Where ONS Voices Talk Cancer
Join oncology nurses on the Oncology Nursing Society’s award-winning podcast as they sit down to discuss the topics important to nursing practice and treating patients with cancer.
ISSN 2998-2308
php/*
Where ONS Voices Talk Cancer
Join oncology nurses on the Oncology Nursing Society’s award-winning podcast as they sit down to discuss the topics important to nursing practice and treating patients with cancer.
ISSN 2998-2308
Copyright: © Copyright 2017
"These policies, procedures, order sets, and algorithms for oncologic emergencies are so important. They give you knowledge in your back pocket: This is the way we're going to treat this, this is the way to quickly respond to this, and this is the way to treat this in the safest way possible," ONS member Cassie Durand, MS, RN, CNS, AGCNS-BC, OCN®, clinical nurse specialist at Memorial Sloan-Kettering Cancer Center's Long Island, NY, regional site, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Durand discussed how to develop and apply procedures to care for patients with oncologic emergencies. This episode is part of a series of oncologic emergencies; the others are linked in the episode notes. You can also earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: At the conclusion of this podcast, the learner will report an increase in knowledge related to an institutional approach to preparing for oncologic emergencies.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"Nurses who are caring for these patients getting certain infusions have such a greater sense of autonomy. They can react in a moment's notice. You need to have an algorithm and order set in order to treat the patients so, so, so quickly." Timestamp (TS) 07:28
"We know that following metrics is so important for checking adherence to our standards and, most importantly, for improving patient outcomes." TS 08:23
"We all combine thoughts to figure out what the most relevant simulation would be for nurses in specific areas. The scenarios are very real-life mannequins—they're life-sized, they breathe, they talk, they have IV access, and they portray what we want them to. We load up the mannequin software before nurses come here. In our infusion unit, we'll have the mannequin portray a hypersensitivity reaction, and then, all of a sudden, they'll be in respiratory distress, and they may or may not code, just to keep the nurses on their toes. Because of all the preparation that goes into it on our end before the simulation is so relevant to their area, the nurses really like it because it's not random. We also hold a structured informal debrief, just like what we do in real life, after the simulation so we can ask questions, what went well, what didn't, and what we can change in the future. Simulation has become a huge aspect of our nursing education here." TS 13:51
"We have a lot of new staff members on the floor, just like I'm sure that every institution has. So I think they really appreciate a debrief, because they can really learn so much from it. We call it a 'hot debrief,' which means we're debriefing right after the event so that way we can get almost every member from our interprofessional group to stay and very quickly and succinctly talk about the event. That way, we're not chasing people down the next day or next shift to debrief. And we've seen some pretty good results." TS 17:33
"We have a clinical nurse specialist (CNS) who is available 24 hours a day at our main campus site where all of our inpatient beds are. Nights, weekends—there's always one there. And they support the nurses and respond to emergencies. Our CNSs have such a great rapport with our staff members, and I find that the nursing staff always feel so comfortable now asking them questions, calling for help, wanting to show them something, or asking them to look up a policy for them. . . . As the CNS at the bedside, I think that sometimes when the nurses see us there, even just our presence there, it keeps them at ease during a critical situation because they know that we can jump in and help when needed. Our nurses do such a great job in emergencies, but I do think that having people in the CNS role there really just makes them feel so much more comfortable." TS 23:13
"Acknowledge that grief is a reoccurring theme. This isn't something that's a one and done. This is a process that you're going to continue to revisit, and in recognizing that, I think this allows us to be more proactive and responsive to this emotional part of our job," ONS member Carla Jolley, MN, ARNP, ANP-BC, AOCN®, ACHPN, palliative care advanced practice nurse and coordinator for the palliative care consult service embedded within the oncology program at the Whidbey Health Medical Center in Coupeville, WA, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, in a conversation about how oncology nurses can approach and manage the grief they face in their work. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Learning outcome: Upon completion of this activity, the learner will report an increase in knowledge related to grief experienced by oncology nurses.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"Really look at where our own losses have happened in life, whether that's mapping out people who have passed on that we've cared for and loved that have had a lot of meaning to us, what kind of changes or transitions that have happened in our own lives. . . . There's a lot of loss that happens on a day-to-day basis, and so think about who we are and the accumulation of our own personal losses, because I think sometimes where it gets triggered in that secondary trauma is when we see ourselves in other people's situations." Timestamp 09:48
"How good or challenged are you with boundaries? There's always going to be patients and situations that are going to tug at your heart, and that doesn't make you bad with boundaries. But if you're going home and always taking it all in and can't separate your work life from your personal life, then there's a place to start thinking about that as far as that assessment. Is there something I can do for myself to make this not so difficult? Because that of course leads to burnout and compassion fatigue." TS 13:06
"I think the culture in our workplace can sometimes really impact our ability to be authentic and respond to our own personal grief." TS 17:48
"Create a place and a space to debrief patients that we have lost. A place where we can remember and acknowledge, and not only acknowledge the names of the names . . . really reflect on those gifts and the learnings from the patients and families that you care for." TS 18:48
"Acknowledge that grief is a reoccurring theme. This isn't something that's a one and done. This is a process that you're going to continue to revisit, and in recognizing that, I think this allows us to be more proactive and responsive to this emotional part of our job. I so recommend that you put a self-care plan in place ahead of time and be thinking about that." TS 41:57
"We also need that card like from a game that says, 'Call a friend.' If you are feeling overwhelmed, I really encourage you to identify who is going to be that call a friend name? Who is it that you can find as a partner or mentor that you can urgently debrief if something really tragic happened during your day? Maybe it's not your family or partner, and maybe it is. But sometimes I think that nurses' pain—we hold it and can share it with each other better. Because again, just like the families in their grief process, the telling of the story is important. It's important that we can tell it, and then it's also important that we can hear other people's stories and hold those in that container in that sacred space as well. So, find that 'call a friend.'" TS 45:49
"Effective communication with healthcare providers, making informed decisions about their care, and gaining strength through connections to others" are the key aspects of patient self-advocacy, ONS member Teresa Thomas, PhD, RN, assistant professor at the University of Pittsburgh School of Nursing in Pennsylvania, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, in a conversation about how patients can self-advocate and how nurses can support them. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Upon completion of this activity, participants will report an increase in knowledge related to patient self-advocacy.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"Effective communication with healthcare providers, making informed decisions about their care, and gaining strength through connections to others. That's really how we define the key aspects of what patients do to advocate for themselves." Timestamp (TS) 04:39
"At the end of the day, if a patient doesn't feel like the care really is attuned to what is going on in their life and they don't feel like they're understood or appreciated, or their self-worth isn't identified by their care team, then are we really patient-centered?" TS 06:32
"Really, patient self-advocacy is about making sure that your clinical care team knows what's most important to you, even if the clinician doesn't ask you, 'What is it like at home?' or 'Tell me about your family,' or 'Tell me about what you're looking forward to getting back to after treatment.' Put that into the conversation where they understand exactly what your quality of life means to you and they understand what your main goals of treatment are." TS 12:33
"When patients don't have that voice to speak up, ask questions, and push a little bit if they don't understand what's happening, their care, adherence, health, and quality of life suffer because they don't know enough to be engaged enough to ask for help." TS 19:53
"We're interested in patients' quality of life, and we see that their emotional, social, physical, religious, and spiritual quality of life just goes down because they're not themselves and they don't quite know how to get back to themselves. And that's the saddest part to see—them going through the physical rigor of going through cancer treatment is one thing, but feeling like you're not yourself—we've had several people call it self-worth, the idea that I'm worth fighting for and I'm worth standing up to my providers and insisting that my pain finally gets a treatment that works." TS 21:27
"Patient self-advocacy really centers around communication, and the informed decision making comes part and parcel with that because that's the getting the information and gathering the resources to help communicate those ideas to your providers or whomever. And the connected strength also is about communication, too, since frequently family dynamics also require really good communication skills. So, if there was one thing that we would really want to train our patients in in terms of self-advocacy, it's that effective communication aspect." TS 31:42
"We know that cancer puts people at a disadvantage and makes them feel different from who they are. And what we're trying to do is get them to feel like who they are is the same person they were, maybe slightly different from, who they were before cancer and that their cancer team and their loved ones know and support them for who they are." TS 57:47
"Once patients come out on the other side, nursing care involves understanding how to triage their disease: If they call you with concerns, how would you address those concerns? How would you find out if there's something going on? Just given how acute the onset is, a lot of these patients have some post-traumatic stress disorder, so there's a lot of worried-well conversations, and in outpatients you need to figure out how to coordinate future care given their history of thrombotic thrombocytopenia purpura (TTP)," ONS member Amanda Weatherford, MSN, RN, OCN®, clinical nurse coordinator at Fred Hutchinson Cancer Center in Seattle, WA, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS in a conversation about nursing considerations to manage TTP. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by November 18, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Upon completion of this activity, participants will report an increase in knowledge of thrombotic thrombocytopenia purpura.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"Immune or acquired thrombotic thrombocytopenia purpura (TTP) is the most common. It's 95% of all the cases. It is what we as nurses are most likely to encounter in our practice." Timestamp (TS) 03:29
"TTP can show up in cancer and also as the result of chemotherapy and medications. They say it's either a system of malignancy or a consequence of treatment, and it has also shown up in patients who are post allogenic stem cell transplants." TS 07:05
"Once you suspect that TTP is into play, you would immediately start the patient on plasma exchange or plasma pheresis, daily or twice daily, and also on high-dose steroids. You do that until you start to see improvement in platelet counts and some of the other hemolysis markers, like LDH." TS 11:26
"Once patients come out on the other side, nursing care involves understanding how to triage their disease: If they call you with concerns, how would you address those concerns? How would you find out if there's something going on? Just given how acute the onset is, a lot of these patients have some post-traumatic stress disorder, so there's a lot of worried-well conversations, and in outpatients you need to figure out how to coordinate future care given their history of TTP." TS 14:58
"In patients with cancer, TTP is either a symptom of disease or caused by the treatment. So, you could potentially just have a new patient with cancer and, along with this major, acute crisis that they've had, so dealing with a cancer diagnosis and having had TTP. Or trying to figure out if it was medication. How do we resolve that? Are we able to find a different drug and switch to a different regiment, or do we continue to give it because it's the only therapy? And do we have to continue to be on the lookout for relapse?" TS 17:47
"Participating in formal academic degree programs, obtaining contact hours for renewing your certification, peer-to-peer sharing with colleagues—they're all types of education that you can use to be the best version of the oncology nurse that you want to be for our patients," Danya Garner, PhD, RN, OCN®, CCRN-K, NPD-BC, ONS director-at-large from 2021–2024 and associate director of continuing professional education at the University of Texas MD Anderson Cancer Center in Houston, TX, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS, during a conversation about how nurses can stay current in the evolving landscape of oncology. Garner presented on the topic during the 2022 ONS Bridge™ virtual conference in September 2022. You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.5 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by November 11, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"With the availability of many virtual conference opportunities and several conferences offering in-person options, the past adage of divide and conquer has really been reinvigorated. I use the acronym ACE: A for attend the event, C for categorize the content, and E for explain to colleagues. There is so much great work that oncology nurses are doing across the nation that should be disseminated. Aside from attending formal education events, oncology nurses can also involve themselves in opportunities for formal and informal mentorship opportunities at their work locations. . . . Peer-to-peer training and dissemination is a wonderful opportunity to continue the conversation and disseminate those practices." Timestamp (TS) 06:26
"Just-in-time training is really applicable for those refreshers. And considering the constant changes that have taken place and are continuing to take place, when you know about the content that you need for practice but just need a few quick reminders that are easily accessible, that's the perfect place for just-in-time training to occur." TS 11:51
"Certification is not necessarily a formal education, but in that preparation of expanding that particular content knowledge in a field, such as your OCN® examination, your bone marrow transplant certification—those really increase that scope of content and add to what knowledge you have to take care of these patients and ultimately improve the outcome of care that we provide to oncology patients." TS 14:46
"Participating in formal academic degrees, renewing your certification, obtaining contact hours for certification, peer-to-peer sharing with colleagues—they're all types of modalities of education that you can utilize to be the best version of the oncology nurse that you want to be for our patients." TS 18:23
"For those without cancer or other illnesses, we often have a resolution or relief of this fatigue. 'Oh, I'm just going to go to bed early and get a couple more hours of sleep tonight.' Or 'I'm going to have a cup of coffee.' But for people with cancer, it's not an easy fix. People with cancer describe fatigue as something much more long-lasting," ONS member Paula Anastasia, MN, RN, AOCN®, clinical nurse specialist for UCLA Health in Los Angeles, CA, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Anastasia discussed fatigue in patients with cancer undergoing PARP inhibitor maintenance therapy, management strategies, and nursing considerations. This podcast episode is supported by a sponsorship from AstraZeneca. ONS is solely responsible for the criteria, objectives, content, quality, and scientific integrity of its programs and publications.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"Fatigue is not necessarily life threatening, so I think unfortunately, it's underplayed at how disruptive it can be in somebody's quality of life and day-to-day life." Timestamp (TS) 03:10
"For those without cancer or other illnesses, we often have a resolution or relief of this fatigue. 'Oh, I'm just going to go to bed early and get a couple more hours of sleep tonight.' Or 'I'm going to have a cup of coffee.' But for people with cancer, it's not an easy fix. . . . People with cancer describe fatigue as something much more long lasting." TS 04:02
"I think it's really important when we educate our patients to let them know that this is a common side effect. Research tells us, and also patient experience, that fatigue does plateau after about four to eight weeks. It's not zero, but it gets much more manageable for our patients. So, I think priming our patients with what to expect can be very helpful." TS 07:48
"I want patients to have some sort of physical activity. It doesn't have to be hours or marathons. Just a 10-minute walk in the morning and then maybe a 10-minute walk in the afternoon. Things like that. We try to, if possible, refer patients to a physical therapy-type setting initially, and that will help give them tools on how to be active and safe activities, and also gets them motivated. So, that's really helpful for patients." TS 09:41
"I think it's important to assess the cause of the fatigue. Ruling out anemia, hypothyroidism, vitamin deficiencies, things like that. So, that is ruled out and we know what we're doing to our poor patient with the interventions; they've had surgery, they've had chemotherapy, now we're going to put them on a PARP inhibitor, all of these lifestyle changes." TS 12:20
"I think since COVID-19, there's a lot more awareness of how much people have anxiety and depression. I think we're more in tune with that and how stressful life is, and that's not even having cancer and all of the challenges with that. So, I think that plays into it. Depression and anxiety can contribute to fatigue." TS 16:53
"One of the biggest misconceptions about fatigue is that there's nothing that you can do about it. Just accept it. And I totally disagree with that. It's an undervalued side effect. It's not necessarily life threatening, but it's definitely something that can interfere with patients' day-to-day quality of life. So, we really need to address it. We need to assess, communicate, and plan for it." TS 28:39
"Work culture is really how people work together. But in my opinion, there are three major components: it's the employer, it's the leadership, and it's the staff—all staff, we're not only talking nurses. We know that it takes a village to really make clinical care happen. All three of those components are critical in creating a healthy work environment. The staff component, including the clinical nurses, is key to that," Linda Laskowski-Jones, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN, editor-in-chief of Nursing 2022: The Peer-Reviewed Journal of Clinical Excellence, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Laskowski-Jones led a panel discussion on the topic at the ONS Bridge™ virtual conference in September 2022. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
Earn 0.75 contact hours of nursing continuing professional development (NCPD) by listening to the full recording and completing an evaluation at myoutcomes.ons.org by October 28, 2024. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"Work culture is really how people work together. But in my opinion, there are three major components: it's the employer, it's the leadership, and it's the staff—all staff, we're not only talking nurses. We know that it takes a village to really make clinical care happen. All three of those components are critical in creating a healthy work environment. The staff component, including the clinical nurses, is key to that. When you look at how the nurses work together and the environment that they are working in, their teamwork, camaraderie, and connections to each other can actually help those staff make it through when perhaps there may be some challenges with employers or leaders as they work through whatever changes they need to make." Timestamp (TS) 04:12
"It's important to recognize that when you motivate and influence people, whether it's positively or negatively, you're behaving as a leader. There may be people who have some personal need to feel like they can be the judge of others and that they have a very tight group, and unless you're looked at favorably by that group, then you don't have value. So, in this particular type of case, you can have a nursing leader show all the value in the world to that staff, but if you have these cliques where people come in and they feel like, 'Oh my gosh, I'm working with so-and-so on this particular shift.' Or 'I've been assigned to this shift permanently. How will I survive?,' that is a big driver of turnover." TS 10:40
"Watching someone working with a family or a patient, and when the person comes out when they least expect it, saying something like, 'That was really an amazing interaction, and a very tough situation, and you handled that beautifully.' That can go a long way, and it's all part of value and recognition. . . . Let's show value where value needs to be shown." TS 21:24
"That value is a 360-degree type of value where really everyone that you're working with in the physician-nurse relationship is critical. Recognizing the role that nurses play and looking at the nurses as colleagues is absolutely critical." TS 22:56
"Right now, in many places still across the country, nurses feel that they don't have the tools they need to do their job. That of course leads to this negative culture where nurses are very upset, they're coming in extremely unhappy, and they're communicating that unhappiness to everybody, and they have very real concerns. And management has taken different approaches to that, in health or not health as the case may be, and now we have to focus on: How do we fix it? And I think those are the factors that led to where we are. We have a lot of work to do, but at the same time, organizations have to also make fundamental changes." TS 26:45
"Ultimately, I don't think people on the front line realize how much power they actually have. And the power is in creating effective working relationships, and that includes the nurse-patient interaction, but it also includes working with people." TS 39:15
"A lot of healthcare workers that I talk to say that they are kind of brought up with the culture that violence is part of the job. It's not your job to take abuse," Chris Snyder, University of Utah Health security manager for the University of Utah Department of Public Safety in Salt Lake City, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS. Snyder gave an overview of violence in health care, educational resources for de-escalation strategies, and violence prevention tips. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"If I have a patient who maybe comes in two or three times a month for an appointment, or maybe they're inpatient, I do want to focus on their baseline behavior. Because any deviation from that gives me the opportunity to practice situational awareness and know that something is happening." Timestamp (TS) 07:36
"The number-one rule is you have to give your undivided attention. All too often we are multitasking and doing different things, and we're in a hurry, or it's the end of our shift, or we're working overtime. But when you just stop and drop everything and give that undivided attention and show that individual that you're there to support them and that you're listening to them and that you're there to help them, it makes a huge difference in setting the path for the rest of their journey." TS 12:45
"Another reason why we don't see things reported is because a lot of our employees feel like, 'Hey, it has to be an actual physical act of violence for me to report it. Someone has to actually hit me or grab me or throw something at me.' But workplace violence is defined by the Occupational Safety and Health Administration and other groups as all forms that include verbal aggression, verbal abuse, name calling, intimidation, workplace bullying, sexual harassment, sexual inuendo, in addition to those physical acts of violence." TS 13:22
"Taking the time to ask questions, explain procedures, even talk about wait times—and in the meantime, tending to a physiological need. . . . Anything like that is a huge step in keeping that person closer to their baseline behavior." TS 18:50
"We need to trust our intuition because if something doesn't feel right, it most likely isn't right. Sometimes our mind does not connect the dots there, but if the hair on the back of your neck stands up, listen to that." TS 24:03
"[Another important factor is] training and education. You need some kind of training on de-escalation and it dovetails with personal safety. And the reason I say that is because when we talk about personal safety, we talk a lot about how we communicate, and a big piece of that is nonverbal communication. So, safety, communication, de-escalation, all of those things are important." TS 29:48
"Know before you go. Have you reviewed a patient's chart? Is there a history? Say we have disruptive behavior—maybe we have a patient who is sexually inappropriate with female staff members. Do all staff members know? Is there a plan in place? . . . Check that patient's chart information. Are there behavioral indicators that we're concerned about or any red flags that we want to be aware of?" TS 31:07
"One major rule of de-escalation is that you cannot control somebody else's behavior. It's not possible. We can only control our own behavior. And by mastering that, we can influence another person's behavior. And hopefully, if they're at the top of that roller coaster, we're not riding up to meet them. We're staying down at the bottom. We want them to come down and meet us because that's when we're going to actually communicate and have a conversation. . . . And also know what our own boundaries are. We're human beings. I could be the best at de-escalation and always maintain my composure, but I have a tipping point as well." TS 32:42
"Another thing that we don't often discuss is the importance of debriefing. We talk about, 'Let's debrief as a team,' what went right, what went wrong, what were the triggers, what happened, is everybody okay? That includes physical injury and emotional injury, as well. But we are in the habit of only debriefing bad things. How about we debrief a good thing every once in a while?" TS 37:30
"Oftentimes, local policy changes are the ones that are going to influence your day-to-day practice most directly—and are the ones where your voice has the most power because you're closer to the decision makers. There are so many ways for nurses to become involved in advocacy, and it can be simple things just like voting or being knowledgeable on the issues," Erica Fischer-Cartlidge, DNP, RN, AOCNS®, EBP-C, chief clinical officer at ONS, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS. Fischer-Cartlidge explained how she discovered advocacy and encouraged oncology nurses to get involved at multiple levels and speak out for their colleagues and patients. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"We think of advocacy and policy, and our minds automatically go to the national level in Washington, DC. But advocacy at the local level, even within a local organization or regionally at the state level, are just as important, if not more sometimes. There are so many ways for nurses to become involved, and it can be simple things just like voting or being knowledgeable on the issues. And then even bigger like supporting a candidate or communicating with legislators." Timestamp (TS) 03:18
"Oftentimes, local policy changes are the ones that are going to influence your day to day most directly. And the ones where your voice has the most power because you're closer to the decision makers. For example, if your hospital was proposing policies around mandatory overtime or floating throughout the hospital, you would really be impacted by those decisions. But chances are, people who are making the decisions are also those you are interacting with on a routine basis. . . . So being involved and sharing your knowledge and experience with decision makers can really influence the outcome." TS 03:58
"Policy I see as a responsibility to my patients and colleagues now. . . . Politics, which is largely about the process of how things get done, is different from the policy, which is the principles we have to guide what we do. I may not like the process of how something gets done, but that doesn't mean I can turn away from the decisions that are made through the process, because they are going to be the standards that govern my day to day. Whatever side of the aisle you fall on, ultimately, we want to do what's best for the patients and the profession. That's what the policy is all about." TS 07:05
"Awareness I think is the biggest thing that nurses need. Take time to read what issues are up for discussion and the implications of them, sign up for newsletters related to healthcare advocacy so you're routinely informed, think about what you would want the people who are making the decisions on the issues to know. These are small steps that can really be the foundation." TS 14:26
"Consider your patient's diagnosis. What kind of cancer do they have? And ask yourself, 'Could this patient be in disseminated intravascular coagulation (DIC)? Is there something more that we should be doing or looking at?'" Leslie Smith, RN, APRN-CNS, DNP, BMTCN®, AOCNS®, oncology clinical specialist at the National Institutes of Health in Bethesda, MD, told Jaime Weimer, MSN, RN, AGCNS-BC, AOCNS®, oncology clinical specialist at ONS. Smith discussed the nursing considerations for the management of DIC. This episode is part of a series about oncologic emergencies; the others are linked in the episode notes. You can earn free NCPD contact hours after listening to this episode by completing the evaluation linked below.
Music Credit: "Fireflies and Stardust" by Kevin MacLeod
Licensed under Creative Commons by Attribution 3.0
The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.
Episode Notes
To discuss the information in this episode with other oncology nurses, visit the ONS Communities.
To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.
Highlights From Today's Episode
"If the D-dimer is high, that is indicative of a clotting issue occurring. So, the next step for the nurse would be to look for the lab or ask for an order—you can order a DIC panel in some institutions—but look at coagulation labs. And really care and support these patients. DIC is not a disease in itself; it is a symptom of a disease, it is a syndrome. And it's indicative of another problem occurring." Timestamp (TS) 07:09
"In the chronic form, patients who live in a chronic inflammatory state—maybe from arthritis or whatever the process is—their coagulopathy will not be as severe as an acute form. They may have an elevated prothrombin time (PT) or partial thromboplastin time (PTT). Their platelets may be a little bit low and their fibrinogen may be just a little bit low, but it's not life-threatening. And in an acute stage of DIC, it is life-threatening." TS 08:43
"If we are taking care of patients who have received CAR T cells, for example, nurses know to monitor for cytokine release syndrome, we're watching for fever, we're watching the C-reactive protein levels or the ferritin levels, and we're treating appropriately via tocilizumabs . . . preventing DIC that way. Patients who are at risk for developing sepsis. . . . watching for signs of impeding infection . . . . Those types of things can prevent DIC from occurring." TS 12:26
"I think it can be a little bit confusing for the nurse because they're vague symptoms. So, if you have a patient that is maybe thrombocytopenic, you could attribute, 'Well, they have all this petechiae from their thrombocytopenia.' It's difficult. That's why you need to really draw a lab. . . . It is not just one lab or one sign or symptom that will diagnosis DIC. There's no one thing that tells you that the patient has DIC. You need to look at all the lab work to make that determination." TS 14:15
"Nurses are going to support the patient with transfusions. . . . And this will help in an attempt to normalize the lab or at least get the factors and the platelets back up. And then treating the disease. . . . And then in addition, if the patient is infected or septic, administering the antibiotics." TS 16:26
"DIC is often thought—especially by patients or family—that once you start that chemotherapy or the antibiotics, that the DIC will go away. That is not true. It can take days to weeks for the DIC to resolve itself. It's not something that is going to happen overnight. The patient will need to continue to be supported." TS 18:13
"Consider what is the diagnosis of your patient. If they have cancer, what kind of cancer do they have? And ask the question to yourself, 'Could this patient be in DIC? Is there something more that we should be doing or looking at?'" TS 19:22