toxicities, treatment interruptions and significant changes to normal life
routines. These challenges have led to examining ways in which
treatment and associated impact on quality of life can be improved.
Permanent Breast Seed Implant (PBSI) is a pioneering treatment
approach for women with early stage breast cancer. PBSI involves
implanting small beads of pallidium that release very low doses of
radiation over the course of two months. It is a half day procedure
under local anesthesia. Since this treatment is specifically different from
standard approaches, a phase I/II study examining PBSI has been
initiated at a cancer centre in Toronto. It is the first centre to trial this
approach in the world. If the goal of PBSI and clinical outcomes are
achieved, this approach will dramatically reduce treatment times and
costs, and will change the conventional approach of care for these
breast cancer patients.
This presentation will provide a description of the expanded role of the
oncology nurse caring for women undergoing this treatment including
direct care, education, patient coordination, and data acquisition.
Potential nurse sensitive research, specific to the unique issues these
patients face, will be discussed.
P-01
A NEEDS ASSESSMENT TO DEVELOP A PROACTIVE NUTRITIONAL
INTERVENTION AND NUTRITION RESOURCE FOR PATIENTS
WITH MULTIPLE MYELOMA
Devi Ahuja, RN; Christine Chen, MD; Sunshine Giesbrecht, BSc; Joyce
Nyhof-Young, PhD; Princess Margaret Hospital, Toronto, Ontario
Nutritional problems in multiple myeloma stem from complications of the
disease, treatment toxicities, and psychological barriers, such as
depression and anxiety. Renal impairment, anemia and steroid induced
diabetes, common complications of myeloma, mandate specific dietary
modifications. Limited mobility from bone pain, neuropathy, myopathy and
fatigue may prohibit regular access to fresh foods and proper preparation
of meals. Optimal nutrition improves therapeutic efficacy and alters clinical
outcomes in cancer patients (Rivadeneira et al, 1998). Nutritional
information “specific” to myeloma is needed.
At our institution, an educational plan tailored to the nutritional needs of
myeloma patients has been initiated. As an initial phase, a needs
assessment survey is being conducted. Thirty randomly selected myeloma
patients with chronic fatigue were individually interviewed, and completed
a semi-structured nutrition questionnaire. This questionnaire is a patientgenerated subjective global assessment tool developed internally and
consists of 155 myeloma-specific questions.
We will present the findings of our needs assessment, which will facilitate
the integration of a proactive nutritional intervention to myeloma patient
care and the development of a nutrition resource with a myeloma-specific
diet. Results will also assist in developing future clinical trails focused on
nutrition in myeloma patients.
P-02
AN INNOVATIVE ONCOLOGY NURSING ORIENTATION
PATHWAY: A COLLABORATIVE PROGRAM FROM NOVICE TO
EXPERT ACROSS ALL UNITS OF A PROGRAM
Elaine Avila, RN, BScN; Angela Boudreau, RN, MN, CON(C); Amy
Melnick, RN, MN (candidate); Beverley Page, RN, BScN, CON(C);
Joan Pope, RN, MN; Sunnybrook & Women’s College Health
Sciences Centre, Toronto, Ontario
The changing nursing workforce has accentuated the nursing
shortage in health care institutions. In 2003 - 2004, this cancer
program, hired 61 nurses. Of those hired, 41% were new
graduates, 20% were nurses with no oncology background, and
39% had a minimum of 2 years oncology experience. The lack of
experienced nurses, the increasing acuity and complexity of cancer
care, and the amalgamation of the cancer center with the host
hospital emphasized the need to evaluate orientation. Oncology
nursing leaders developed a structured, competency-based
orientation pathway. The pathway supports the educational needs
of new nurses, increases their capacity to practice safely, and
provides ongoing learning opportunities to advance their expertise.
This process is pivotal in the development of novice to expert
oncology nurses.
The pathway is organized in three phases. Phase I combines
corporate and general oncology orientation. Common themes and
competencies provide new nurses with the initial knowledge in
cancer care. Phase II provides specific competencies for surgical,
medical, and radiation oncology both in inpatient and outpatient
units. Phase III offers ongoing education related to complex
cancer care.
P-03
THE CLOT THICKENS: DEEP VEIN THROMBOSIS: A PROGRAM
FOR THE CANCER PATIENT
This presentation will focus on
the development process of the
P-04
oncology
nursing orientation
pathway.WITH
ChangesRECTAL
in today’sCANCER
nursing
MANAGEMENT
OF PATIENTS
workforce require
nursing leadership
teams to develop
innovative
RECEIVING
TRADITIONAL
RADIATION
THERAPY
VS.
approaches to oncology
nursing
orientation programs.
BRACHYTHERAPY:
A TEAM
APPROACH
Sylvi Baillie, RN, CON(C); Maureen Lee, RN, CON(C); Heather
Fashanu, RN; BC Cancer Agency, Centre for the Souther Interior,
Kelowna, British Columbia
Astride Bazile, BSc, MEd; Lorraine Brown, BScN; Radiation Oncolody
Department, McGill University Health Centre, Montreal, Quebec.
Oncology patients are at an increased risk of developing a deep vein
thrombosis (DVT). The most recent statistics indicate that ten percent
of cancer patients will develop this potentially life threatening
complication. Patients presenting with a DVT may be identified at any
point during the continuum of care in the clinical areas of ambulatory
care, chemotherapy and radiation therapy.
Nurses at our centre are leading an initiative that will improve patient
care outcomes following a diagnosis of a DVT. Currently at our centre
there is no formalized process for teaching and/or follow up care for
patients who present with a DVT.
This presentation will outline an overall strategy to implement a
standard approach to improve service delivery for this population of
patients and strengthen the quality and effectiveness of care.
Brachytherapy is a method of internal radiation therapy that has been
used for a number of years for different tumor sites.
Rectal
intracavitary High Dose Rate (HDR) brachytherapy is a fairly innovative
technique, developed at this teaching university health center.
Patients with a diagnosis of rectal cancer face many challenges: pain,
discomfort, and the possibility of a permanent colostomy, all of which
can be very distressing. Nurses specialized in radiation oncology play a
key role in the care of this patient population. Often the patient’s first
contact is the nurse so that establishing a trusting relationship is critical.
This presentation will describe the multidisciplinary approach to the
assessment of patients’ needs, teaching about the treatment plan,
coordination of radiation therapy with chemotherapy and prevention
and management of acute side effects.
A comparison between
traditional external beam radiotherapy and intracavitary HDR
brachytherapy with respect to the nursing care of these patients will be
presented. Furthermore, a discussion of the importance of a
multidisciplinary approach to ensure the delivery of the treatment in a
timely fashion will be included. The goal of this presentation is to
provide information on the role of the radiation oncology nurse with
patients diagnosed with rectal cancer and to demonstrate how a team
approach is fundamental to achieve comprehensive care.
P-05
VENOUS THROMBO-EMBOLISM DISEASE
PATIENT
IN
THE
CANCER
Carole Beals, RN, BScN, CON(C); Royal Victoria Hospital, Barrie, Ontario
“Thrombotic events represent one of the most common complications and
frequent causes of mortality in patients with malignancy” (Goldenburg,
Kahn and Solyman, 2003). In fact, the risk of thrombosis is reported to be
six times greater in patients diagnosed with cancer (Heit et al., 2000).
There is a strong association between cancer and venous thromboembolism (VTE) with little data to assist clinicians in predicting which
cancer patients will develop VTE (Geerts et al., 2004). Armand Trosseau
suggested this link as early as1865 and recent research is directed towards
understanding this relationship and formulating interventions for the
purpose of primary and secondary prevention of VTE in cancer patients.
A number of authors have described Virchow’s triad of symptoms and
pathologic factors contributing to the development of thrombotic disorders
in cancer patients (Haliquist Viale & Schwartz, 2004; Prandoni Piccioll,
1998). The triad of symptoms includes a hypercoaguable state, stasis, and
endothelial injury.
Additional risk factors contributing to VTE include use of central venous
access devices, chemotherapy, surgery, hormonal therapy, and patients
diagnosed with mucinous adenocarcinomas of the pancreas, lung, breast,
ovary and gastrointestinal tract.
P-06
CHANGING THE PATH OF PATIENT EDUCATION: EVALUATING A
NEW DIRECTION
Angela Boudreau, RN, MN, CON(C); Kathy Beattie, RN, OCN; Sherrol
Palmer-Wickham, RN, BScN, CON(C); Toronto Sunnybrook Regional
Cancer Centre, Toronto, Ontario
With rising patient volumes and increasingly complex chemotherapy
treatments one challenge is to provide chemotherapy information in
ways that result in improved retention, comprehension and desired
behavioral outcomes.
The chemotherapy unit at a large cancer treatment center piloted group
chemotherapy information sessions for patients and families. The
sessions addressed: 1) common side effects of chemotherapy and 2)
processes involved in navigating the system. The goal was to decrease
the amount of information provided in the initial treatment visit to the
chemotherapy unit, allowing for a more focused discussion of the
patient’s individual treatment. As a result, information retention would
improve. A secondary goal was to streamline patient teaching time.
The pilot evaluated: 1) a pre and post information session survey to
determine knowledge; 2) a pre-chemo survey to determine knowledge
retention and identify knowledge differences between attendants and
non-attendants; and 3) a threat assessment scale, a profile of mood
states scale and a self care behavior tool. These measurements identify
differences between provision of incremental information versus a bolus
of information during the first chemotherapy.
This presentation will examine the identification, screening, prevention,
management and new advances in the treatment of VTE in cancer
patients.
This presentation will highlight: the successes and challenges of
creating a new education program; results of the patient surveys; the
influence of timing on self care behaviors and nurses perception of the
group teaching session.
P-07
THE NURSING PERSPECTIVE ON TREATMENT OF BREAST
CANCER: EXTERNAL BEAM RADIATION THERAPY VS.
BRACHYTHERAPY
P-08
DETERMINING THE ACCURACY OF ONCOLOGY NURSES IN
PREDICTING THE SURVIVAL OF PATIENTS WITH ADVANCED
METASTATIC CANCER
Lorraine Brown, BScN; Astride Bazile, BScN, MEd; Radiation
Oncology Department, McGill University Health Centre, Montreal,
Quebec
Grace Chan, RN, CON(C); Kin Wah Fung, MSc; Kathy
Katherine Enright, MD; Shari Moura, RN, MN, CON(C); Carmen
RN; Emily Sinclair, BSc, MRT(T); Edward Chow, MBBS;
Sunnybrook & Women’s College Health Sciences Centre,
Ontario, Canada
Patients with breast cancer face a multitude of challenges such as
alteration in body image, which may in turn affect their femininity,
and fear of the unknown. Undergoing major treatments such as
surgery, chemotherapy, and external beam radiation therapy become
part of the experience and the difficult battle against breast cancer.
The role of the nurse in radiation oncology is to support women
during that battle, thereby alleviating as much physical and
psychological suffering as possible at each of these steps.
Among all the treatment options for breast cancer, high dose rate
(HDR) interstitial brachytherapy remains fairly unknown to many
nurses yet is regularly offered at selected centers in North America
and Europe. This presentation will provide an overview of the nursing
assessment and teaching that is provided to women with breast
cancer undergoing radiation therapy, particularly with HDR
brachytherapy, at this teaching university health center. This will
include a comparison of the differences between traditional external
beam radiation therapy and HDR brachytherapy for breast cancer as
well as an examination of the nurse’s role in prevention and
management of side effects related to each of these radiotherapy
treatments. The objective of this presentation is to familiarize nurses
with HDR interstitial brachytherapy and to explore the nursing and
patient implications involving this treatment.
Li, BSc;
Gosselin,
Toronto
Toronto,
Precise prediction of survival of terminally ill cancer patients is important
for both the family and health care professionals. To the patients and
their family, it is often the paramount issue. They need the information
to plan and address the end-of-life issues and to optimize their
remaining time together.
Health care professionals employ this
estimate to plan for timely supportive services and appropriate
allocation of resources. Accurate prediction of life expectancy of
terminally ill cancer patients is a difficult task for health care
professionals, especially nurses who have very little training in this
practice.
The study included thirty-three nurses with varying experience,
employed in an ambulatory cancer centre. The research method was
based on analysis of five real cases of patients with metastatic disease.
The cases were analyzed retrospectively. The subjects ranked the five
most important prognostic factors based on: 1) symptom distress
scores; 2) Karnofsky Performance Status and; 3) other individual
variables. Additionally, the subjects estimated the mean, the shortest
and longest survival times for each patient case. Study results have
enhanced our understanding of oncology nurses’ perception of the
impact of prognostic factors and the nurses’ ability to predict survival.
Further research is required into the development of prognostic
prediction tools to aid accuracy in survival prediction.
III-05-A (French) – from page 56 (English)
SÉANCES D’INFORMATION EN PRÉOPÉRATOIRE
FEMMES ATTEINTES D’UN CANCER GYNÉCOLOGIQUE
POUR
Joanne Brodeur, BSc; Thérèse Vincent, BSc; Nicole Tremblay, MSc,
CSIO(C); Lucie Bédard, BSc, MBA; Jacinthe Brodeur, BSc, CSIO(C);
Chantal Bélanger, BSc; Josée Beaudoin, Dt.P. clinicienne; Centre
Hospitalier de l’Université de Montréal.
Ces dernières années, le développement du rôle d’infirmière pivot et
l’établissement d’une équipe d’amélioration continue de la qualité des
soins en oncologie gynécologique a permis d’identifier certaines cibles
d’amélioration dans les soins offerts. Parmi ces cibles d’amélioration,
la nécessité de mieux planifier le retour à domicile des femmes
subissant une chirurgie gynéco-oncologique est ressorti comme
prioritaire. En effet, bien que des efforts importants soient fournis par
l’équipe pour préparer le départ de ces patientes, beaucoup de
problèmes ne devenaient connus que lors du retour à domicile. La
fatigue, la difficulté de prendre soin de soi, diverses inquiétudes
reliées à la chirurgie et l’anxiété ont été identifiés comme des
problèmes fréquents. Suite à ce constat, un projet de séances
d’information et d’enseignement préopératoire destinées à cette
clientèle a été débuté au début de l’année 2005. Ces séances visent
notamment à mieux renseigner la clientèle sur la chirurgie et à
détecter des situations problématiques avant l’admission afin
d’intervenir pour corriger la situation. Les auteures du projet
présenteront le contenu du programme et les diverses constatations
qui en résultent.
P-11
STREAMLINING PATIENT CENTRED
DELIVERY MODEL OF THE FUTURE
CARE:
NURSING
CARE
Anne DeVries, RN, CON(C); Janice McLorn, RN, CON(C); Laurie Locke,
RN; St. Thomas Elgin General Hospital, St. Thomas, Ontario
The challenge in 1987 was to provide seamless cancer care through our
community hospital serving approximately 70,000 people. The problem of
a fragmented referral system and lack of continuity in patient care
between the regional centre and the local medical community needed to
be addressed.
By making the referral coordinator the pivot around which the community
clinic worked, patient referrals between the regional centre and the
community hospital have become much more streamlined and efficient.
This resulted in better use of resources through a team approach covering
the whole continuum of care. Communication between health care
professionals at the regional centre and the local clinic is enhanced by the
collaborative working relationships.
As a result, today leading edge chemotherapy treatment and follow-up is
delivered in a timely and effective manner, in a patient centred setting
within their own community. Working closely with the regional cancer
center has closed the gaps and provides integrated patient centred cancer
care.
The clinic is often looked to as a model for other communities to study and
emulate.
While constantly building on past performance and maintaining
collaborative working relationships, the clinic will continue to provide the
best cancer care a community hospital can offer.
P-12
EXAMINING POSSIBLE INCENTIVES AND BARRIERS TO
EXERCISE FOR REDUCING CANCER-RELATED FATIGUE IN MEN
WITH PROSTATE CANCER UNDERGOING RADIATION AND/OR
HORMONAL THERAPY
Megan Doyle, RN, BScN, MN(C); University of Manitoba/PEI Cancer
Treatment Centre
Fatigue has been shown to be the most common side effect of cancer
and is reported to decrease the quality of life for clients suffering from
the disease and its treatment (Magna & Noose, 2003; Stone, 2002).
Exercise has been proposed as one intervention to combat cancerrelated fatigue; however, the majority of the research has been
performed with breast cancer clients. In order to ensure the possible
effectiveness of exercise; a further exploration of the possible
adherence issues is required, specifically for other types of cancers.
One of the purposes of this exploratory study was to measure the
fatigue level of men with prostate cancer. Another purpose of the study
was to explore the possible incentives and barriers to exercise, with the
same population, to help reduce cancer-related fatigue.
A convenience sample of 31 men participated in the study. Three
instruments were used to elicit data from participants. Results are being
analyzed and will be available in April, 2005.
From this data, exercise interventions can be designed that will aid in
attracting clients and increasing the rates of adherence over the long
term. The most significant outcome from this study was a further
understanding of the meaning of fatigue for this population.
P-13
PRACTICAL ISSUES IN ESTABLISHING PET SCANNING IN
YOUR CENTRE
Michelle English, RN; Cross Cancer Institute, Edmonton, Alberta
Positron Emission Tomography (PET) is the latest imaging technique
offered to oncologic patients at the Cross Cancer Institute in
Edmonton AB. PET scanning creates a unique role for nursing. This
presentation will look at the issues related to PET scanning an its’
impact on nursing care.
PET scanning uses a radiolabeled analogue, flurodeoxyglucose (FDG)
which allows imaging and quantification of invivo intracellular
glycolysis. Imaging with PET identifies lesions that can escape
detection by other techniques. PET also allows detection of response
to anti-cancer treatment modalities.
PET imaging is a standard of care in many developed nations but in
Canada, PET is an investigational procedure which requires clinical
trial investigation to prove its safety and efficacy.
The Cross Cancer Institute is the only centre in Alberta currently
seeking approval for PET imaging as a standard of care.
Nursing issues related to the use of this diagnostic tool include
compliance with Health Canada regulations, funding concerns, patient
and staff education, and manpower issues.
Based on PET’s widespread use outside of Canada, there is an
inevitability that PET will become a reality of your nursing practice.
PET is the tool of tomorrow
P-14
LEAVING AN IMPRINT ON THE CARE OF THOSE AFFECTED BY
LUNG CANCER TOMORROW: THE EXPERIENCE OF REGIONAL
CARE PATH DEVELOPMENT
Valerie Fiset, RN, MScN, CON(C); Lorraine Montoya, BSN, CON(C);
The Ottawa Hospital Regional Cancer Centre, Ottawa, Ontario
The care of individuals with suspected lung cancer or proven lung
cancer is extremely complex. State-of-the-art care often requires input
from many sources, necessitating an interdisciplinary approach.
Unfortunately, numerous referrals to a variety of specialists and care
providers may result in fragmented, poorly coordinated, and even
inappropriate care.
The anticipated growth in incidence rates will have a compounding
negative impact on care for patients and families experiencing a lung
cancer diagnosis, or living with the disease. Through interdisciplinary
collaboration with regional stakeholders, improving healthcare
practitioner and public education, and fostering continuous quality
improvement activities, Regional Clinical Pathways will help to better
coordinate comprehensive inpatient and outpatient services thus
improving resource utilization (i.e. avoid duplication of tests, reduce
emergency visits; decrease wait times), and ultimately lead to better
clinical outcomes for individuals and their families affected by lung
cancer.
This presentation will describe the process of development and
implementation of Regional Care Paths to address the needs of those
living with lung cancer and their families. Specifically, the presentation
will address how the Regional Clinical Pathways will enhance 1) the
quality of care of patients and families; 2) system efficiencies and
effectiveness and 3) knowledge transfer and evidence-based practice.
P-15
MONITORING PATIENT PERSPECTIVES ON SATISFACTION WITH
INFORMATION
P-16
HOW WELL ARE SEXUAL CONCERNS OF CANCER PATIENTS
ADDRESSED: PROVIDER AND PATIENT PERSPECTIVES
Margaret I. Fitch, RN, PhD; Laurel Plewes, RN, BScN; Toronto
Sunnybrook Regional Cancer Centre, Toronto, Ontario
Margarent I. Fitch, RN, PhD; Gerry Beaudoin, MSW; Laurel Plewes,
RN, BScN; Toronto Sunnybrook Regional Cancer Centre, Toronto,
Ontario
An individual’s capacity to cope with the many changes and challenges
following a diagnosis of cancer is influenced to a great extent by their
access to relevant, understandable information. The information needs to
be about the disease, its treatment, expected side effects, and available
supports and resources to manage with the illness. Many cancer patients
have described heightened emotional distress when they are not able to
obtain the information they need. Providing patient information, then, is an
important aspect of the activities within a cancer care program. However,
in addition to providing information, is it important to know whether or not
the provision of the information is appropriate from the patient
perspective. The service of delivering patient information ought to be
monitored on a regular basis. Given the busy nature of our clinical settings
and a desire not to overburden patients, this performance monitoring must
be accomplished with data collection tools that are easily administered and
scored.
The purpose of this work was to implement a performance monitoring
approach to the provision of patient information in an ambulatory setting.
A psychometrically sound indicator tool has been introduced that measures
patient perspectives regarding the importance of, and satisfaction with, the
provision of selected information in the cancer setting. This presentation
will describe the data collection approach and the resulting data gathered
during the 5 rounds of data collection (N1=540; N2=39, N3=42, N4=59,
N5=63). Trends in the data observations will be presented as well as
discussion about the implications of such an approach for quality
improvement initiatives in patient information.
Cancer has more than a physical impact. There are emotional, social,
psychological, spiritual and practical consequences. Patients confront a
multitude of change and may well experience challenges in having their
needs addressed in busy clinical settings. This is particularly the case for
complex or sensitive psychosocial needs such as those related to
sexuality.
A project was undertaken in our ambulatory setting to explore how well
we were addressing patient concerns regarding sexual issues. Initially,
interviews were conducted with oncologists (n=10), nurses (n=10),
social workers (n=10) and radiation therapists (n=5) to explore their
perspectives regarding the approaches they used in their daily practice
to address patients’ sexual concerns. In many instances, discussion with
patients about this topic occurred in relation to informed consent
procedures or questions revised by patients. The majority of health care
professionals indicated they had very few conversations with patients
about the impact of cancer on sexuality and often waited for patients to
raise the topic. A second set of interviews was conducted with cancer
patients. Twenty individuals shared their perspectives about the topic.
These patients confirmed that cancer had evoked concerns regarding
sexuality and described barriers they experienced to raising/discussing
these concerns with health care professionals. This presentation will
highlight the findings from these two inquiries and stimulate dialogue
about practice change.
P-17
DIALYSIS AND PAIN MANAGEMENT: A CHALLENGE
Corsita Garraway, RN, MSN, FNP, CON(C), CHPCN(C), Acute Care
Nurse Practitioner; Oncology & Palliative Care, St. Joseph’s Health
Centre, Toronto, Ontario
Management of cancer pain is a complex process in itself without the
presence of Chronic Renal Failure as a co-morbidity. There is a
plethora of treatments available to manage a patient’s pain. Chronic
Renal Failure is an added challenge to care providers in modifying
treatment plans and providing individualized care to patients. In this
workshop, nurses will be provided with: 1) A review of the pain
pathway. 2) Causes of cancer pain. 3) Treatment modalities in cancer
pain. 4) Review of renal system. 5) Challenges of pain management
in Chronic Renal Failure patients receiving dialysis.
P-19
NURSING INTERVENTION: AN APPROACH TO TREATING GAS PAIN
Mary Glavassevich, RN, BA, MN; Shari Moura, RN, MN, CON(C);
Brenda Leung, RN, BSc; Janet King, RN; June Raymond, RN, BScN;
Sunnybrook & Women’s College Health Sciences Centre – Sunnybrook
Regional Cancer Centre, Toronto, Ontario
A desire for developing a nursing intervention to treat gas pain was
initiated by concerns of nurses on our surgical oncology units and as a
result of our recent study exploring patients’ experience of gas pain
following abdominal surgery. Patients described their experience of
postoperative gas pain as being moderate to severe (Glavassevich et
al., CANO Conference, 2004).
Nurses expressed concerns that they were not meeting the needs of
their patients experiencing gas pain. In our large tertiary hospital,
current postoperative pain management protocols do not address the
gas pain experience. Patients who experience gas pain may be
reluctant to mobilize. A recent literature review has shown limited
research pertaining to gas pain and no research focusing on the gas
pain experience of patients having abdominal surgery for cancer.
Thomas et al., 2002, evaluated the effects of rocking, diet
modifications and anti-flatulent medication on gas pain following
cesarean section. Hence, there is a need to develop and evaluate
nursing interventions to lessen the experience of gas pain for oncology
patients having abdominal surgery.
This presentation will discuss the nursing interventions utilized and the
outcome evaluation. In addition, the information will serve to develop
best practice guidelines for the care of surgical oncology patients.
P-18
A DECISION TREE FOR FEBRILE NEUTROPENIA: MEDICAL
ONCOLOGY SOLID TUMOUR AND LYMPHOMA PATIENTS
Wendy Gillis, RN, MScN, CON(C), ACNP; Marcia Langhorn, RN, CON(C);
Catherine Bond-Mills, BSc (Pharm); Susan Poirier, BSc (Pharm); Anne Marie
Bombassaro, BSc (Pharm), PharmD; London Health Sciences Centre, London,
Ontario
Neutropenic fever is a common and serious complication of cancer
chemotherapy. Timely, appropriate, and effective decision-making is
vital to minimize morbidity and mortality. In keeping with the goals of
the London Regional Cancer Program (LRCP) many patients undergoing
cancer chemotherapy are managed in regional cancer centres and home
communities. This document was developed in response to requests
from our regional partners for assistance in managing neutropenic fever.
To implement the above goals a decision tree was developed for
patients with solid tumours and lymphoma. It incorporated the latest
guidelines from the Infectious Diseases Society of America (IDSA)
(2002). It was based on current practices at the LRCP and London
Health Sciences Centre (LHSC). The document provides not only a
guideline for real-time reference, but also serves as an educational tool
for health care practitioners. It promotes consistency of treatment for
neutropenic patients with fever.
An algorithm was created for determining the most appropriate therapy
based on level of risk, presence of defined focus, history of penicillin
allergy, and response to therapy at 48 hours. It guides the practitioner
in decision-making at distinct times within the episode of fever and
neutropenia.
The process of development was a collaborative effort involving nursing,
pharmacy, and infectious diseases with ongoing feedback from the
medical oncologists and hematologists at the LRCP/LHSC.
The
document will be evaluated and updated to remain current with
evidence-based practice.
P-20
INFORMATION: KEY TO REDUCE FEAR OF THE UNKNOWN
Laurie Greaves, RN, BScN, CON(C); Joanne Svela, RN, CON(C), MN;
McLaughlin Durham Cancer Centre, Oshawa
Bone marrow aspiration and biopsy is a common investigative procedure to
confirm or diagnose a hematological or potential cancer diagnosis. The
decision to perform a bone marrow assessment is based on the patient’s
clinical presentation and abnormal hematological findings.
At our oncology clinic, oncologists perform approximately three to four bone
marrow procedures daily. It is the role of the oncology nurse to provide a
verbal explanation of the procedure and post instructions.
Historically, this education was done immediately prior to the procedure. The
patient is usually apprehensive with a high level of anxiety, which is triggered
by an understandable fear of the unknown. Observations of patients by the
oncology nurse demonstrate a decrease in anxiety followed by this brief
explanation.
In response to our observations, a bone marrow procedure pamphlet
including discharge instructions will be developed. By providing this
information we will demonstrate benefit in increasing patient’s preparation.
We anticipate the time prior to the procedure will become more valuable for
the patient by creating an opportunity for reinforcement and support.
This presentation will show how the pamphlet was developed. We will report
on the evaluation of our impact of the education intervention on anxiety. We
believe this education tool will have a lasting and very positive imprint on our
patients’ well being.
P-21
IMPROVING QUALITY OF LIFE: IMPLEMENTING BEST
PRACTICE FOR MANAGING CHRONIC ONCOLOGICAL WOUNDS
IN A COMMUNITY INPATIENT SETTING
P-22
BRIDGING THE GAP… FOR TOMORROW; COMMUNITY CLINICS,
EDUCATION
AND
PATIENT
TEACHING
THOUGH
AN
ELECTRONIC ENVIRONMENT
Anne Hack, RN; Shelley Debison, RN; Royal Victoria Hospital, Barrie,
Ontario
Donna Holmes, RN, BHScN, CON(C) ; Grand River Regional Cancer
Centre
“The perception of quality of life is unique to each individual patient
and family member. Living with a cancer related lesion causes
significant lifestyle changes, potentially impacting the ability to have
control over one’s life” Barton and Parslow 1998
Malignant wounds present a unique challenge to caregivers and
patients. Challenges include wound containment from drainage, odour
control, and pain management. A wound treatment program is
important to minimize distressing symptoms and to maximize quality of
life.
Malignant wounds are characterized by visible changes in the skin.
Some lesions may result from a primary skin cancer e.g., melanoma,
squamous or basal cell tumours. Others develop as a secondary lesion
from infiltration in the late stages of disease. Lesions caused by
radiation therapy or extravasations will have a predicted outcome.
Other lesions, such as fistulae, malignant cutaneous wounds, and
those coming from surgical seedings, have less defined outcomes. In
order to improve the management of these types of wounds, a multidisciplinary approach is required.
Local oncology networks (LON) are community based oncology clinics
developed to bring cancer care closer to home. The main purpose of
LON’s are to extend the electronic environment to community sites.
Community staff were involved in the development of the clinics from
the initial stage. Education, orientation, and set up of the clinic is
achieved through an electronic environment. Nurses play a pivotal role
in the leadership of these clinics by identifying the patients at high risk
for symptom management as well as those needing additional
supportive care and providing the navigational aspects for the treatment
and outcomes of care.
Nurses assist the patient through the
educational components of their care by providing access through an
electronic environment in their home.
As a result of implementing LON, patients will be able to view their
treatment regimen, appointments, and side effects management at
home. In order to evaluate the outcomes associated with this innovative
network, the following variables were assessed: Usage, ease of access,
and network links between sites, Patient and staff satisfaction and wait
times.
This presentation will highlight how our Community Care in-patient
centre implemented the Registered Nurses Association of Ontario
(RNAO) Best Practice Guidelines for care of malignant wounds to
improve the quality of life of our patients.
P-23
MEASURING CANCER PATIENT CARE COMPLEXITY AND
INTENSITY OF NURSING CARE NEED: AN INITIAL
VALIDATION STUDY OF AN INSTRUMENT BASED ON
SUPPORTIVE CARE DOMAINS
Doris Howell 1, RN, PhD; Eva Pathak 2, RN, BScN; Stephanie BurleinHall 2, RN, MScN; Barb Mildon, RN, MN (candidate); Linda Lee-O’Brien
Pallis, RN, PhD; Souraya Sidani, PhD; 1 University Health Network; 2
Interlink Community Cancer Nurses’ Toronto, Ontario
Nursing workload measurement using validated instruments is a
standard in hospitals. These instruments have limited relevance for
predicting nursing resource use in community-based oncology nursing
care. Care delivery in the community is multifaceted with care focused
on the multiple domains of supportive care need. Socio-demographic,
social support structure, family, environment, and illness-characteristics
and the degree of supportive care need may impact on patient
complexity and nursing care need. A measurement system is needed
that measures these variables from a supportive care needs
perspective that can predict nursing resource use. This paper will
describe the development of a “Supportive Care Case
Complexity/Intensity of Need Scale (SCCSI)”, based on the Fitch
(1997) seven domains (informational, emotional, psychological, social,
spiritual, practical, physical) of supportive care needs. The results of
the initial validation study to examine the psychometric properties of
this instrument for predicting nursing resource use in the community
will be described. The potential use of the community-based oncology
care will be discussed with a focus on future research priorities.
P-24
INTRODUCTION OF A GUIDED IMAGERY PROGRAM FOR SURGICAL
ONCOLOGY PATIENTS
Stephanie Raimondi, RN, BN; Sylvia Huber, RN, MN, CON(C); Pat LewisVanderbrink, RN, BN; Foothills Medical Centre, Calgary Health Region,
Calgary, Alberta
Guided imagery is a therapeutic technique that uses the power of the mind
to effect physiological and psychological change by focusing on relaxation,
positive thoughts and images. Research has shown the benefit of guided
imagery in managing stress in everyday life and in a variety of illnesses and
treatment settings including surgery and chemotherapy.
The stress and anxiety accompanying a cancer diagnosis and its treatment
are well-recognized. Patients undergoing cancer surgery experience a variety
of physical and emotional stressors. The effectiveness of guided imagery in
enhancing recovery by decreasing stress and anxiety pre- and postoperatively and reducing postoperative pain and opioid use has been well
documented. In order to help patients cope with distress and challenges,
increase their sense of participation in care, and to enhance our holistic
approach to nursing care, a guided imagery program was introduced.
This presentation will provide an overview of guided imagery as a therapeutic
intervention, the process of introducing its use on acute care surgical units,
and implications for nursing staff. Patient evaluations regarding the use of
guided imagery and its perceived benefit before and after surgery, and as an
ongoing strategy to optimize wellness, will be discussed.
P-25
NURSING MANAGEMENT OF PATIENTS REQUIRING IRON
CHELALATION
THERAPY
FOR
TRANSFUSIONAL
IRON
OVERLOAD
P-26
IMPLEMENTING COLLABORATIVE CARE NURSING PRACTICE
ON A GYNECOLOGY-ONCOLOGY SURGICAL UNIT: A SUCCESS
STORY
Barbara Hues, RN, BScN, CON(C); CancerCare Manitoba, Winnipeg,
Manitoba
Pat Lewis-Vandenbrink, BN; Tanya Miller, BN; Foothills Medical
Centre, Calgary Health Region, Calgary, Alberta
Long term dependence on red cell transfusion leads to iron overload
since the body has no mechanism to excrete excess iron. Iron is most
damaging to the heart, liver, and pancreas, and overload is eventually
fatal unless the iron burden is decreased by chelation. Iron overload
typically occurs after >20 units of red cells have been given. In the
Oncology clinic, the patients most often at risk are those with
myelodysplastic syndromes.
Providing high quality patient care during staffing shortages and limited
financial resources is a challenge faced by today’s health care system.
Historical approaches to staffing models are no longer useful in this new
environment as they do not produce enduring, cost effective solutions.
Creative planning is required to utilize all levels of staff to their potential.
The underlying principle is to have the right caregiver for the patient at
the right time, in the right place, for the right cost. If this principle is
followed, patient outcomes and satisfaction of patients, families and
staff will be enhanced.
The focus of this presentation will be on the nursing implications of
iron chelation therapy with deferoxamine. This drug is given by longterm infusion, either subcutaneously or through a central venous
catheter. Treatment is thus a cumbersome process requiring patient
education and ongoing monitoring. There are physical, emotional and
social consequences for the patient, and the treatment is not suitable
for all patients. The nature of myelodysplasia, including limited life
span, thrombocytopenia and immune defects add to the challenges of
management. Nurses can take responsibility for monitoring patients
receiving iron chelation and to assess for both problems and benefits.
The presentation will be useful in establishing criteria for initiating and
discontinuing iron chelation treatment. Practical insights for a nursemonitored course of treatment will be provided.
P-27
SAFE HANDLING: LEARNING FROM THE PAST TO PROTECT OUR
FUTURE
Christine Gloin, RN, BA, CON(C); Heather Logan, RN; Carment Gosseling,
RN; Toronto Sunnybrook Regional Cancer Centre, Toronto, Ontario
Safe handling of hazardous drugs is a practice that must continually
improve in order to protect patients, families, staff and the workplace from
unnecessary exposure to potential danger. As oncology nurses who work
daily with antineoplastic agents, we believe this is an important issue to
examine.
In 2003, the Oncology Nursing Society (ONS) released guidelines for
safehandling of hazardous drugs. In 2004, the National Institute for
Occupational Safety and Health (NIOSH) issued an alert about preventing
occupational exposures to antineoplastic and other hazardous drugs in
health care settings. These publications led to the formation of a task force
in a large tertiary teaching facility. The purpose of this task force was to
collaboratively compare current practice within the facility to the newly
published guidelines. The task force consisted of staff members from
nursing, pharmacy, risk management, occupational health, environmental
services and strategic sourcing. The focus areas scrutinized by the task
force included inpatient and outpatient settings where the highest volume
of hazardous drug storage, preparation, administration and disposal occurs.
This poster will briefly illustrate: 1) the process involved in identifying safe
handling practice, 2) procedures that needed modification, 3)
implementation of new practices, and 4) in particular the impact on nursing
and pharmacy. Successes, ongoing challenges and future directions will be
shared.
Due to staffing constraints and a desire by the Licensed Practical Nurses
to increase their responsibilities and job satisfaction, their role was
expanded. This resulted in restructuring of the care delivery model from
team nursing to a Collaborative Care Nursing Model. RN’s and LPN’s
work in collaboration, with individual assignments based on acuity and
needs of patients and competencies, skills, experience of staff.
This presentation focuses on how this initiative, of increasing the LPN’s
scope of practice was implemented on a 27 bed Gynecology-Oncology
Surgical Unit and how it led to the Collaborative Nursing Care model. As
well, this presentation will share outcome data post implementation.
CHEMOTHERAPY
PROTOCOL
P-28
HYPERSENSITIVITY
AND
ANAPHYLAXIS
Gail Macartney, RN, MSc(A), ACNP, CON(C); Sean Hopkins, BSP;
Lynne Jolicoeur, RN, BScN, CON(C); The Ottawa Hospital, Ottawa,
Ontario
Anaphylaxis and hypersensitivity reactions are feared complications
related to chemotherapy delivery. When it is suspected, nurses do not
have time to search for and read lengthy policies and procedures to
determine their next steps. This easy to follow protocol was developed
by a multidisciplinary team including nurses, pharmacists and physicians
to facilitate appropriate decision making when anaphylaxis or
hypersensitivity reactions are suspected.
This protocol helps nurses identify the systemic clinical presentation of
hypersensitivity and anaphylaxic reactions. High-risk drugs are
identified. The assessment criteria and medical interventions are clearly
outlined. Patient education and documentation guidelines are also
included. This protocol can be useful in establishing nursing policies and
procedure or unit specific medical directives.
This poster presentation will outline the protocol. Copies of this userfriendly decision aid will be made available for electronic distribution.
Additionally, posters can be enlarged, laminated and posted in
chemotherapy treatment units for easy reference. No chemotherapy unit
should be without one!
P-29
EFFICACY
OF
A
DECISION
AID
FOR
TAMOXIFEN
CHEMOPREVENTION MADE AVAILABLE ON THE WEB
Wanda Martin, RN, MN; University of Victoria, Victoria, British
Columbia
A decision-making guide to be used in clinical practice was developed
and evaluated to inform eligible women of chemoprevention with
tamoxifen and then posted on the world wide web. As with the paper
form of this guide, the web version had a poll asking whether the
reader is interested in taking tamoxifen. Through this web poll and the
“hit counter,” we have been able to evaluate the usefulness of
delivering this decision-making guide for tamoxifen chemoprevention in
this form. Problems that were encountered in the process and
recommendations for web-based health information delivery will be
made. Through this presentation we hope to receive feedback on this
project and engage in dialogue on the best way to make this type of
patient information available.
P-31
RADIOTHERAPY IN PATIENTS WITH CARDIAC PACEMAKERS: A
NEW CHALLENGE FOR ONCOLOGY NURSES
Linda Robb Blenderman, RN, MSc, CON(C); Linda Giles, RN, BScN;
Cancer Centre of Southeastern Ontario at Kingston General Hospital,
Kingston, Ontario
Cardiac devices may be affected by radiation used in the treatment of cancers
of the breast, lung, chest wall, head and neck, skin and lymphomas (Last,
1998). The increasing use of cardiac devices has necessitated a Regional
Cancer Centre to explore the Radiotherapy Nurses role with respect to the
advanced specialized skill of cardiac monitoring.
This presentation will provide an overview of how cardiac devices can
impact radiotherapy, the professional and operational assessment of
the nurses’ role as well as the challenges faced by the medical team in
managing the care for these patients. We will report on results of a
provincial and international radiotherapy nurses survey; professional
practice standards and radiation oncology standards. It is anticipated
that the information gained from this presentation will contribute to the
future planning of oncology nurse’s skills to meet the increasing
complex needs of cancer patients with co-morbidity conditions such as
heart disease.
P-30
THE TREATMENT OF GASTRO-INTESTINAL SIDE EFFECTS WITH
T1-2 PROSTATE CANCER TREATED WITH 3D CONFORMAL
RADIATION
Margaret Pavlin, RN, PHN, CON(C); Grace Chan, RN, CON(C);
Margaret Fitch, RN, PhD; Toronto Sunnybrook Regional Cancer Centre,
Toronto, Ontario
The gastro-intestinal (G.I.) side effects from radiation therapy for
prostate cancer include proctitis and tenesmus. An informal survey of
ten Canadian Cancer Centers identified a wide variation in clinical
practice governing the management of these symptoms. One approach
at our centre is to use psyllium to help control these symptoms. A
review of the literature revealed one article to support this practice.
The principles of evidence-based practice are based on the use of
research, clinical experience and patient outcomes.
In order to determine whether further investigations into the use of
psyllium is warranted, nurses did a retrospective chart review to
determine the prevalence of G.I. symptoms, treatment and overall
effectiveness. They also developed a tool to measure the client
experience of these symptoms and their impact on quality of life. This
presentation will share the results of the review, the process of
development of the survey tool and the patient survey.
P-33
DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF A
NEW PATIENT INFORMATION PACKAGE – A CHANGE
MANAGEMENT STRATEGY
Mary Scott, RN; Brenda Ross, RN, BscN; Jaspreet Battu, BScN
Student; Hon Chen, BScN Student; Vancouver Centre, BC Cancer
Agency, Vancouver, British Columbia; University of Victoria, Victoria,
British Columbia
Patients newly diagnosed with cancer require information to understand
their disease and the treatment options available. Patients who attend
busy ambulatory care centers can be expected to have needs for
information about their disease, the resources available to them, and
treatment options. Some patients will need additional nursing support
to understand the treatment plan, make decisions, manage symptoms,
and to access community resources. Nursing leaders have been
challenged to find new ways to safely and efficiently prioritize patients’
need for nursing care during a time of fiscal restraint. A patient support
clinic has been developed to better align nursing resources with patient
needs to enhance patient outcomes.
Making change can be difficult and nursing leaders had found it
challenging to move the patient support clinic forward. Our center
supports many student projects including one related to change
management. The Unit’s Clinical Nurse Leader and Education Resource
Nurse saw an opportunity to support both the learning needs of change
project students and the change process itself. The students drafted a
population-specific new patient information package in collaboration
with the nursing group. The impact of this strategy on the change
process and on other patient education strategies will be explored.
P-34
DETECTING EPIDURAL SPINAL CORD COMPRESSION (ESCC)
IN HIGH-RISK ONCOLOGY PATIENTS
P-35
DEVELOPMENT OF AN ORIENTATION TO
CLINICAL TRIALS NURSE COORDINATOR
Milena Segatore1, RN, MScN, MNI-PG; Karen Lock, RN, BScN, MN,
CON(C); 1 North York General Hospital, Toronto, Ontario
Karen Sill, RN, CON(C), CCRP; Brenda Ross, RN, BScN; Vancouver
Centre, BC Cancer Agency, Vancouver, British Columbia
Advances in oncology have prolonged survival of many patients with
cancer – unfortunately, frequently at the cost of significant morbidity.
As survival has lengthened, there has been a parallel increase in the
incidence and prevalence of ESCC in patients living with metastatic
disease. Holding the key to preservation of baseline functional status
and optimal pain control is early detection and prompt treatment, prior
to the onset of neurological deficits. Detection, screening and ongoing
clinical assessment by oncology nurses remains critical to achieving
good patient outcomes.
Retention of ambulatory function and
continence are directly related to timeliness of diagnosis: The vast
majority of persons ambulatory at diagnosis continue to walk, only half
of paretic patients ambulate after treatment, and almost all who have
lost their mobility at time of diagnosis never walk again.
The role of Clinical Trials Nurse Coordinator is complex and expanding,
and integral to an effective and functional Clinical Trials Unit.
Recruitment and retention of Clinical Trial Nurse Coordinators is a
challenge in our provincial cancer organization. As a result a need for a
formal process to introduce nurses to the role was identified and a
Clinical Trials Orientation was proposed.
The purpose of this presentation is to provide oncology nurses with the
knowledge and skills for screening and assessing patients at risk for
ESCC. A case-based interactive approach will offer a comprehensive,
efficient and feasible method for conducting spinal cord assessment
that incorporates historical, functional and classical motor testing
elements. Evidence-based assessment tools and clinical algorithms
from the clinical neurosciences will be introduced. ESCC is an neurooncologic emergency. Early recognition of the signs and symptoms
followed by prompt and aggressive surgical and or medical
management are the keys to preserving sensori-motor and sphincter
function and ensuring an acceptable quality of life for patients living
with metastatic disease.
P-36
PATIENT AND FAMILY EMPOWERMENT ON A SURGICAL
ONCOLOGY UNIT: DEVELOPING A CARING MODEL OF
PATIENT/FAMILY
INTERACTION
THAT
SUPPORTS
PARTICIPATION AND INFORMED DECISION MAKING
Tracy Soloninka, RN, MBS, MS (oncology candidate), CON(C); Trish
Murphy-Kane, RNm BScN, MN (candidate); Natalie Lalor, RN, BScN;
Janice Azan, RN, BScN; Mount Sinai Hospital, Toronto, Ontario
Patricia Benner states, “Within a practice lies its legacy”1. No where is
this statement truer than oncology and palliative care. Spiritual distress
becomes an unfortunate “state of being” when surgeons, nurses and
the entire multidisciplinary team work at cross purposes and without a
cohesive framework in identifying patient and family concerns around
diagnosis and deciding next steps. Each of us truly care about the
patient, but few of us have the self-awareness to meet and recognize
each patient and family in their particular lifeworld. This unit has
committed to developing a practice environment where caring and
healing is a by-product of the daily team interaction. The Dreyfuss
Model of Skill Acquisition supports experiential learning through
different levels of defined competency. However, no practitioner can
practice beyond their awareness and experience. Using the best
practice guideline developed by the Registered Nurses Association of
Ontario for Therapeutic Relationships as a foundation for self-reflection
and developing self-awareness, the unit has developed a vision and
framework to guide patients and families through the challenges of
diagnosis and therapy.
The presentation will lay out problem
identification, needs assessment and program re-engineering of the
existing framework.
THE ROLE
OF
Collaboration between the Clinical Trials operational leaders, expert
Clinical Trials Nurse Coordinators, and professional practice nursing
leaders was essential for the success of this program. The program
linked foundational knowledge of clinical trials with the strategies used
to successfully implement clinical trials protocols in our organization.
Newly hired staff had an opportunity to learn about the elements of
clinical trials and their regulatory requirements, and to meet with and
discuss trial implementation with members of the interdisciplinary
Clinical Trials team.
This paper will describe the content of the program and the processes
use to introduce generalist oncology nurses to the role of Clinical Trial
Nurse Coordinator. Challenges to implementation and plans for the
continued refinement of the program will be discussed.
P-37
DEVELOPMENT OF A NURSE-LED CLINIC IN GYNECOLOGICAL
MALIGNANCY: THE ROLE OF THE ADVANCED PRACTICE NURSE
Sharon Thomson, RN, MSc; BC Cancer Agency, Vancouver, British
Columbia
Evidence has shown that the development of medical/nursing
partnerships gives women with a gynecology cancer diagnosis, access to
the essential expert knowledge and information they need (Allen, 2003).
Women with a gynecological malignancy can present with many
different needs during the follow-up phase of their ‘cancer journey’.
Nurses in advanced roles are in an excellent position to provide
psychological, social and sexual rehabilitation, which are often complex
needs of women, especially in the later years of follow-up. The new
nurse-led clinic will run alongside a physician’s clinic, with the nurse
seeing women within predefined criteria. This allows ready access to the
physician should the patient feel they want a medical consultation, or if
the nurse feels the patient should be reviewed. The nurse’s role will be
to provide information, support, assessment, with any necessary
referrals; and routine pelvic examinations and smears, as required,
addressing both physical and psychological needs. The nurse-led clinic
can therefore improve, not only collaboration with other members of the
multi-disciplinary team, but also providing more holistic care of a
continuous nature. This presentation will focus on the how the nurse-led
clinic has been perceived by the advanced practice nurse, physicians
and the women involved, since its introduction. The intended approach
on how to evaluate this clinic will also be discussed.
P-38
SENTINEL LYMPH NODE BIOPSY: AN INFORMATION GUIDE
FOR PATIENTS
Lisa Verity, RN, BScN, CON(C); Toronto Sunnybrook Regional Cancer
Centre, Toronto, Ontario
ABSTRACT: Twenty thousand women develop breast cancer in
Canada annually and 30% will have lymph node involvement. Over the
past decade the treatment of breast cancer has changed. Currently,
efforts are focusing on less invasive surgical procedures such as
Sentinel Node Mapping. The sentinel lymph node biopsy (SLNB)
procedure is a relatively new procedure and it is an option for some.
However, there is very little patient information available to help inform
women of their choices in this area.
There was no written information available in our centre or in any of
the other major centres in Toronto. A literature review of SLNB
teaching tools resulted in one article that included a patient guide. The
author found this to be less than satisfactory.
In collaboration with the oncology surgeons, a pamphlet was created
that outlines the purpose of the procedure, preparation required, the
procedure itself and the associated risks and benefits. The pamphlet is
distributed to patients who are in the process of making decisions
about their breast cancer treatment.
REFERENCES:
Swenson KK, Sladek ML, Lally RM, Tuttle TM. (2001). Educating patients on
sentinel lymph node dissection for breast cancer. Cancer Practice, 9 (2):
92-96.
Zack E. (2001) Sentinel lymph node biopsy in breast cancer: scientific
rationale and patient care. Oncology Nursing Forum. 28(6): 997-1005.
P-41
NURSING COMPETENCIES AND ORGANIZATIONAL SUPPORTS
FOR THE URGENT CARE OF AMBULATORY CANCER PATIENTS:
A CANO STANDARDS OF CARE APPROACH
Kelly A. Walsh, RN, BSc; Eileen Lacroix, RN, BScN, MPA; Tracy L.
Robertson, BScN, RN; Gregory Doiron, BSSc, MHA; Lisa A. Bitonti,
BScN, RN; The Ottawa Hospital Regional Cancer Centre, Ottawa,
Ontario
Over the last decade, there has been a significant shift in cancer
treatment delivery from the in-patient to the ambulatory environment.
Increasingly complex and toxic treatment protocols and/or advancing
disease can cause rapid, critical complications requiring urgent care.
Resource-strapped hospital emergency rooms and homecare services
contribute to the rise in urgent cases treated in ambulatory centres.
Ambulatory oncology nurses require the appropriate knowledge and
skills to provide urgent care as a member of an interdisciplinary team.
Administrators are responsible for ensuring the appropriate
organizational supports are in place to deliver quality patient care.
Patients and families deserve timely access to coordinated,
comprehensive care provided by skilled professionals (CANO, 2002).
This presentation reports on the evaluation of the urgent care services
at one ambulatory Regional Cancer Centre. Clinical nurses used the
CANO Standards of Care (2002) as the framework for assessing current
practice and operations, developing a plan to address identified
practice/operational improvement opportunities, implementing changes
and evaluating outcomes. The goals of this presentation are to raise
oncology nurses’ awareness of the importance of their role in providing
urgent care; to highlight the need for clinical professionals and
administrators to work together to improve care; and to share a
framework for providing urgent care in the outpatient oncology setting.
P-39
MULTIPLE MYELOMA: THE PATIENT’S PERSPECTIVE
Donnaleen Vlossak, RN, BScN, CON(C); Toronto Sunnybrook Regional
Cancer Centre, Toronto, Ontario
Multiple Myeloma is a severe debilitating and incurable malignancy that
accounts for 1% of all new cancer cases, usually affecting older
patients. It follows a variable and unpredictable course. After decades of
clinical trials, patients still face a poor outcome.
The purpose of this study was to gain an understanding of the impact of
Multiple Myeloma on the patient. The research team felt a strong need
to pursue this study in order to gain a better understanding of the
ravages of the disease, side effects of the treatments, ability to work
and to provide for one’s family, changes in self-image, and related
psychosocial issues, and a shortened life expectancy. These issues can
be difficult no matter what the patient’s age.
This qualitative study was based on a convenience sample of 20
generated from a list of patients currently receiving treatment at
Toronto Sunnybrook Regional Cancer Centre. In-depth telephone
interviews, lasting from 30 to 90 minutes were taped and then
transcribed verbatim. Themes, including decision- making, coping,
relationships, dealing with treatments, and hopes for the future, were
analyzed in the context of the disease trajectory.
This initiative’s main objective is to fill the knowledge gap surrounding
life with Multiple Myeloma. It is hoped that by having a more thorough
understanding of the patients’ perspectives, the nurse will be better able
to response to their needs.
CONNECTING THRU
IMPRINT CARING
P-42
COMMUNICATION
TO
CONSISTENTLY
Pamela J. West, RN, MSc, ACNP, CON(C), CHPCN(C); Rouge Valley
Health System, Centenary Site, Toronto, Ontario
As nurses working in cancer care, we all have favourite memories of
special patients that we have cared for over the years: patients who
have touched us deeply. These are patients who have left an imprint on
our hearts-patients we will never forget. Nothing, not even time, will
ever erase these memories. I contend that the imprint is mutual,
experienced yesterday, today and hopefully tomorrow.
How can we, as health care professionals, leave our imprint on patients
unless we connect with them? Further, how can we connect without
utilizing (perhaps even mastering) the art of communication? It is an
honour and privilege to connect – really connect – with someone. When
this connection involves a health care professional who works in cancer
care, the connection and resulting imprint can be profound and last a
lifetime.
This paper will review basic and advanced communication and will
explore what it is that health care professionals and patients feel is
important in their connecting with one another. Using survey
methodology, patients will share what they would say to a newly
diagnosed cancer patient to enable effective communication with the
health care team. Health care professionals will reveal what they would
like to say to their patients. Results are interesting and refreshingly
honest! The real secret is in the connection – where the imprint is left
forever – in and on the heart!