Oncology Nursing Society 34th Annual Congress Podium and Poster Abstracts Each abstract has been indexed according to first author and identified as a podium or poster session on page 81. The abstracts appear as they were submitted and have not undergone editing or the Oncology Nursing Forum Editorial Board’s review process. If any errors or omissions have been made, please accept our apologies.
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PATIENT AND FAMILY NEEDS AND EXPECTATIONS DURING AN INPATIENT ONCOLOGY EXPERIENCE. Mary Dougherty, RN, MSN, OCN®, AOCNS®, Spectrum Health, Grand Rapids, MI; Kara Bykerk, RN, OCN®, Spectrum Health, Grand Rapids, Ml; Monica Hentemann, RN, BSN, OCN®, Spectrum Health, Grand Rapids, MI; Sara Maxwell, RN, BSN, OCN®, Spectrum Health, Grand Rapids, MI; Laura Paulsen, RN, BSN, OCN®, Spectrum Health, Grand Rapids, MI; Brooke Byrne, RN, BS, Spectrum Health, Grand Rapids, MI; Deb Stoutjesdyk, RN, OCN®, Spectrum Health, Grand Rapids, MI
Hospitalization for either the treatment of cancer or side effect management is an extremely stressful time for both the patient and caregiver. Regardless of the advances in cancer diagnosis/ treament and transiton to outpatient care, there will continue to be inpatient care settings. Few studies have focused on identification of the needs of patients and their families in this environment. One of the ONS priorities for research is in the area of family caregiving and the family group. The purpose of this study was to determine the needs of patients as well as family members during an inpatient oncology admission. Since patient satisfaction scores do not specifically focus on oncology-specific issues, this study was designed to not only identify needs but also focus on the ability of staff/structure of the inpatient unit in a community hospital setting to meet these needs. An exploratory-descriptive design was used to identify the needs and expectations of hospitalized, adult-oncology patients and their family members. The participants were asked to complete a survey ranking the importance of perceived needs on a 5 point Likert scale as well as how adequately those needs were met on a met/partially met and did not meet basis. Descriptive statistics were used to calculate the perceived needs and expectations. Rank order based on the average score for each item was used to list the perceived needs, with the percent of subjects whose needs had been met (met, partially met, not met at all). Most important needs identified by both patients and families related to their need for information and communication about their medical care. Surprisingly less important needs were continuity of nursing care and need for support from non-family members. Patient and family rating of satisfaction with the unit’s ability to meet their needs pointed to opportunities with orientation to unit structure and provider care team in a community hospital setting as well as clearer opportunities to involve the family in discussions regarding side effect managment.
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OPTIMIZING VITAMIN D STATUS TO REDUCE COLORECTAL CANCER RISK: A REVIEW OF EVIDENCE. Guiyun Zhou, MSN, CRNP, AOCNS®, Vita Hemtology Oncology, P.C., Bethlehem, PA
Vitamin D deficiency is common in both the general public and oncology population. Optimizing vitamin D status is increasingly recognized in cancer risk reduction, with specific, evidence of substantial decrease in colorectal cancer (CRC) risk. Therefore, it is important to summarize the current clinical evidence to promote the best practice.
Oncology Nursing Forum • Vol. 36, No. 3, May 2009
The primary objective of this evidentiary review is to examine the current research evidence regarding vitamin D’s impact on CRC risk reduction. The secondary objective is to provide practice recommendations for clinicians. Following a literature search, research articles from 2002-2008 were retrieved from varieties of electronic databases. Reference lists of relevant articles were also manually searched. Twenty-four research reports were selected for review, including four studies from randomized clinical trials (RCTs), ten cohort or case-control studies measuring serum 25-OH-D level as the main research variable, and ten cohort studies reporting vitamin D intakes. Result: Higher vitamin D intakes, in general, were found to decrease CRC risk. Effective vitamin D intakes that raise 25-OH-D level to the vitamin D sufficient state of 32-100ng/mL were shown to reduce CRC risk by about 40-60%. Vitamin D 1000 IU daily is safe and likely sufficient to raise 25-OH-D level into the range required to achieve CRC risk reduction. Practice recommendations, such as counseling patients about vitamin D intakes, correcting vitamin D deficiency and maintaining 25-OH-D level in the range of 32-100ng/mL, are supported by this review. Implication and Conclusion: Considering that over 50% of Americans and 80% of cancer survivors are taking dietary supplements without clinical advice and acknowledging the overall safety profile of vitamin D and its wide range of health benefits, it is reasonable to make practical recommendations of vitamin D 1000 IU daily. Besides, it is important to correct vitamin D deficiency and to maintain an optimal 25-OH-D level range. However, using effective doses of vitamin D in longitudinal RCTs with large population-based samples is needed for more definitive evidences. At present, clinicians must consider the current evidences, patients’ condition and preferences, and use own clinical judgment when addressing the need for vitamin D supplementation for their patients.
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NURSING CARE OF IV/VASCULAR CONNECTORS BASED ON CONNECTOR TYPE. Cynthia Chernecky, RN, PhD, AOCN®, FAAN, Medical College of Georgia, Augusta, GA; Lindsey Casella, RN, MSN, CCRN, University Hospital, Augusta, GA
Intravenous and vascular access connectors are important in oncology nursing practice as they are used in administering fluids, blood products, medications and chemotherapy. Connectors can also cause patient problems due to blood backup into the connector causing partial or complete occlusions and/or catheter related bloodstream infections (CRBSIs), either intra-luminal or extra-luminal. We have developed a basic chart related to 3 major types of connectors (positive, negative, neutral pressures) used in the clinical setting and staff nursing maintenance guidelines based on the literature that proper disconnect care may decrease or avoid occlusions and CRBSIs. The goal was to develop a basic maintenance care guide on disconnection for staff nurses who use connectors in patient care. The setting can be in-patient, out-patient, or community care. The avenue of connector use can be intravenous or vascular access. Oncology nurses utilize connectors multiple times, every day, on each patient and need to base their care related to disconnection on the type of connector used.
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A pocket guide was developed based on previous research that revealed 78% of staff nurses did not know there were different types of connectors and 30% believed the maintenance was the same for all types. The guides are available for use from the authors and are free to be copied. The nursing staff and intravenous teams of local hospitals found the guides easy to use and effective in implementing bedside care. The guide can be posted on medication carts, in medication rooms, in IV supply areas and in community and home health bags. The type of connector(s) used can be highlighted on the guide so the maintenance care during disconnection is easily identified for specific institutions or nursing units. The maintenance of multiple manufacturer connectors should be based on guidelines that are connector technology specific. Involvement of the end user, staff nurses, is imperative to optimal patient care. This small intervention may be a major step in decreasing infections and occlusions in oncology patients requiring intravenous and vascular access.
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REDUCING THE RISK OF LYMPHEDEMA: KNOWLEDGE, MOTIVATION, AND BEHAVIORS. Mei Fu, RN, PhD, ACNSBC, New York University, New York, NY; Judith Haber, PhD, APRN-BC, FAAN, New York University, New York, NY; Amber A. Guth, MD, NYU Clinical Cancer Center, New York, NY; Deborah Axelrod, MD, FACS, NYU Clinical Cancer Center, New York, NY
Despite advances in treatment, many breast cancer patients still face permanent disruption of their lymphatic system which predisposes them to the risk for lymphedema (swelling). Lymphedema exerts negative impact on patient’s quality of life. Lack of research examining patients’ lymphedema knowlege in relation to patients’ motivation, behavioral skills, and practice of risk reduction behaviors has hindered our progress in identifying and developing effective strategies to reduce the risk of lymphedema. The purpose of this study was to explore the relationships among patients’ lymphedema knowledge, motivation, behavioral skills, and practice of risk reduction behaviors. The study was based on the Information-Motivation-Behavioral [IMB] Model that emphasizes the need for patients to have adequate information relevant to a particular health issue (lymphedema risk) as the primary prerequisite to initiate a health behavior (lymphedema risk reduction behavior). Individual is viewed as an active participant in a behavioral change process. Accordingly, personal and social motivation and behavioral skills are essential for initiating and maintaining health behaviors (lymphedema risk reduction behaviors). A cross-sectional design was used to collect data from 136 patients using a Demographic and Medical Information interview tool, Knowledge Test, and Lymphedema Risk Reduction: Motivation and Behavioral Skill, and Lymphedema Risk Reduction Behavior Checklist. Data analysis included descriptive statistics, correlation coefficients, and regression. Participants with higher lymphedema knowledge had significantly higher behavioral skills (r=0.48; p