Cindy J. Rishel

Conceptual framework for the study of parental end-of-life decision making in pediatric blood and marrow transplantation.

PURPOSE/OBJECTIVES To describe a conceptual framework that will facilitate research and practice concerning parental end-of-life decision making in pediatric blood and marrow transplantation (BMT). DATA SOURCES A review of relevant literature from Ovid, CINAHL, EBSCO, MEDLINE, PsycINFO, and various sociology and theology databases was combined with experiential knowledge. DATA SYNTHESIS The method of concept and theory synthesis and derivation as described by Walker and Avant was used in the development of this framework. CONCLUSIONS Use of the proposed conceptual framework is expected to provide the organization necessary for thinking, observation, and interpretation of parental end-of-life decision making in pediatric BMT. IMPLICATIONS FOR NURSING The ability to describe the process of parental end-of-life decision making in pediatric BMT will help nurses to provide appropriate counseling, education, and support for these children and their families at the end of life. In addition, the process will help nurses to promote the well-being of the childrens families after end of life.

Implementing Evidence-Based Practice Using an Interprofessional Team Approach: Part Two

The complexity inherent in the inpatient oncology population requires effective interprofessional collaboration and integrated evidence-based practice (EBP), drawing from each of the disciplines to achieve desired outcomes. Each member of the team lends a strength and expertise that, when combined, often results in outcomes greater than the sum of its parts (Hall & Weaver, 2001; Petri, 2010; Pullon & Fry, 2005). EBP promotes the use of research to solve issues raised in day-to-day nursing practice. This article provides an overview and summary of an evidence-based project to increase compliance of sequential compression devices (SCDs) in gynecologic oncology and urology patients on a post-surgical inpatient unit using the Plan, Do, Study, Act (PDSA) model for continuous quality improvement (CQI) (Institute for Innovation and Improvement, 2013).

The role of resilience and mindful leadership in oncology nursing.

When oncology nurses think of the word resilient, they often describe the term in the context of the patients and families they care for each day. When patients face a diagnosis of cancer, their lives have suddenly been altered in a frightening manner. Everything changes, and they must find a way to navigate the troubled waters ahead. 
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Succession Planning in Oncology Nursing: A Professional Must-Have

The average age of the active nursing force in the United States is approaching 50 years (U.S. Department of Health and Human Services, 2010). Nurses are retiring at a rapid rate; 55% of respondents to one survey indicated a plan to retire in the next seven years (Sverdlik, 2012). Of the survey participants, 13% held an administrative or management position and 44% were aged 55 years or older (Sverdlik, 2012). The age demographic of active oncology nurses mirrors that of the national nursing force. Of the 33,323 active members of the Oncology Nursing Society who indicated an age range on their membership application, 15,735 (47%) self-identified as aged 50 years or older (see Figure 1). At a time when many are planning for retirement, their respective employers are scrambling to fill open positions. With no clear vision or plan in place, many healthcare organizations will struggle to meet the ongoing needs of communities they serve. The challenge is to develop programs that identify, develop, motivate, and transition younger nurses to available positions.

Epistemic Injustice and Nurse Moral Distress Perspective for Policy Development

The focus of this article is epistemic injustice as an underlying explanation for the lack of communication associated with moral distress in frontline nurses who provide end-of-life care. Improvements in interprofessional collaboration and communication in this challenging area of practice are needed, as supported by research on moral distress and related studies. Policy development that addresses interprofessional practice inclusive of all healthcare providers, particularly frontline nurses, in deliberations about end-of-life treatment deliberations and decisions is proposed.

An emerging theory on parental end-of-life decision making as a stepping stone to new research

cson, AZ 85724. Tel.: +1 520 Pediatric bone marrow transplant (BMT) is an aggressive medical treatment associated with highmorbidity andmortality. Mortality rates for BMT vary from 37 to 77% depending on the underlying diagnosis and type of transplant performed (Pasquini & Wang, 2009). Parents are confronted with agonizing end-of-life (EOL) decisions for their child who is dying following BMT. As a pediatric BMT nurse, I accompanied many parents along the path of this decision making process. I had intimate knowledge that this process,whether a decision to agree to a do not resuscitate (DNR) order for their child or towithdraw life-sustaining therapy for their child who was dying following BMT, was both excruciatingly painful and courageous. But neither I nor the healthcare field in general had adequate knowledge of how this process occurred andwhatmight be done to facilitate it for parents and their children.My dissertation provided an opportunity for initial study of this process. The purpose of this article is to describe how a beginning middlerange theory, generated from my dissertation research, was used as a stepping stone to identify a focus for my next research project. During doctoral study, I was encouraged to look beyond my dissertation to consider a plan of continued scholarly inquiry. Developing that initial study after doctoral graduationmaybemore difficult thanfirst imagined. A theoretical framework can facilitate this next step in research.

Professional development for oncology nurses: a commitment to lifelong learning.

Think back to the day you graduated from your entry-level nursing program. The feelings we experienced at that time are likely universal, whether that day was one year ago or more than 40 years ago. No more tests, no more papers, no more clinical skills practice, and no more preparing the dreaded nursing care plan. School was finished. We all looked forward to passing our nursing boards and getting our first real nursing jobs. Certainly, we all had some vague idea that during our life as nurses we would, at some time, have to learn a new skill, or work with a new type of equipment; however, many of us did not seriously contemplate or acknowledge that we were embarking on a career path that expected us to be lifelong learners. Little did we know that engaging in the process of lifelong learning is not necessarily something that comes naturally; it is, in fact, a personal commitment that each of us makes to the pursuit of learning throughout our professional career.

Financial Savvy: The Value of Business Acumen in Oncology Nursing

Have you given serious thought to your individual ability to affect the high cost of health care? If so, you may have determined that the opportunity to have any meaningful effect on cost of services for patients with cancer is limited. You may believe that budgets are the responsibility of nursing leadership. Indeed, the development of the unit or department budget is an activity that many of us have no direct (or even indirect) role in completing. Once the budget is finalized, we are frequently given directives to control our costs and improve the financial bottom line for our employers. One could argue that this is a particularly difficult missive for oncology nurses with the soaring costs of chemotherapy and biotherapy drugs, the expenses incurred to provide supportive care needed by patients with cancer, and the need to provide services to the increasing number of cancer survivors.

Tough Courage: Oncology Nursing Forum Addresses Childhood Cancer Then and Now

Cancer is a devastating diagnosis for anyone, but none more so than for children and their parents--so many questions to be asked, so much information to sift through and absorb, and so many difficult decisions to be made. It is no wonder that a diagnosis of childhood cancer is often met with fear, anger, guilt, and feelings of being overwhelmed, yet also a determined resilience on the part of families to do whatever it takes to help their child get well again (Rishel, 2010).