Nurses Succeeding in Bone Marrow Biopsy Program

A nurse-led bone marrow aspiration/biopsy program is providing evidence that the use of procedurists is good for patient outcomes and good for clinical practice, according to a presentation at the Oncology Nursing Society’s 40th Annual Congress in Orlando, Florida. The presentation was titled Multidisciplinary Development of a Bone Marrow Aspirate and Core Biopsy Performed by Registered Nurses.

This use of nurse procedurists in bone marrow biopsies “demonstrates an innovative partnership for clinical practice, as recommended by the Institute of Medicine (IOM),” said Daravan Kao of the Seattle Cancer Care Alliance. The IOM’s landmark 2010 report, The Future of Nursing: Leading Change, Advancing Health, states that nurses “should practice to the full extent of their education and should be full partners in the redesigning of health care delivery,” Kao continued.

Registered nurses who participated in the bone marrow program maintained a 98 percent score, as rated by pathologists, for the quality of the samples they collected. Furthermore, there were no reported incidences of post procedure complications, Oncology Nurse Advisor reports.

A multidisciplinary team developed and implemented the biopsy program, which included didactic training, technical skills acquisition, and ongoing quality assurance.

Nurse-Led Interventions Reduced Shortness of Breath, Fatigue in Lung Cancer Patients

A nurse-led symptom management program conducted in Canada showed improvements for patients with lung cancer in the areas of dyspnea, or shortness of breath, and fatigue. Nurses provided patients with information and support, according to a study presented at the Oncology Nursing Society (ONS) 39th Annual Congress.

Researchers at the Grand River Regional Cancer Centre in Kitchener, Ontario, Canada, conducted the study in partnership with the Dyspnea Management Clinic. Oncology nurses used the results of an assessment of patients’ understanding of their symptoms to develop a protocol for patients with underlying lung cancer, Oncology Nurse Advisor reports. The protocol included:

• Assessment of breathlessness,
• Understanding the meaning of symptoms,
• Recognition of problems that require medical intervention,
• Offering breathing retraining,
• Use of relaxation technique, and
• Goal setting.

Each of the 43 patients participating received a one-hour consultation combined with follow-up visits. Their understanding of symptoms was measured by advanced nurse practitioners. The nurses could then implement a comprehensive approach to address dyspnea symptoms. Scores for dyspnea and tiredness were significantly improved in all patients when compared to a previous control group of 40 patients. The results demonstrate that oncology nurse-led interventions are effective methods for improving symptom management in patients with lung cancer, according to the researchers.

The role of nurses in providing care to cancer patients was explored by an INQRI team at the University of Utah. Led by Susan Beck, this interdisciplinary team designed a robust measure to assess adult patients’ opinions about how nurses manage cancer-related pain. Beck and her team developed an instrument using qualitative and quantitative data to elicit patients’ opinions about how their nurses and other members of their care team managed their pain and, ultimately, to help patients select hospitals based on this dimension of their care experience.

Nurse Navigator Intervention in Cancer Treatment Effective and Efficient

A new study finds that nurse navigators provide crucial emotional support and guidance for people diagnosed with cancer. Additionally, patients report significantly fewer problems with care as a result of nurse intervention.

The study, “Nurse Navigators in Early Cancer Care: A Randomized, Controlled Trial,” was published in the November Journal of Clinical Oncology. It focused on whether nurse navigator intervention improved quality of life and patient experience for 251 adults recently given a diagnosis of breast, colorectal, or lung cancer. 

Researchers found that patients who had access to a nurse navigator soon after diagnosis reported feeling that they had better emotional support, were better informed, and were more involved in their care, Medscape Medical News reports. Patient outcomes typically improve when patients are more involved in their care and self-care, researchers said.

For the study, 118 participants were randomly assigned to receive oncology nurse navigator support and 133 received enhanced usual care (the control group). Patients in the intervention group received weekly phone calls from a nurse navigator and met with that nurse in person at least once during the four-week period. The control group received educational material designed by a patient advisory committee.

Nurse Navigator Intervention Effective and Efficient

Patients in the nurse navigator group reported significantly better scores on the Patient Assessment of Chronic Illness Care and had significantly fewer problems with care, especially psychosocial care, care coordination, and information, according to the study.

The intervention also yielded an unanticipated cost benefit. While cumulative costs after diagnosis did not differ significantly between the two groups; costs were $6,852 less for lung cancer patients in the nurse navigator group.

The nurse navigators involved in the trial had previous experience with cancer patients and received special training to deal with psychosocial distress, which may have been factors in the success of the interventions, according to Edward H. Wagner, MD, MPH, the lead author. Wagner is senior investigator at Group Health Research Institute.

The benefits for disadvantaged patients may be even greater than those found in this study, researchers said. The trial intervention participants were generally well educated, insured, and of higher income.

Nurse Navigators Help Patients Through Maze of Cancer-Treatment Decisions, Fears

Last week, Laura Landro, of the Wall Street Journal, detailed how nurse navigators can help patients make informed medical decisions and assist them with treatment options, tests and laboratory work and appointment scheduling.

Click here to read Ms. Landro's article.

Nurses and Cancer Treatment

The Institute of Medicine (IOM) has issued a report on improving the quality of oncology care through patient-centered treatment planning. Marie Bakitas, APRN, DNSc, AOCN, FAAN, associate professor of anesthesiology at Dartmouth Medical School, noted that a systematic review of 46 studies found that nurses are prominent information providers for cancer patients, especially after the initiation of treatment.

Click here to learn more about the report.

Indicative of the role nurses serve in providing care to cancer patients is the work conducted by an INQRI team at the University of Utah.  Led by Susan Beck, this interdisciplinary team has designed a robust measure to assess adult patients’ opinions about how nurses manage cancer-related pain.  Although nurses are the frontline providers of pain management in hospitals, pain goes unrelieved which affects patient outcomes, length of stay and costs a great deal. Beck and her team developed an instrument using qualitative and quantitative data to elicit patients’ opinions about how their nurses and other members of their care team managed their pain and, ultimately, to help patients select hospitals based on this dimension of their care experience. For example, the surveys asked patients whether nurses believed them when they said they were in pain and evaluated whether the team involved patients in decisions about their pain management. The Pain-CQ survey tools will let patients rate their experiences and help hospital administrators and policymakers who want to improve the care provided by nurses and other health team members. The initial tool was developed with the help of cancer patients. The tool is now being tested at a Veterans Administration hospital with patients who have a number of different diagnoses. The research may eventually spark the creation of a nurse-performance measure related to pain management.