The effectiveness of palliative care simulation in newly hired oncology nurses’ training

Background: With the renewed emphasis on palliative care in Singapore, coupled with a dearth of studies on provision of palliative care in acute services, it is timely to explore the experiences, barriers and challenges faced by oncology nurses in the acute care setting. Aim: This study aimed to explore nurses’ experiences of providing palliative care in the acute oncology care unit. Method: An exploratory descriptive research methodology was adopted. Focus group interviews, involving a total of 24 nurses, were conducted. Interviews were audio-taped and transcribed verbatim. Data was analyzed using an inductive content analysis approach. Results: Five key themes emerged from the analysis: (1) nurses’ perceptions of palliative care; (2) multiple roles of nurses in palliative care; (3) emotional burden of providing palliative care; (4) misconceptions of palliative care; (5) challenges in providing palliative care. Conclusion: The provision of palliative care in the acute care setting remained challenging. This is partly due to the attitudes of patients, families and healthcare workers, as well as organizational factors such as lack of training. Nurses play an important role in giving and facilitating palliative care for patients in the hospitals. Future studies can explore interventions to help overcome the challenges that are impeding nurses from providing high-quality palliative care in the acute care setting.

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The Emotional Intelligence, Occupational Stress, and Coping Characteristics by Years of Nursing Experiences of Newly Hired Oncology Nurses

Asia-Pacific Journal of Oncology Nursing ◽

10.4103/apjon.apjon-2117 ◽

2021 ◽

Vol 8 (4) ◽

pp. 352

Author(s):

AnnM Mazzella-Ebstein ◽

KaySee Tan ◽

KatherineS Panageas ◽

JudithE Arnetz ◽

Margaret Barton-Burke

Keyword(s):

Emotional Intelligence ◽

Occupational Stress ◽

Oncology Nurses ◽

Stress And Coping ◽

And Coping ◽

Newly Hired

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Palliative care from cancer diagnosis for all: Memorial Sloan Kettering’s “One-Two-Three” program.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.111 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 111-111 ◽

Cited By ~ 2

Author(s):

Andrew S. Epstein ◽

Virginia M. Klimek ◽

Kimberly Chow ◽

Anjali V. Desai ◽

Peter Justin Wan ◽

...

Keyword(s):

Palliative Care ◽

Unmet Need ◽

High Volume ◽

Core Values ◽

Oncology Nurses ◽

Health Care Proxy ◽

Care Needs ◽

Information Preferences ◽

Communication Needs ◽

Hospice Use

111 Background: Early, universal palliative care is an unmet need for cancer patients. Our new program aims to provide palliative care, by primary oncology teams with support from palliative care specialists, from diagnosis as an institutional standard. Methods: One-Two-Three is a structured program of assessment and response addressing palliative care needs regardless of cancer stage or prognosis starting with the first 3 visits after diagnosis. Assessments include patient physical/emotional/spiritual symptoms (10 symptoms, self-reported 0-10), communication needs (information preferences, illness understanding), and proactive care planning through exploration of core values. As first responders, oncology nurses are guided by “ready responses” in an empathic framework and coaching or direct patient consultation by palliative care specialists. Feasibility, acceptability, and impact on patient, caregiver, and utilization outcomes are evaluated quantitatively and qualitatively. Results: Assessments were piloted with 25 consecutive, newly-diagnosed patients in blood cancer and solid tumor clinics. Symptom and communication assessments each took < 5 minutes and showed high prevalence of moderate/severe distress ( > 50% for 8/10 symptoms, 144 assessments), variation in information preferences (76% wanting detail, 24% broad overview only), and unmet communication needs. All but 1 patient without a health care proxy chose one. Oncology nurses engaged patients in structured discussions ( < 15 minutes) of core values. Clinic workflow was maintained. Patients, families, and oncology clinicians endorsed the initiative. As palliative care skills of oncology teams improved, specialists focused on more complex issues. Conclusions: Routine interprofessional primary palliative care with specialist support from diagnosis is feasible and acceptable in our center’s high-volume outpatient oncology clinics. Ongoing evaluations will assess other outcomes (e.g., quality of life); impact on clinicians/ processes; and utilization (e.g., ED/hospital visits, hospice use).

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Novel malignant bowel obstruction (MBO) management program for women with advanced gynecological cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.31_suppl.158 ◽

2017 ◽

Vol 35 (31_suppl) ◽

pp. 158-158 ◽

Cited By ~ 1

Author(s):

Yeh Chen Lee ◽

Nazlin Jivraj ◽

Catherine O'Brien ◽

Jenny Lau ◽

Tanya Chawla ◽

...

Keyword(s):

At Risk ◽

Palliative Care ◽

Patient Care ◽

Bowel Obstruction ◽

Symptom Management ◽

Management Program ◽

Oncology Nurses ◽

Malignant Bowel Obstruction ◽

Gynecological Cancers ◽

Management Algorithm

158 Background: Malignant bowel obstruction (MBO) is a common and challenging clinical predicament in women with advanced gynecological cancers. However, there is a lack of evidence-based guidelines or innovative approaches to improve patient care and quality of life. We implemented an inter-professional MBO management program incorporating a nurse-led ambulatory symptom management algorithm and multidisciplinary care conferences (MCC) as hallmarks of this program. Methods: Princess Margaret Cancer Centre has piloted an inter-professional MBO management program that supports women with advanced gynecological cancers who are at risk of/have developed MBO. The MBO team includes oncologists (medical, surgical, gynecologic and radiation), palliative care physicians, diagnostic and interventional radiologists, home parenteral nutrition physicians, specialized oncology nurses, dietitians, pharmacists and social workers. Complex MBO cases are discussed at regular MCC to derive treatment consensus. A symptom-driven MBO management algorithm has been devised and all patients are educated with a personalized bowel symptom management and dietary plan. For outpatient care, patients with MBO are proactively monitored by our specialized oncology nurses via phone or an eHealth bowel application to facilitate communication of symptoms and early intervention. Access to community services and home palliative care services are utilized to support care at home. All patients are enrolled into a prospective database to assess care impact and quality. Results: A total of 145 patients have been followed through the MBO management program over 12 months. At time of data cutoff, 14 had MBO (3 inpatients and 11 outpatients) and 22 were deemed at risk of MBO. Majority patients are managed as an outpatient and avoided unnecessary emergency department episodes. Detailed methodology and data analyses will be presented. Conclusions: A successful novel MBO program incorporating inter-professional care model and nurse-led ambulatory symptom management algorithm optimizes patient care in this vulnerable population and foster collaboration in implementing best practice clinical processes.

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“I’m going to push this door open. You can close it”: A qualitative study of the brokering work of oncology clinic nurses in introducing early palliative care

Palliative Medicine ◽

10.1177/0269216319883980 ◽

2019 ◽

Vol 34 (2) ◽

pp. 209-218 ◽

Cited By ~ 1

Author(s):

Shan Mohammed ◽

Pamela Savage ◽

Nanor Kevork ◽

Nadia Swami ◽

Gary Rodin ◽

...

Keyword(s):

Palliative Care ◽

Nurse Practitioners ◽

Oncology Nurses ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Structured Interviews ◽

Early Palliative Care ◽

Practice Nurses ◽

Starting Point ◽

Psychosocial Processes

Background: Early palliative care improves quality of life during life-prolonging treatment for patients with cancer, but the role of nurses in facilitating the early involvement of palliative care is unclear. Aim: To conceptualize the psychosocial processes involved in the introduction and provision of palliative care by oncology nurses. Design: A constructivist qualitative grounded theory study was conducted. Setting/participants: A total of 20 nurses (6 staff nurses, 10 nurse practitioners, and 4 advanced practice nurses) completed semi-structured interviews. Participants were from multiple ambulatory care oncology clinics (i.e. breast, pancreatic, hematology) in a comprehensive cancer center. Results: The core category, brokering palliative care, represented the overarching concept of the study that linked other subcategories. The other subcategories were as follows: opening the door—creating the possibility of discussing early palliative care at a time when patients show signs of being receptive to this discussion; building trust—establishing relationships with patients as a starting point for open discussions about palliative care; tackling misconceptions—addressing patients’ assumptions about palliative care as signifying death; and advocating with oncologists—seeding the process of referral by bringing patients’ concerns forward. Conclusion: Oncology nurses play a central role in “brokering” the introduction of early palliative care; this process is supported by their relational proximity to patients and their location “in between” the patient and the oncologist. Training all nurses in palliative care and empowering them to have proactive discussions in a collaborative practice context would allow greater access to early palliative care.

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