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    Health

    The ONS Podcast

    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

    Advertise

    Copyright: © Copyright 2017

    • Apple Podcasts
    • Google Play
    • Spotify

    Latest Episodes:
    Episode 227: Biomarker Testing, PARP Inhibitors, and Oral Adherence During Ovarian Cancer Maintenance Therapy Sep 30, 2022
    Show notes

    "We found that nurses still needed clarity of terminology and the rationale for germline, somatic, and homologous recombination deficiency testing," 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 the findings of a July 2022 ONS focus group that she facilitated on PARP inhibitor therapy, biomarker testing and terminology, and oral medication adherence for patients with ovarian cancer. 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

    • NCPD contact hours are not available for this episode.
    • Clinical Update: PARP Inhibitors
    • Survey: 2022 Member Feedback on Ovarian Cancer Treatment Focus Group Outcomes
    • ONS Biomarker Database
    • ONS Genomics and Precision Oncology Learning Library
    • ONS Guidelines™ to Support Patient Adherence to Oral Anticancer Medications
    • Oncology Nursing Podcast episodes:
      • Episode 215: Navigate Updates in Oral Adherence to Cancer Therapies
    • ONS Voice articles:
      • Oncology Nurses' Role in Translating Biomarker Testing Results
      • Maintain Oral Adherence With ONS Guidelines™
      • Help Patients Understand Biomarker Test Results and Clinical Trials Options
      • Genetic Counselors Help Patients and Providers Understand Biomarker Testing Goals and Results
      • Nursing Considerations for Ovarian Cancer Survivorship Care
      • An Oncology Nurse's Primer on Genomics and Biomarker Terminology
      • Ovarian Cancer: Prevention, Screening, Treatment, and Survivorship Recommendations
    • Clinical Journal of Oncology Nursing article: Shifting to a Biomarker Paradigm Across Cancer Care
    • ONS video: Cancer Treatment Therapies Overview
    • Oral Chemo Patient Education Sheets
    • National Society of Genetic Counselors

    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 found in this focus group that nurses still needed clarity of terminology and the rationale for germline and somatic/homologous recombination deficiency (HRD) testing. They all shared that those who worked in the infusion center in general medical oncology offices as opposed to the specific gynecologic clinics, that they weren't as familiar with somatic and HRD terminology as you would suspect." Timestamp (TS) 06:31

    "As cancer care is evolving and patients are living longer and better, I think it's we nurses who are actually the ones that are doing these behind the scenes. The most common barriers that were consistently discussed across the board were cost and insurance approvals. . . . Other issues were access to the results. Results are not always being uploaded into the patient's medical record." TS 09:51

    "The nurses discussed wanting more knowledge of the mechanism of action with PARP inhibitors and how that alteration benefits patients with germline or somatic mutations. And most nurses did agree that their patients were offered germline testing at the time of diagnosis, but they were unclear as to when somatic or HRD testing was being done. . . . It was very inconsistent, so not all nurses knew where to find these results or to even know if it was done." TS 16:54

    "Education was key, and the nurses all agreed that it was important to identify who the appropriate patient would be that would most likely receive a clinical benefit, and who also would be following through or maintaining oral adherence. It was recommended to reinforce the side effects with the patients. . . . It was determined that patients should be informed that the goal of treatment of maintenance therapy was to prevent or decrease risk of recurrence." TS 18:17

    "It was recommended to assess patient adherence by asking open-ended questions. . . . The nurses agreed that the most common question to ask a patient would be: 'How many doses did you miss this week? Or this month?' Recognizing that people miss doses, and it's not necessarily intentional, but it does happen, so we are validating and giving them permission to be honest with us." TS 21:26

    "I think having tools or resources—quick handouts—that they can give their patients that's like an easy guide, and they can review it with the patient, but the patient if they have questions can follow up. I think it's important to find out the patient's needs and how they learn best, on a video or paper, that sort of thing. . . . But the nurses also wanted quick-references guides, just an overview of what the indication is, what needs to be done prior to ordering this, and the mechanism of action." TS 30:32


    Episode 226: Patient Education for Next-Generation Sequencing to Guide Cancer Therapy Sep 23, 2022
    Show notes

    "Nurses can bridge the information gap and help patients better understand that the information received from next-generation sequencing (NGS) can really help to determine which treatment they will respond best to, if there are therapies that won't be effective, or if there are clinical trials that are open to them based on the results," Danielle Fournier, RN, MSN, APRN, AGPCNP-BC, AOCNP®, CORLN, advanced practice RN in the department of thoracic surgery at MD Anderson Cancer Center in Houston, TX, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Fournier discussed the advancements being made in NGS technology and how it can be used to care for patients with cancer. This episode was produced by ONS and sponsored by Foundation Medicine.

    Music Credit: "Fireflies and Stardust" by Kevin MacLeod

    Licensed under Creative Commons by Attribution 3.0

    Episode Notes

    • NCPD contact hours are not available for this episode.
    • ONS Next-Generation Sequencing Toolkit, Sample Report, and Discussion Tool
    • ONS Biomarker Database
    • Oncology Nursing Podcast episodes:
      • Episode 169: How Biomarker Testing Drives the Use of Targeted Therapies
      • Episode 172: Address Knowledge Gaps in Evidence-Based Precision Medicine Care
      • Episode 180: Learn How Nurse Practitioners Use Biomarker Testing in Cancer Care
    • ONS Voice articles:
      • Oncology Nurses' Role in Translating Biomarker Testing Results
      • Advocate for Equal Access for Next Generation Sequencing and Clinical Trials
      • Help Patients Understand Genomic Variants of Unknown Significance
      • How DNA Sequencing Technologies Are Used in Cancer Care, Now and in the Future
    • ONS clinical practice resources:
      • Biomarker Testing Quick Guide
      • Biomarker Testing for Genomics Variants: What to Know From the Laboratory Performing the Test
      • Paired Somatic and Germline Testing Resource
      • The Oncology Nurse's Role in Somatic Biomarker Testing
      • Biomarker Testing Nursing Process
      • Understanding Genetic Variants Discussion Tool
    • ONS Genomics Taxonomy
    • ONS Genomics and Precision Oncology Learning Library
    • International Society of Nurses in Genetics
      • Position statement on informed consent
    • National Comprehensive Cancer Network Guidelines
    • National Comprehensive Cancer Network Biomarkers Compendium
    • Information on Sanger sequencing
    • Information on the Genetic Information Nondiscrimination Act
    • Video series: Seq It Out

    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 next-generation sequencing (NGS), multiple biomarkers can be evaluated using one test. So, in cancer care, we're learning that any given tumor may harbor a variety of variants. So, if we're considering using in situ hybridization (ISH) or fluorescence in situ hybridization (FISH) to identify biomarkers, multiple assays may be needed and may need to be performed in order to test for multiple variants." Timestamp (TS) 10:21

    "There are multiple testing strategies that can be used with NGS technology, which is kind of what makes it so versatile. What type of testing is most appropriate really depends on the patient's risk factors, their diagnosis, their cancer stage, what testing has previously been completed, and what tissue is available for analysis." TS 12:00

    "Within oncology care, there is a role for NGS in the identification and management of both solid tumors and hematologic cancers, and this role is likely just going to continue to expand. So, really there's been an increased focus on genomic pharmacotherapy and targeted therapy, and this is playing an ever-greater role in the treatment of cancer. So, NGS will really continue to serve as a means to take a closer look at a patient's cancer at the molecular level and hopefully match patients with treatments that will be most effective at treating their cancer." TS 20:54

    "In reality, there's an expanding role for NGS testing in the diagnosis of many complex diseases. So, I think more than likely what we're going to see is that the indications and utility of NGS is only going to continue to grow in both the oncology setting as well as the non-oncology setting." TS 23:08

    "The oncology nurse really plays a key role in several important steps along the way. The first place they may be involved is in the informed consent process. Many—but not all—hospitals require patients to sign consent for genetic and genomic testing and this is just acknowledging that the patient is making an informed and autonomous decision related to their health care. Nurses may also play a role in the collection of a tissue sample or blood sample. And once testing has been completed, nurses may play a role in discussing the NGS results with patients." TS 24:03

    "Nurses really can help to somewhat bridge this information gap and help patients better understand that the information received from NGS can really help to determine which treatment they will respond best to, if there are therapies that won't be effective, or if there are clinical trials that are open to them based on the results. And these are all really important considerations for cancer treatment." TS 36:21


    Episode 225: Central Line Dressing Changes: Get It Right the First Time Sep 16, 2022
    Show notes

    "Really knowing these steps can save our own nursing time and save our patient's skin from all the dressing removals. If we're not doing these dressings as much, we're all going to be happier," MiKaela Olsen, DNP, APRN-CNS, AOCNS®, FAAN, clinical program director in oncology at the Johns Hopkins Hospital and Johns Hopkins Health System in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a discussion on the importance of properly changing central line dressings and recommendations in practice. 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 nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

    Episode Notes

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • Oncology Nursing Podcast episodes:
      • Episode 162: What Nurses Need to Know About Central Lines and Ports
      • Episode 218: Central Venous Catheters: Heparin Harms and Recommendations for Flushing
    • ONS Voice articles:
      • In the Absence of Standard Guidelines, Here Are the Recommendations and Best Practices for Vascular Access Devices
      • Use Evidence-Based Strategies for Managing Central Venous Catheters
    • Clinical Journal of Oncology Nursing articles:
      • Central Line Care: Reducing Central Line–Associated Bloodstream Infections on a Hematologic Malignancy and Stem Cell Transplant Unit
      • Central Line Care: Empowering Patients to Prevent Infection and Injury Via EPIC2
      • Central Line–Associated Bloodstream Infection Prevention: Standardizing Practice Focused on Evidence-Based Guidelines
    • ONS book: Access Device Standards of Practice for Oncology Nursing
    • ONS courses:
      • Complications of Vascular Access Devices and IV Therapy
      • Vascular Access Devices
    • ONS videos:
      • Standard of Practice for Cleansing Access Sites
      • Standard of Practice for Topical Anesthetics Prior to Insertion of a Peripheral IV
    • American Journal of Infection Control article: Implementing a Program to Standardize Central Line Maintenance
    • Critical Care article: Ultrasound-Guided Central Venous Catheter Placement: A Structured Review and Recommendations for Clinical Practice
    • Critical Care Medicine article: Dressing Disruption Is a Major Risk Factor for Catheter-Related Infections
    • Association for Vascular Access

    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

    "One of the most important points at which a line can become infected is at the insertion site. So that central line dressing is of the utmost importance. We cannot ignore it and we have to inspect it frequently and teach our patients to do the same so that they don't have an infection caused by bacteria getting into that insertion site." Timestamp (TS) 04:28

    "If we don't get the dressing right and we don't do a good job with it, it's not going to be clean, dry, and intact. It's going to come off too soon. We really want our transparent, highly moisture-permeable dressings that we put over our central line catheters to stay on and meet the guidelines to stay on for seven days, and then we need to do a dressing change. If they come off sooner and you're having to change them more frequently, then that can increase the risk of central line–associated bloodstream infections." TS 12:07

    "It's really important that when you are doing these dressings, you have a very simple procedure in place to validate skill for the staff, and they do the same steps every time. But it's very important that they do all the steps and that they always make sure that they have good dry time in between every step." TS 13:10

    "Bleeding is definitely a challenge, and sometimes it's related to the way the line was inserted, if they used a cutting mechanism at the site instead of using a dilation. Sometimes the root of the problem can be that you have to go back to the people who inserted the catheters and tell them about the downstream effects and tell them some of the techniques." TS 20:05

    "If you stack dressings on top of your transparent dressing, it can no longer breathe. And now, it is going to trap moisture under there and cause infection. How you apply each of these chemicals, the dry time—there is definitely a science behind doing a dressing change. So really knowing these steps can save our own nursing time and save our patient's skin from all the dressing removals. If we're not doing these dressings as much, we're all going to be happier." TS 29:37


    Episode 224: Meet the ONS Board of Directors: Nevidjon, Geddie, and Garner Sep 09, 2022
    Show notes

    What is it like to guide a professional association that serves more than 100,000 oncology nurses? ONS Chief Executive Officer Brenda Nevidjon, MSN, RN, FAAN, and Directors-at-Large Patricia (Patty) Geddie, PhD, APRN, AOCNS®, FCNS, and Danya Garner, PhD, RN, NPD-BC, OCN®, CCRN-K, reflect on their experiences with ONS, how a diverse Board supports a diverse membership, and how you can get involved in ONS leadership.

    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

    Check out these resources from today's episode:

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • ONS Leadership Process
    • ONS DEI Commitment Statement
    • Oncology Nursing Podcast episodes:
      • Episode 200: Meet the ONS Board of Directors: Houlihan, Ferguson, and Polovich
      • Episode 213: Meet the ONS Board of Directors: Brant, Burger, and Knoop
    • ONS Voice articles:
      • Find Your Voice With ONS's Leadership Development Committee
      • New Selection Process Supports Diversity on the ONS Board of Directors
      • Nursing Leadership Has Space for You and Your Goals
      • Boards and Committees Need Oncology APRN Voices. Will You Step Up to the Challenge?
      • Nursing Representation Is Critical in All Industries—Even Those Outside of Health Care
    • ONS Leadership Learning Library
    • ONS Strategic Plan
    • Find an ONS chapter near you.

    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

    Garner: "Obtaining a PhD in nursing has always been a goal since I entered my initial program, because I've had the goal to always teach and give back to nurses. I am the first person in my family to obtain a PhD and was encouraged by my family to acquire more education. They didn't necessarily say, 'You need to get a PhD,' but rather, 'Get the education you need to fulfill your life goals,' and I've really seeded that throughout my lifetime." Timestamp (TS) 06:30

    Geddie: "Sometimes it is difficult to receive honest feedback, but it is much appreciated. . . . When honest feedback is given from a sincere and authentic perspective, you grow and develop so much from it." TS 09:42

    Nevidjon: "As board members, you also give feedback to one another. That is part of the board experience. When a new board member comes on, there is a 'board buddy' who is assigned, and then there are check-ins in terms of how things are going, what kinds of experiences [there are]. We embrace that in terms of the board experience." TS 10:03

    Garner: "Mentorship is a great opportunity for growth and self-reflection. I believe that mentorship is a continual journey. There is so much to learn from others as well as impart what you have learned to others." TS 10:53

    Nevidjon: "The path to a national board isn't necessarily just within that organization itself, but the total kind of experiences that you bring." TS 14:07

    Geddie: "When I began my oncology nursing career, I could always identify gaps where improvement was needed to enhance the daily practice of nurses in the acute care setting. I could not make a difference to improve practice while providing direct care every day, so I decided to pursue a master's degree for the clinical nurse specialist. And this role allowed me not only to stay close to clinical practice but to also drive improvements in the healthcare system in which we worked." TS 18:14


    Episode 223: Oncologic Emergencies 101: Superior Vena Cava Syndrome Sep 02, 2022
    Show notes

    "I think that we as nurses need to advocate when a patient is uncomfortable. And it's not your classic 'pain in my hip' kind of thing. This is a more subtle, 'I can't breathe, I have a sense of impending doom, I'm panicked, I want someone beside me.' It may sometimes appear to be a psychosocial coping issue when it really is a physiologic one," ONS member Brenda Shelton, DNP, RN, AOCN®, clinical nurse specialist at Johns Hopkins Medicine in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Shelton discussed the warning signs of superior vena cava syndrome and nursing considerations for its management. 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

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • Other Oncology Nursing Podcast episodes on oncologic emergencies
    • Clinical Journal of Oncology Nursing articles:
      • STAT: Superior Vena Cava Syndrome
      • Superior Vena Cava Syndrome: An Education Sheet for Patients
    • ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition)
    • ONS courses:
      • Oncologic Emergencies
      • Treatment and Symptom Management—Oncology RN
      • Essentials in Oncologic Emergencies for the Advanced Practice Provider
    • ONS Huddle Cards™
    • Information from the National Cancer Institute
    • Information from Cancer.net
    • National Comprehensive Cancer Network Guidelines
    • American Cancer Society

    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

    "Superior vena cava syndrome was first recognized with tuberculosis, and now it's almost exclusively going to occur in patients with cancer because it's physiologically the outcome of too much mass in between the sternum and the spine." Timestamp (TS) 01:57

    "You might see some very subtle right arm heaviness, edema; you might see a prominent right antecubital, or prominent veins on the hand of the right arm, or a prominent right jugular vein. But these are all things that can be subtle, and the patient may present with aching of the arm, numbness or tingling of that arm, just really things that don't necessarily raise your awareness because it's not the classic signs or symptoms you see in your textbooks." TS 05:35

    "When we think of superior vena cava syndrome, we associate it with upper body edema, particularly worse in the morning when somebody rises after having laid flat for all night. . . . But the thing that patients report the most is dyspnea. It is not necessarily entirely due to respiratory problems. In this case, it's due to compression of the vena cava and an alteration of the blood returned to the heart that leads to an altered cardiac output." TS 06:45

    "The three biggest life-threatening complications I think about are airway incompetence, cardiovascular collapse, and clotting. As you compress the vena cava, you are going to diminish the blood return into the heart, and this is going to compromise your ability to oxygenate that blood and put it back out the other side." TS 08:46

    "We always start with a total body assessment, and it's hard because this patient is going to present with potentially neurologic symptoms, cardiac and respiratory symptoms, as well as just generalized discomfort and constitutional symptoms. You know, we're so focused sometimes on febrile neutropenia and the very classic complications, that this one is a little more subtle. And so the nurse needs to be very comfortable with their cardiovascular assessment in general and be looking at vessels and be looking at jugular venous distention and pulsations." TS 15:32

    "I think that we as nurses need to advocate when a patient is uncomfortable. And it's not your classic 'pain in my hip' kind of thing. This is a more subtle, 'I can't breathe, I have a sense of impending doom, I'm panicked, I want someone beside me.' It may sometimes appear to be a psychosocial coping issue when it really is a physiologic one." TS 17:16

    "We often think of this as something that is a sign of terrible, bad, irreversible disease, when in fact, it could be the presenting symptoms." TS 19:32


    Episode 222: Ethical and Moral Dilemmas of Futility in Cancer Care and Treatment Aug 26, 2022
    Show notes

    "Let's take time, invest time, in learning more about futility. Let's invest some time in learning more about how to understand our patient's goals, their family's goals, what their values are," Kathleen Turner, BSN, RN, CHPN, CCRN-CMC, clinical nurse in the medical-surgical intensive care unit at the University of California, San Francisco, Medical Center, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a discussion on a nurse's approach to futility in cancer care and treatment. 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

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • Oncology Nursing Podcast:
      • Episode 78: Ethical Distress Impacts Nursing Practice
      • Episode 135: ELNEC Has Trained More Than One Million Nurses in End-of-Life Care
    • ONS Voice articles:
      • It Takes a Team to Confront Moral Distress
      • Palliative Care Resources Comfort Nurses Through COVID-19 Stress, Dilemmas, and Grief
      • Articles about ethics and communications
    • Clinical Journal of Oncology Nursing articles:
      • When Does Treatment in Cancer Care Become Futile?
      • How Does an Oncology Nurse Increase Moral Resilience During a Pandemic?
      • Moral Distress: A Qualitative Study of Experiences Among Oncology Team Members
      • Moral Distress: Identification Among Inpatient Oncology Nurses in an Academic Health System
    • Oncology Nursing Forum article: Coping With Moral Distress in Oncology Practice: Nurse and Physician Strategies
    • Journal of Nursing Education and Practice article: R.A.C.E. for Nurses: Cultivating Compassion in Nurse/Patient Interactions
    • AACN Advanced Critical Care article: Ethical Discernment and Action: The Art of Pause
    • JAMA article: Conflicts Regarding Decisions to Limit Treatment: A Differential Diagnosis
    • Podcast: Decompress by Anthony Back
    • Resources on Being Mortal:
      • Book by Atul Gawande
      • FRONTLINE documentary
    • VitalTalk resources and IMPACT-ICU toolkit
    • American Association of Colleges of Nursing: End-of-Life Nursing Education Consortium project

    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

    "Medical futility has traditionally been framed as care that can't achieve its stated purpose. For instance, treating myocardial infarction with an antibiotic. There's no way that that medicine is going to fix somebody's heart attack. Often, though, I think it is something that we tend to invoke in our own practice when we feel like the care that we're providing may not be able to achieve our goal for the patient—and I mean our personal goal as opposed to a clinical goal. And from there, moral distress arises." Timestamp (TS) 02:40

    "I think that there's a tremendous opportunity for nurses to also actively participate in that conversation, especially oncology nurses, because we are with patients throughout their continuum of care and work with people for a long time and have more 'in-the-room-time' with our patients. I think of the nurses who had been giving my own mom her chemotherapy, where they spend so much time in the room with her and talking about her impressions of her care, what she wants, what's important, what's a meaningful result, and we can share that with our physician colleagues." TS 04:38

    "I think it's the question of, 'Because there is another thing that we can do, should we do it?' That feeling of futility that clenches at our heart, at our guts, that's a signal to us to stop and think, 'What is the goal of treatment? Whose goal is that? And is what's happening right now aligned with that goal, or have we somehow gone astray?'" TS 08:51

    "When futility rears its head in our nursing practice, our first duty to ourselves and our patients is to take a pause. . . . Stop and reflect with a learner mindset on, 'What it is I'm not seeing in this situation, whose voice is not being heard, what are my assumptions and biases?' And then think about, 'What's another narrative that I can write about this situation?,' trying to be very mindful of other patients that we've cared for in similar situations where we might be bringing or protecting these other patients onto this current patient." TS 09:40

    "Several years ago, when I was really going through some struggles in the ICU with this issue of futile or potentially inappropriate care, I went to a workshop and learned this mnemonic called GRACE to help clinicians remain compassionate and see what is the ethically appropriate thing to do in really fraught situations." TS 16:18

    "Let's take time, invest time, in learning more about what is futility. Let's invest some time in learning more about how to understand our patient's goals, their family's goals, what their values are. Taking some time to invest in communication training, ethics—if clinical ethics is something that's a particular interest to you—that's a great way to start, but also just really investing in learning how to communicate." TS 36:18


    Episode 221: Surgical Interventions for Patients With Cancer Aug 19, 2022
    Show notes

    "Our goal in surgical oncology is, of course, to treat the cancer for a cure, but to do it in a safe manner so the patient is able to recover and resume their normal living activities that they had before their surgery," ONS member Lisa Parks, MS, APRN-CNP, ANP-BC, inpatient nurse practitioner of hepatobiliary surgery at the James Cancer Hospital and Solove Research Institute, Division of Surgical Oncology, at the Ohio State University Wexner Medical Center in Columbus, OH, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a discussion on prehabilitation and preoperative assessments for patients with cancer undergoing surgery, implications of and advancements in cancer surgery, and the interprofessional collaboration that takes place in this scenario. 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 August 19, 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

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • Oncology Nursing Podcast episodes:
      • Episode 58: The Power of Cancer Rehabilitation
      • Episode 66: Updates in Surgical Oncology—ONS Congress
      • Episode 185: Surgical Oncology: Where We've Come and Where We're Going
      • Episode 212: When Cancer Care Gets Complex: Those Other Oncologic Emergencies
    • ONS Voice article: The Power of Prehabilitation
    • Clinical Journal of Oncology Nursing articles:
      • Perioperative Care Implementation: Evidence-Based Practice for Patients With Pancreaticoduodenectomy Using the Enhanced Recovery After Surgery Guidelines
      • Use of Robotics in Oncology Surgery
    • Oncology Nursing Forum article: Cancer Prehabilitation Programs and Their Effects on Quality of Life
    • ONS books:
      • Surgical Oncology Nursing
      • Gastrointestinal Cancer Care for Oncology Nurses
      • Cancer Basics (second edition)
    • ONS's Get Up, Get Moving
    • Dana-Farber Cancer Institute article: How 'Prehabilitation' Can Benefit Cancer Patients
    • American Journal of Physical Medicine and Rehabilitation article: Cancer Prehabilitation: An Opportunity to Decrease Treatment-Related Morbidity, Increase Cancer Treatment Options, and Improve Physical and Psychological Health Outcomes
    • Journal of Human Nutrition and Dietetics article: Nutritional Screening in a Cancer Prehabilitation Programme: A Cohort Study
    • National Cancer Institute article: Surgery to Treat Cancer
    • Enhanced Recovery After Surgery Society guidelines

    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

    "Prehabilitation for surgery is probably one of the most underutilized areas of the surgical process. The goal of prehabilitation is to initiate coordinated, preoperative, optimized strategies. During the patient's preoperative assessment by the oncology nurse in the clinic, as well as the provider, risk factors are identified that can be addressed for a better surgical outcome." Timestamp (TS) 02:27

    "Any solid tumor patient that is having an oncological surgery can benefit from prehabilitation. It really depends on their overall assessment preoperatively. . . . And certainly, any lengthy surgery that is going to require the patient to be under anesthesia for prolonged time, the patient would benefit from being optimized prior to a surgical procedure." TS 07:43

    "When a patient is initially seen by a surgical oncologist in a pre-op setting, all of these assessments are completed by the oncology nurse, as well as the advanced practice oncology nurse, for the patient. And in order for the patient to go through the surgical process, prehabilitation is started immediately after that initial visit. The patient will be brought back in and reassessed periodically while going through prehabilitation." TS 09:03

    "Our goal in surgical oncology is, of course, to treat the cancer for a cure, but to do it in a safe manner that the patient is able to recover and resume their normal activities that they've been living, that they had before their surgery." TS 10:51

    "I think [one] of the greatest challenges that I hear from nurses are family support. The family needs to understand the whole process of prehabilitation and the fact that the patient is not going to come to harm by waiting a couple weeks to optimize themselves to undergo a major cancer operation, and to make sure that they're providing transportation and assisting their family member if they need to go to outpatient physical therapy, occupational therapy, pulmonary rehab, things like that, that the provider may, based on assessment, refer these preoperative candidates for." TS 12:18

    "I think that people always think of surgery as being curative, but a lot of times, some of the procedures that we do are to sustain a quality of life for the patient at the end of their life." TS 20:41

    "Now, what I'm seeing is that the majority of the time, robotic surgery is utilized more often than an open surgery. Of course, any time there is uncontrolled bleeding, any time they're unable to really visualize the surgical field well, they may start out robotically, and then go to an open procedure, but certainly I'm seeing them starting the cases and scheduling them as robotic or robotic-assisted. . . . I just think that robotic-assisted surgery continues to really grow, and I don't think we've reached the full potential of what surgeons can do with the surgeries. There is a great learning curve for these surgical oncologists." TS 28:10

    "Surgical oncology nurses are trained in post-operative care, preoperative care, and for nurses that are in the OR, perioperative nursing, as well as oncology. They have to be competent, not only in surgical care, but in oncology care, too. . . . This specialty is very different than a medical oncology nurse, or a hematology nurse, who is mainly giving chemotherapies, CAR T's, immunotherapies. The surgical oncology nurse needs to understand what chemotherapies, treatments, radiation therapies, anything like that, that has been done with that patient, because that would certainly impact that patient's outcome, but also to understand the whole surgical process." TS 31:28


    Episode 220: Oncologic Emergencies 101: Febrile Neutropenia and Sepsis Aug 12, 2022
    Show notes

    "It's actually the nurse who most often first identifies the subtle signs of sepsis in patients. Trust your clinical judgement," ONS member Laura Zitella, MS, RN, ACNP-BC, AOCN®, nurse practitioner at the University of California, San Francisco, told listeners during a conversation with Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS. Zitella explained the nursing and management considerations for febrile neutropenia and what to do if it transitions into sepsis. This episode is part of a series about oncologic emergencies; the previous episodes are also linked below. You can also 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

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • Previous Oncology Nursing Podcast episodes on oncologic emergencies
    • Clinical Journal of Oncology Nursing articles:
      • Sepsis: Symptoms, Assessment, Diagnosis, and the Hour-1 Bundle in Patients With Cancer
      • NEWS Scoring System: Use in Hematologic Malignancies and Cellular Therapeutics Patient Populations
      • Febrile Neutropenia: Decreasing Time to Antibiotic Administration in a Community Hospital Emergency Department
    • ONS book: Understanding and Managing Oncologic Emergencies: A Resource for Nurses (third edition)
    • ONS courses:
      • Oncologic Emergencies
      • Treatment and Symptom Management—Oncology RN
      • Essentials in Oncologic Emergencies for the Advanced Practice Provider
    • ONS Huddle Cards™
    • International Guidelines for Management of Sepsis and Septic Shock
    • National Comprehensive Cancer Network guidelines on prevention and treatment of cancer-related infections
    • Sepsis Alliance
    • Surviving Sepsis Campaign

    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 know that fever and neutropenia in combination needs to be treated immediately. This is a high-risk oncologic emergency. Our patients who have febrile neutropenia are at very high risk of having a severe infection or sepsis." Timestamp (TS) 03:44

    "Patients with cancer are at an increased risk for infection because of the inherent immunosuppression of the cancer itself and also the treatment." TS 08:28

    "There are some very, very basic things that patients can do [to decrease risk for infection]. The most important is good handwashing. I explain to patients that your skin is the best barrier against getting an infection. If there's no break in the skin, then infection cannot get in. So, if your hands get contaminated and you wash them before you touch your eyes or your mouth or your nose, then that is a good way to prevent infection." TS 11:42

    "Even if a patient does everything perfect, most of the time when you're neutropenic, the infections that develop come from endogenous organisms. So, our body is colonized with probably 10 times as many microbes as human cells, and when the immune system is suppressed, it allows these organisms sometimes to cause infection. So, it's very important for patients to know that if they have signs of infection that they should let us know so that we can start immediate treatment to treat the infection." TS 14:01

    "If patients are higher risk or they have any organ dysfunctions, or other symptoms—like they're unwell, nausea, vomiting, diarrhea, any symptoms like that—they should be admitted to the hospital, and we would initiate IV antibiotics." TS 17:37

    "It's actually the nurse who's most often the person that first identifies sepsis in patients, so I think it's really important to trust your clinical judgement. When you look at a patient, it's really easy to tell when something is wrong. When they're starting to breathe too heavy or they're a little bit off and they're starting to get some altered mental status, or suddenly their heart rate is elevated for no reason even though they're just lying in bed. So, nurses are really positioned and are most often the ones who first pick up on these subtle signs." TS 27:17


    Episode 219: Use Acupuncture and Acupressure to Manage Cancer Symptoms and Side Effects Aug 05, 2022
    Show notes

    "Using that view of looking at the whole person, we can provide some acupuncture or acupressure to help maybe reduce anxiety, to help them relax a little bit more, settle their thinking down a little bit, and get some improved sleep," ONS member Susan Yaguda, MSN, RN, RN manager in integrative oncology at the Atrium Health Levine Cancer Institute in Charlotte, NC, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a discussion on using acupuncture and acupressure to manage symptoms and side effects of cancer and cancer treatment. Yaguda also demonstrated example acupressure techniques that nurses can try at home and in their practice. 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

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • Yaguda's 2022 ONS Congress® session: Improving Quality of Life With Acupuncture, Acupressure, and Oncology Massage
    • Oncology Nursing Podcast Episode 129: Safely Use Acupuncture as Integrative Care for Symptoms and Side Effects
    • ONS Voice articles:
      • Acupuncture for Cancer-Related Fatigue
      • What the Evidence Says About Acupuncture and Cognitive-Behavior Therapy for Insomnia
      • Evidence Is Building for Acupuncture as an Opioid Alternative for Cancer Pain
    • Oncology Nursing Forum articles:
      • Acupuncture as a Treatment Modality for the Management of Cancer Pain: The State of the Science
      • Effects of Acupuncture and Acupressure on Cancer-Related Fatigue: A Systematic Review
      • Assessing the Impact of Acupuncture on Pain, Nausea, Anxiety and Coping in Women Undergoing a Mastectomy
    • Clinical Journal of Oncology Nursing article: Acupuncture for Menopausal Hot Flashes
    • Current Oncology article: A Systemic Review of Acupuncture for Chemotherapy-Induced Peripheral Neuropathy
    • International Journal of Nursing Studies article: Effects of Acupressure on Chemotherapy-Induced Nausea and Vomiting-A Systematic Review With Meta-Analyses and Trial Sequential Analysis of Randomized Controlled Trials
    • Acupressure's Potent Points: A Guide to Self-Care for Common Ailments
    • The Society for Integrative Oncology
      • Clinical Practice Guidelines on the Evidence-Based Use of Integrative Therapies During and After Breast Cancer Treatment
    • LCI Supportive Oncology video: Acupressure Points Reference
    • Memorial Sloan Kettering video: How to Perform Acupressure for Nausea and Vomiting
    • Cancer Help Program: Beyond Conventional Cancer Therapies
    • Medical Acupuncture article: Information on Battlefield Acupuncture

    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

    "When people have a disruption in their health—and it could be your emotional well-being, physical, or both—in traditional Chinese medicine, it is reflected in that the flow of qi has been disrupted. Acupuncture and acupressure address this by trying to open up and even out that flow, by either inserting tiny little needles called acupuncture needles, or by exerting gentle pressure—called acupressure—on specific acupoints." Timestamp (TS) 03:22

    "What I really love about traditional Chinese medicine is it's very holistic. It's looking at the whole person, at systems working together, and it really meshes beautifully with what I think of as nursing practice, as nurses, that we step back and that we are looking at the whole person. And how maybe an imbalance in one area of one's life can definitely impact other areas as well." TS 05:27

    "We know that patients who receive neurotoxic chemotherapies can develop painful neuropathy that can really be impactful on their quality of life. We have found, and the literature also supports, that if patients can come in and get some sessions of acupuncture, it can be really impactful on their neuropathy." TS 08:09

    "Using that view of looking at the whole person, we can provide some acupuncture or acupressure to help maybe reduce anxiety, to help them relax a little bit more, settle their thinking down a little bit, and get some improved sleep, which as we all know is a very important part of health and well-being and definitely for our patients something that can better help them manage treatment moving forward." TS 10:56

    "Integrative medicine looks at using complementary therapies in a very collaborative way with what we would consider to be more conventional medical treatment, so that it's coordinated and very intentionally meshed together to best suit the patients' needs at whatever point along the trajectory of their care." TS 12:58

    "Some cancer centers do have an integrative medicine department, and oftentimes acupuncture is part of that." TS 15:56

    "Not only could our care partners use some acupressure themselves to help with fatigue, anxiety, and their own sleep difficulties, but it gives them something that they can be easily trained to do to share with their loved one. And sometimes, it's so important for them to feel like they can contribute positively to their loved one's well-being in some sort of way. I always encourage, if possible, for a care partner to be involved in the process as well." TS 20:47

    "Using battlefield acupuncture, or acupuncture and acupressure of any kind, is not a replacement for appropriate medical management of symptoms—whether it's pain, nausea, or anxiety, for example. Think about this as another tool in the toolbox to offer to our patients that has very few side effects. . . . It should never be considered a replacement for that type of care." TS 32:45


    Episode 218: Central Venous Catheters: Heparin Harms and Recommendations for Flushing Jul 29, 2022
    Show notes

    "Saline is very benign and doesn't have any risk of harm for the patient. They're small doses, so we're not worried about sodium or anything. The risk of heparin is actually quite extensive," MiKaela Olsen, DNP, APRN-CNS, AOCNS®, FAAN, clinical program director in oncology at Johns Hopkins Hospital and Johns Hopkins Health System in Baltimore, MD, told Stephanie Jardine, BSN, RN, oncology clinical specialist at ONS, during a conversation about the latest evidence surrounding central venous catheter flushing solutions and techniques. 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

    Check out these resources from today's episode:

    • The NCPD activity for this episode has expired, but you can still earn NCPD through many other Oncology Nursing Podcast episodes. Find a full list of opportunities.
    • ONS Access Device Standards
    • Oncology Nursing Podcast
      • Episode 127: Reduce and Manage Extravasations When Administering Cancer Treatments
      • Episode 162: What Nurses Need to Know About Central Lines and Ports
    • Clinical Journal of Oncology Nursing articles
      • Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Pediatric Patients With Cancer
      • Heparin Versus Normal Saline: Flushing Effectiveness in Managing Central Venous Catheters in Patients Undergoing Blood and Marrow Transplantation
      • Implanted Port Patency: Comparing Heparin and Normal Saline
      • Central Venous Access Devices: An Investigation of Oncology Nurses' Troubleshooting Techniques
    • ONS books
      • Access Device Standards of Practice for Oncology Nursing
      • Chemotherapy and Immunotherapy Guidelines and Recommendations for Practice
    • Journal of Vascular Access article: Flushing of Intravascular Access Devices (IVADS) – Efficacy of Pulsed and Continuous Infusions
    • Medical Devices: Evidence and Research article: Pulsative flushing as a strategy to prevent bacterial colonization of vascular access devices
    • ASCO/ONS Chemotherapy Administration Safety Standards
    • ONS/ONCC Chemotherapy Immunotherapy Certificate Course
    • Infusion Nurses Society's Infusion Therapy Standards of Practice

    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 Conversation

    "The way that you can eliminate heparin is by really focusing on education and teaching of patients and nurses and other staff that access central lines about how to do that." Timestamp (TS) 06:13

    "One of the barriers right now I think is that a lot of the manufacturer guidelines are old, and they still recommend in their catheter guidelines to use heparin because they aren't up to date either." TS 07:50

    "The risk of heparin is actually quite extensive. For instance, we know that heparin can cause heparin-induced thrombocytopenia, or HIT. Unfortunately, you don't always know that your patient is experiencing that, but I've had many, many patients over the years where, all of a sudden, their platelet count was low, and no one knew why. . . . We did testing for HIT and found out that it was the heparin flushes that were causing that." TS 09:04

    "Normal saline is the most benign solution that can be used in catheters. There are studies showing benefit in some patient populations, and I know that some places have protocols using an antibiotic lock solution or a sodium citrate lock solution, but in general the most common type of flush solution for central lines as heparin begins to move out of favor is normal saline." TS 13:06

    "We know that using a push-pause, pulsatile, or, I call it sometimes, turbulent flush, has been shown to promote the clearance of the catheter lumen and prevent occlusion. According to the Infusion Nursing Society guidelines. . . . we are instructed to stop and start every millimeter of flush. . . . That is really important because every time you stop and start, you cause turbulence in that catheter." TS 13:55

    "When you study it, you find that patients or nurses are not actually flushing enough. If the patient's at home and you're using saline, then the catheter is usually flushed on a daily basis with pulsation when not in use. If the patient's giving themselves antibiotics or other medications through their catheter, they need to be taught how to do the saline flush after each of the medications." TS 17:47


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