Quick but Powerful Tips and Takeways for Nursing Best Practices and Emotional Support

Cancer Network had the opportunity to speak with Deborah Boyle, MSN, RN, AOCNS, FAAN, from Advanced Oncology Nursing Resources, Huntington Beach, California, about her novel presentation during the 2018 Oncology Nursing Society (ONS) Congress. Ms Boyle presented “Rapid Fire Report: 20 Best Practices in 20 Minutes,” at the ONS booth in the Walter E. Washington Convention Center.

During her presentation, she discussed common clinical dilemmas facing oncology nurses, especially those occurring at the bedside. She also offered practical and creative solutions that are currently being implemented in a variety of cancer care settings. 

-Interviewed by Lori Smith, BSN, MSN, CRNP

Cancer Network:Can you briefly describe your presentation and why you felt it was important to share with bedside oncology nurses?

Deborah Boyle: This was a new education approach shared in a “Rapid Fire” format. Twenty common dilemmas facing bedside oncology nurses were briefly described, followed by the depiction of novel solutions. These interventions were identified through my interactions with staff nationally and internationally when speaking and consulting, and through my ongoing surveillance of the literature. The 20 issues fell within the categories of teamwork, communication, education, end-of-life care, symptom management, and nurse stress.

Cancer Network: In your opinion, what is the biggest dilemma facing bedside oncology nurses today, and is there a practical solution?

Deborah Boyle: Oncology nurses work within a fast-paced, rapidly changing healthcare environment. New therapies, treatment delivery approaches, and supportive care drugs are the norm, along with long work hours, demanding documentation requirements, and the need to provide holistic, quality care to complex patients and their families. The stress oncology nurses experience is challenging and ever-present. Finding time to keep up with new information is a constant struggle.

Cancer Network: In your presentation you discussed team communication, which seems to be a problem facing many nursing and provider teams. What are some interventions being implemented to address this, and could you specifically discuss the “team sheet” you mentioned? 

Deborah Boyle: In academic medical centers, rotations of various teams of house staff and fellows frequently evolve through oncology units. The creation of an orientation guide for these physicians-in-training helps to communicate unit norms and expectations that nursing staff feel are important to optimize patient care.

At the Wilmot Cancer Center at the University of Rochester, nurses on the bone marrow transplant unit have created what they call “T-Sheets,” which facilitate communication among team members. The laminated sheets are posted outside the patient’s room, accompanied by pictures of the nursing staff caring for the patient that shift. The sheets reflect the patient’s mobility, vital signs, and bathing status. Other special precautions are also posted on this sheet, so that there is a central place for important information to be shared within the team.

In cancer programs throughout Canada, Australia, and the United Kingdom, kiosks-much like ATMs and check-in portals at airports-have been used at the time of registration in ambulatory sites for patients to log in and rate their symptom distress. This information is then downloaded to the patient’s ambulatory medical record such that at the time of patient assessment prior to therapy, the patient’s current distress has already been ascertained.

Cancer Network:How are nursing leadership teams addressing some of the dilemmas facing bedside oncology nurses?

Deborah Boyle: Oncology nurse leaders are key to lobbying on behalf of their staff for a variety of opportunities that augment nursing care. This includes addressing processes that facilitate bedside staff nurse participation in interdisciplinary rounds and family meetings. Leaders can also lobby for resources to support nurses in the workplace, such as the need for counselors to be available to nurses. Justifying the need for additional education opportunities that enhance communication skills for all nursing staff is another example of leader advocacy. The special needs of new graduates who frequently work on the night shift is an additional education-support strategy that nurse leaders can request. This acknowledges new graduate nurses’ need for ongoing mentorship when educational resources are minimal.

Cancer Network: You mentioned in your presentation methods to address nurse stress and distress. Can you discuss some of the methods being used to address these issues?

Deborah Boyle: Many cancer programs are introducing a variety of support measures for oncology nurses who work routinely with patients and families facing tragedy and loss. Complementary [therapy] approaches for nurses include massage, Reiki therapy, aromatherapy, and journaling. A “Time Out” room can be created to allow nurses a special place to relax and reflect during their shift. When a nurse cares for a patient who has just died, a “Code White” can be called, where supervisors meet the nurse who cared for the patient at the time of death, to determine how the nurse is coping. In ambulatory settings, initiating the display of a colored electric candle at the central station can signify that staff are experiencing some emotional distress related to work. The implementation of ethics rounds is another forum for nurses to share feelings related to a patient or family scenario that is prompting moral anguish.