AnnMarie Lee Walton

Implementing survivorship care plans for colon cancer survivors

PURPOSE/OBJECTIVES To evaluate the feasibility, usability, and satisfaction of a survivorship care plan (SCP) and identify the optimum time for its delivery during the first 12 months after diagnosis. DESIGN Prospective, descriptive, single-arm study. SETTING A National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE 28 nonmetastatic colon cancer survivors within the first year of diagnosis and their primary care physicians (PCPs). METHODS Regular screening identified potential participants who were followed until treatment ended. An oncology certified nurse developed the JourneyForward™ SCP, which then was delivered to the patient by the oncology nurse practitioner (NP) during a routine follow-up visit and mailed to the PCP. MAIN RESEARCH VARIABLES Time to complete, time to deliver, usability, and satisfaction with the SCP. FINDINGS During one year, 75 patients were screened for eligibility, 34 SCPs were delivered, and 28 survivors and 15 PCPs participated in the study. It took an average of 49 minutes to complete a surgery SCP and 90 minutes to complete a surgery plus chemotherapy SCP. Most survivors identified that before treatment ended or within the first three months was the preferred time to receive an SCP. CONCLUSIONS The SCPs were well received by the survivors and their PCPs, but were too time and labor intensive to track and complete. IMPLICATIONS FOR NURSING More work needs to be done to streamline processes that identify eligible patients and to develop and implement SCPs. Measuring outcomes will be needed to demonstrate whether SCPs are useful or not.

Recognition: a key retention strategy for the mature nurse.

Recognition of staff can be one of the easiest, cost-effective strategies to retain experienced mature nursing staff. The authors discuss the Senior and Generational Excellence initiative that identifies strategies and brings attention to the unique skills and needs of mature professional nurses.

Patient-reported symptoms and quality of life in adults with acute leukemia: a systematic review.

PURPOSE/OBJECTIVES Systematically summarize findings from research conducted on adult acute leukemia survivors as they relate to symptoms and quality of life (QOL). 
 DATA SOURCES Systematic review of the literature from 1990–2013 found in the PubMed, PsycINFO®, EMBASE, and CINAHL® databases, as well as manual searches. 
 DATA SYNTHESIS The review identified 16 quantitative studies and 1 qualitative study published from 1990–2013 that used a self-reported QOL or symptom questionnaire. Fatigue was the most commonly assessed and reported symptom, followed by depression. 
 CONCLUSIONS Acute leukemia and its treatment have a significant impact in all QOL domains. Future studies should include longitudinal research, more than one recruitment site, increased minority representation, and home-based exercise interventions as ways to improve all domains of QOL. 
 IMPLICATIONS FOR NURSING This review increases awareness of commonly reported symptoms faced by adults with acute leukemia. Oncology nurses are central in monitoring and reporting symptoms to the interdisciplinary team that may contribute to changes in function, with the overall goal of optimizing QOL over time. 


Cancer-related fatigue: scientific progress has been made in 40 years.

Cancer-related fatigue (CRF) is a distressing, persistent symptom that is experienced by survivors during and after treatment. Unsurprisingly, many early CRF studies were conducted by nurses. These studies included a look at patients receiving localized radiation treatment (Haylock & Hart, 1979); an exploration of fatigue as a conceptual approach to a clinical problem (Aistars, 1987); the development of a nursing theory focused on fatigue mechanisms (Piper, Lindsey, & Dodd, 1987); an examination of fatigue mechanisms (St Pierre, Kasper, & Lindsey, 1992), as well as of fatigue in advanced cancer (Bruera & MacDonald, 1988) and in non-small cell lung cancer (Sarna, 1993); and a description of fatigue and potential nursing interventions (Nail & King, 1987). Winningham et al. (1994) wrote a state-of-the-science article about fatigue in the cancer experience for the Oncology Nursing Forum, and Mock et al. (1997) was one of the first to conduct an exercise study regarding the effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Nurse scholars from the 1970s-2000s were pivotal in advancing the science of fatigue in various cancers and have provided a scientific foundation for those four decades. 
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Safe Handling: Implementing Hazardous Drug Precautions

Occupational exposure to chemotherapy is a significant and ubiquitous danger to oncology nurses. The Oncology Clinical Nurse III/IV leadership group at the University of North Carolina Hospitals embarked on the challenge of a comprehensive standards review regarding personal protective equipment necessary when handling waste after hazardous drug administration. This review led to practice improvements in education, the use of chemotherapy-rated gloves when handling hazardous waste, and changes in the disposal options available to staff. A discharge teaching pamphlet on safe handling for the caregivers of patients receiving hazardous drugs was created and piloted.

Observed and self-reported pesticide protective behaviors of Latino migrant and seasonal farmworkers

Agricultural pesticide exposure has potential adverse health effects for farmworkers that may be reduced by pesticide protective behaviors (PPBs). The Environmental Protection Agencys (EPA) Worker Protection Standard (WPS) requires PPBs be taught to farmworkers prior to field work. Studies to date have not utilized observational methods to evaluate the degree to which PPBs are practiced by Latino migrant and seasonal farmworkers in the United States. The purpose of this study was to describe, compare, and contrast observed and self-reported PPBs used by Latino farmworkers; both PPBs that the WPS requires be taught and other PPBs were included. Observed and self-reported data were collected from 71 Latino farmworkers during the 2014 tobacco growing season in North Carolina. Participants were consistent in reporting and using long pants and closed shoes in the field most of the time. In addition, gloves, hats/bandanas, and water-resistant outerwear were frequently observed, although they are not required to be taught by the WPS. Farmworkers reported more long-sleeve (p=.028) and glove use (p=.000) than what was observed. It was uncommon to observe washing behavior before eating or drinking, even when washing supplies were available. Washing behaviors were significantly overreported for hand (p=.000; p=.000) and face (p=.000; p=.058) washing before eating and drinking in the field. This study documents that protective clothing behaviors that the WPS requires be taught, plus a few others are commonly practiced by Latino migrant and seasonal farmworkers, but washing behaviors in the field are not. Targeted strategies to improve washing behaviors in the field are needed.

Enabling nurses to lead change: The orientation experiences of nurses to boards

OBJECTIVES Nurses need to be full partners in shaping health care and health care policy. One way to do this is to be present and active on boards at all levels. The purpose of this study is to examine the orientation experiences of nurses to boards and their preparation to influence health care and health care policy. METHODS A Web-based survey about the efficacy of board orientation was sent to members of three local boards made up exclusively of nurses. RESULTS Liabilities and fiduciary duties were least likely to be addressed in board orientation for nurses. Board members requested more training in finance and a more formal/structured orientation process. CONCLUSIONS Standardizing orientation elements for nurses serving on boards would best prepare them to serve on interprofessional hospital boards and work in the health policy arena. The orientation experience on local- and state-level nursing boards is fundamental to nurses beginning board service.

Use of ED and hospital services for patients with acute leukemia after induction therapy: One year follow-up

Previous studies have documented use of health care services by oncology patients in the Emergency Department (ED), but little is known about the utilization of health services of patients with acute leukemia after induction therapy. The aim of this study was to examine chief reasons for ED and hospital use by patients newly diagnosed with acute leukemia patients after induction therapy up to one year after discharge. A retrospective, longitudinal study of all visits to the ED or unplanned hospital admissions at a single institution for patients with acute leukemia was conducted. Inclusion criteria were patients ≥18 years of age at time of diagnosis, a confirmed diagnosis of AML or ALL, and received and discharged from induction treatment between 2007 and 2010. Donabedians structure-process-outcome framework guided this study examining health services utilization and assessing patient outcomes. 80 patients met the inclusion criteria; 52 had AML and 28 had ALL; median age was 48 (range: 18-76) and 29% (n=23) were non-Caucasian. 70% (n=56) were discharged from induction in remission. 81% (n=65) had at least 1 ED or hospitalization event, and 44% (n=35) had 2 or more events. Of 137 events in 65 patients, the most common reason was neutropenic fever/infection (55%), bleeding (12%), and GI problems (11%). Mean number of events for ALL was 2.43 compared to 1.33 for AML patients (p=0.02), and 2.23 for <50 years of age compared to 1.20 for those older (p=0.002). 20 patients died within one year of diagnosis. Findings from this study can help inform health services delivery and utilization among patients with acute leukemia after induction therapy. Oncology providers can anticipate discharge needs and enhance follow-up care for those at higher risk for problems needing hospitalization.

Imagine: Compassion Fatigue Training for Nurses

The residency program for oncology nurses at University of North Carolina Healthcare is comprehensive. New graduate nurses in the inpatient setting undergo 13 weeks of orientation with two primary preceptors on the unit and then meet monthly for four hours of didactic learning and support for the first 12 months. The nurse educators who planned this residency wanted to create a celebration that would encourage reflection on the past year and teach self-care strategies as well. Mimi Alvarez, RN, MSN, PMHCNS-BC, a psychiatric clinical nurse specialist with the Comprehensive Cancer Support Program, has developed a presentation for the nurses on compassion fatigue. Alvarez’s presentation addresses the risks of passionately caring for patients. Alvarez knows that nurses have to be acutely aware of where their “gas tank” of emotional energy hovers and have a conscious awareness of the dynamics of caring. Mimi’s desire to teach this class comes from her own experience. “When I was a baby nurse in oncology, no one told me that I would be coming home and be having dreams about my patients; that something would remind me of my patient. No one told me any of this would happen. I thought I was losing my mind, that something was wrong with me. I was being human. “To understand (the patient’s) humanity I have to go inside of myself and understand my own humanity. There is no way I can be in a relationship with (the patient) and not be touched. There is no way I can care for another and not be changed. That component of self reflection is what is missing in the training of nurses. We teach nurses to reflect clinically, not psychologically.” Ann Marie Lee Walton, RN, MPH, OCN®, CHES, is a clinical nurse IV for inpatient hematology/ oncology and Mimi Alvarez, RN, MSN, PMHCNS-BC, is a psychiatric clinical nurse specialist in the Comprehensive Cancer Support Program, both at the North Carolina Cancer Hospital in Chapel Hill.

Management of Febrile Neutropenia in a Patient With Acute Leukemia

Hematologic cancers comprise an aggregate of several different cancers, such as leukemia, lymphoma, and multiple myeloma. There are more than 100,000 new cases of these hematologic cancers in the United States annually, and more than 50,000 children and adults die from these cancers.1,2 Hematologic cancers affect the body’s blood, bone marrow, and lymphatic system, leaving these patients more susceptible to infections.1 A newly diagnosed patient with acute leukemia receives aggressive chemotherapy treatment and is closely monitored in the hospital for at least 3 to 4 weeks. Treatment-related signs and symptoms including fever, pain, nausea and vomiting, and respiratory distress may bring the patient to the emergency department before his or her next scheduled clinic appointment.3,4 In this article a case study of a patient with acute lymphoblastic leukemia who enters the emergency department will be used to illustrate a common clinical scenario and provide clinical implications for emergency nurses who care for patients with hematologic cancers.