Kelly Brassil

Capturing the experience: Reflections of women with breast cancer engaged in an expressive writing intervention

Background: Expressive writing has been shown to improve quality of life, fatigue, and posttraumatic stress among breast cancer patients across cultures. Understanding how and why the method may be beneficial to patients can increase awareness of the psychosocial impact of breast cancer and enhance interventional work within this population. Qualitative research on experiential aspects of interventions may inform the theoretical understanding and generate hypotheses for future studies. Aim: The aim of the study was to explore and describe the experience and feasibility of expressive writing among women with breast cancer following mastectomy and immediate or delayed reconstructive surgery. Methods: Seven participants enrolled to undertake 4 episodes of expressive writing at home, with semistructured interviews conducted afterward and analyzed using experiential thematic analysis. Results: Three themes emerged through analysis: writing as process, writing as therapeutic, and writing as a means to help others. Conclusions: Findings illuminate experiential variations in expressive writing and how storytelling encourages a release of cognitive and emotional strains, surrendering these to reside in the text. The method was said to process feelings and capture experiences tied to a new and overwhelming illness situation, as impressions became expressions through writing. Expressive writing, therefore, is a valuable tool for healthcare providers to introduce into the plan of care for patients with breast cancer and potentially other cancer patient groups. Implications for Practice: This study augments existing evidence to support the appropriateness of expressive writing as an intervention after a breast cancer diagnosis. Further studies should evaluate its feasibility at different time points in survivorship.

Longitudinal Outcomes of an Institutionally Developed Nurse Residency Program

Nurse residency programs are widely implemented to enhance integration of new graduate nurses entering the workforce. This article presents a retrospective analysis of 10 years of residency data from an internally developed residency program that used the Casey-Fink Graduate Nurse Experience Survey. Outcomes of this program were similar to those from studies using commercially available products, suggesting that an internally developed residency curricula may be equally beneficial to the development of new graduate nurses.

MicroRNAs: Clinical Trials and Potential Applications

&NA; MicroRNAs are novel biomolecules with a crucial function in normal cellular physiology and in pathophysiologic conditions, including cancer. Since the first report on the link between microRNAs and cancer was published in 2002, research has revealed the potential clinical implications of microRNAs. Oncology nurses play an important role in educating patients and their families about possible applications of microRNAs in oncology. AT A GLANCEMicroRNAs are critical in regulating various biologic processes engaged in the promotion or inhibition of cancer growth.MicroRNAs may be biomarkers for various clinical applications, including diagnosis, prognosis, therapy response, treatment side effects, disease risk, disease progression, and metastasis.Numerous clinical trials involving microRNAs and cancer are in progress, with the aim of validating clinical application.

Establishing an Inpatient Gym for Recipients of Stem Cell Transplantation: A Multidisciplinary Collaborative

BACKGROUND Evidence suggests that exercise can have a profound impact on physiologic and quality-of-life outcomes for patients undergoing hematopoietic stem cell transplantation (HSCT). Despite this, implementation of a gym on inpatient HSCT units may be limited because of space, infrastructure, and budget. OBJECTIVES This article presents the design, implementation, and evaluation of the gym and highlights its use for individual and group patient activities. METHODS An interprofessional team at a National Cancer Institute-designated comprehensive cancer center collaborated to design and implement gym space on an inpatient HSCT unit servicing as many as 86 beds. FINDINGS Informal feedback from patients, as well as metrics on use of the space, indicates that the gym is well received and frequently used. Limitations include the absence of a designated physical therapy technician to supervise individual activity, which may limit patient access when a staff member is unavailable. The cost associated with the implementation of such space may be offset by benefits to patients, including enhanced conditioning, quality of life, and time to discharge, as evidenced in the literature.

Symptom word documentation: A novel approach to identifying and managing hospital-acquired infections

An interprofessional team developed a symptom word documentation tool based on surveillance definitions for specific types of infections published by the Centers for Disease Control and Prevention. Nursing documentation was monitored pre- and postimplementation of the tool, revealing increased compliance with symptom documentation. Although symptom word documentation does not reduce the number of infections, it may impact the central line-associated bloodstream infection (CLABSI) rate by better differentiating CLABSI from other infection sources, as was observed in this institution.

Application of Proteomics in Acute Graft-Versus-Host Disease Management: An Integrative Review and Nursing Implications

BACKGROUND After allogeneic hematopoietic stem cell transplantation, one of the major barriers to clinical management of acute graft-versus-host disease (aGVHD) is a lack of reliable and validated noninvasive tests for diagnosis and prognosis. Proteomic studies have indicated a strong correlation between the level of certain body fluid proteins and clinical outcomes after aGVHD. Specific proteins have been identified that could be robust biomarkers for overall prognosis or for differential diagnosis of target organs in aGVHD. OBJECTIVES The authors aimed to evaluate the literature related to proteomic biomarkers that are indicated in the occurrence, severity, and management of aGVHD. METHODS PubMed and CINAHL® databases were searched for articles published from January 2004 to June 2014. Eight articles matching the inclusion criteria were identified, and the findings of these articles were summarized and their clinical implications noted. FINDINGS Proteomics appears to be a promising tool to assist oncology nurses and nurse practitioners with patient education, develop personalized plans of care to reduce morbidity, initiate communication regarding end-of-life decisions, and improve overall nursing management of the population of patients with aGVHD.

Exploring the cancer experiences of young adults in the context of stem cell transplantation

Background: Cancer is the leading cause of nonaccidental morbidity and mortality among young adults (YAs) in the United States. Stem cell transplantation (SCT), a treatment modality for a variety of YA malignancies, often requires prolonged hospitalization and immune-compromising treatment regimens. Stem cell transplantation may isolate YAs physically and emotionally, contributing to uncertainty about treatment processes, outcomes, and long-term sequelae. Studies in this population suggest that uncertainty can contribute to difficulty accomplishing basic developmental tasks. Few studies have examined the experiences of YAs in active cancer treatment, particularly those undergoing SCT. Objectives: This study explored the cancer experiences of YAs aged 18 to 25 years leading up to SCT and explored how YAs construct issues of uncertainty related to the transplantation experience. Methods: Interviews with 14 YAs conducted within 24 hours of admission to undergo SCT were analyzed using thematic analysis from a medical ethnographic perspective. Results: Themes emerged within 2 domains: relational and psychoemotional. The relational theme of “altered relationships” included the subthemes of “moving from” and “moving toward.” The psychoemotional theme of the “power of perspective” included the subthemes of “optimism,” “acknowledgment of death,” “informational empowerment,” and “developing a new outlook.” Conclusions: Our findings offer new insights into the YA experience in the context of active cancer treatment, specifically how the cancer experience impacts relationships and how this experience is influenced by YAs’ perspectives. Implications for Practice: This study provides a foundation for addressing the psychosocial needs of YAs hospitalized for SCT, paying particular attention to the development of specific interventions.

Chemomobilization: Overview of an Educational Quality Improvement Project for Recipients of Autologous Stem Cell Transplantation

BACKGROUND: In preparation for an autologous stem cell transplantation, patients undergo chemomobilization; however, a dearth of standardized, evidence‐based patient education on chemomobilization exists in the literature and in practice. OBJECTIVES: The purpose of this quality improvement educational initiative is to identify an evidence‐based approach to appraise the educational needs of patients and their caregivers and to enhance chemomobilization education. METHODS: A review of the literature related to chemomobilization was conducted, as well as an informal survey of educational practices at five National Cancer Institute‐designated comprehensive cancer centers. A 14‐item survey was administered to 50 patients who underwent chemomobilization to assess their educational needs, experiences, and preferences. FINDINGS: Patients prefer written information to review. Receiving verbal education from reliable healthcare providers in a structured format may enhance effective comprehension and retention. Patients identified timing, process, side effects, and expectations about chemomobilization as the most important topics to include in education.

Immunotherapy: Exploring the State of the Science

&NA; Immunotherapy research provides opportunities for nurse scientists and researchers to be at the forefront of the changing landscape of cancer treatment. As these therapies continue to develop, current initiatives will seek to support nurses in clinical practice who must provide safe, evidence‐based care and education to patients and their families. This article explores the current state of immunotherapy research and the ways in which continued research can help to advance nursing education and practice. AT A GLANCENurse scientists and researchers need to assess the potential challenges of immunotherapy treatment, including initial patient response and long‐term effects.Current initiatives in cancer research will support nursing education on new and emerging immunotherapy treatments.Nurses can contribute to future research by providing insight into patient‐reported outcomes and symptom management following immunotherapy treatment.

Nursing Management of Sustained Rigors and Recurrent Fever as Symptoms of Filgrastim Hypersensitivity: A Case Report.

ONF, 42(4), 415–419. doi: 10.1188/15.ONF.415-419 A 36-year-old man presented to an emergency room with fever, fatigue, and severe rectal pain. He was subsequently found to be pancytopenic with a perirectal abscess. A bone marrow examination revealed 58% blasts consistent with acute myeloid leukemia. The patient was initiated on clofarabine, idarubicin, and cytarabine therapy. The first cycle of therapy was complicated by neutropenic fever, bacteremia, and pneumonia. The second cycle was complicated by delayed platelet recovery. As a result, the patient was referred for possible stem cell transplantation. The patient was enrolled in a phase III trial using standard of care double umbilical cord blood transplantation with myeloblative conditioning to include fludarabine and melphalan, with rabbit antithymocyte globulin. Filgrastim injections were initiated at 600 mcg daily. The patient’s post-transplantation phase was complicated by sustained rigors and recurrent febrile episodes. The patient experienced 1–6 episodes of rigors daily. During this period, the patient also reported severe lower back pain with a majority of the episodes of rigor. The patient then developed neutropenic fever on Day 17 with persistent fever daily ranging from 38.1°–39.5°C through Day 50, with only six days in which he was afebrile. Filgrastim injections were administered at 4 pm daily, and the febrile episodes were noted to occur primarily in the early to late evening hours, with rigors preceding the febrile events by about 30–60 minutes. By Day 30, the patient’s engraftment had plateaued with a white blood cell count of 1.2 and an absolute neutrophil count of 0.89. As a result, the filgrastim dose was increased to 600 mcg twice daily. Diagnostic Workup