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Melissa I love the idea of a Zen room. Stepping away from chaos seems to be my best weapon when I’m feeling overwhelmed. Kelly- I agree with Shalvoy.1 you do a great job on process improvement through unit council. You recently play a big role in coordinating chair massages for the group and I am so very thankful for your time!
Renee- I also wonder what other hospitals are doing to prevent burnout. I also find it really interesting that many of my nursing friends who are burned out leave and travel. To me this seems like more work, exhausting, and not addressing the real mental fatigue they share they are experiencing. Does more money help compensate burnout? It is an interesting time for nursing and the future of where our profession goes from here I think is still to be determined. In the meantime I’m going to start by being honest with myself and treating myself better.
Thanks for hosting Kelly!
What was the knowledge gained from the article?
The knowledge I gained from this artical is how important self care routines are when dealing with burnout. I found it interesting that post chair massage sessions staff reported at 43% reduction in stress levels. This is a significant reduction in stress and with that large of a number I am surprised our facility isn’t doing more to help prevent burnout. Also, I was shocked that burnout was more common in the outpatient setting but when thinking about it that makes a lot of sense. Outpatient nurses spend a large amount of time with patients through out their whole oncology journy. They follow up on scheduling and work with the primary oncologiest to help corrdinate the patient’s care. I can see where burnout results.Will the research/information in this article change or influence your practice? If so how?
Nursing has been emotionally exhausting for me over the past few years. This artical points out the importance of self care and gives me more encouragement to prioritize it. At this time I am doing more meditation, journaling, and self awareness excerises. I also took a plunge and radomly book a retreat for myself that involves my hobbies. I realize if I am not well I am not as great of a mother, coworker and nurse.What other questions does the article raise about current practice?
My question is if burnout is very common especially in the outpatient setting, why isn’t our organization doing more? I remember tea for the soul and mental health nurses rounding while in patient. Seems like I don’t see this as much in the outpatient setting. Maybe I am too new to realize the resources?Greg you mentioned insurance reimbursement. I wonder with OSU and NWCH radiation departments partnered if that will help keep patients who insurance will reimburse coming but at the same time maybe open OSU up to lead more clinical trails for other patients.
Michelle, I agree the cost savings in hospital prevention is a huge benefit. Globally thinking about how hard high hospital capacity is hitting our oncology population at the James I will jump on the band wagon for anything to help hospitalizations.
What was the knowledge gained from the article?
I honestly didn’t know very much about proton therapy other than the James was going to add proton therapy for a treatment option in the new facility. I was interested in learning that the side effects are decreased with proton therapy and the amount of timing proton therapy lasts in the body is decreased. I was also interested in learning that proton therapy is more precise and able to treat harder to reach areas. This makes me excited for our oncology patients who experience a large amount of side effects from radiation and even more happy to hear pediatric patients can benefit.What other questions does the article raise about current practice?
My questions arise from what more data is needed to figure out if proton therapy can be more standard of care? The articles mention there is a lack of data to suggest in some cancers that proton therapy is beneficial. I’m wondering why? Precision and less side effects seem to be a good reason for me!Do you agree/disagree with the conclusions of the author, why?
I agree current research is needed to support proton therapy. It’s interesting that one article mentions ” two-thirds reduction in 90-day severe adverse events associated with unplanned hospitalizations” the cost savings in that alone seems worth investing in more research. Knowing OSU is adding proton therapy as an option gives me hope that maybe that more research is coming.Callihan I’m interested in more recent data regarding HPV knowledge. The “HPV Knowledge and Education: Report on Vaccination Data” article has data from 2005-2018 regarding if the target population knows what HPV is and how it is spread. I’m worried in 2021 that maybe more misinformation is circulating and curious if they repeated the study what today’s data will be.
Blackell- ” The largest study included 134 patients with cervical intraepithelial neoplasia undergoing electrosurgical excision.14 Samples collected from the cervix, surgical smoke, and clinicians’ nares were tested for HPV DNA. Thirty percent of surgical smoke samples contained HPV DNA, and the HPV type detected in smoke samples corresponded to the type detected from cervical samples in all cases. Human papillomavirus DNA was also detected in two of the nasal samples (1.5%; 2/134) collected from clinicians after performing the procedures. In both cases, there was concordance of HPV type across the three sample sources.”
This might help with understanding how they concluded the healthcare professionals were exposed to the HPV DNA during the procedure rather than having other risk factors. Not sure if that was a general statement about healthcare workers or the ones in this study but thought it was important to mention how this article concluded it’s information.I am curious about why you mentioned the vaccine is not safe. Could you discuss a little more?
You mentioned benefits outweigh the risks was that specifically for healthcare workers receiving the vaccine or the general population?
What was the knowledge gained from the article?
I learned that procedures that eliminate HPV can actually be an occupational hazard for those in “at risk areas.” I was stunned to learn that HPV when cauterized can actually be aerosolized and spread to healthcare workers in close proximity to the procedure. Also, I was unaware that the Gardasil vaccine now covers 9 common cancer causing HPV variants. I realized I myself am a little behind in HPV information and resources.What other questions does the acritical rise about current practices?
I am curious now as to what other ways HPV is spread. If HPV is aerosolized when being cauterized does other factors such as vaping and smoking spread HPV? I am also curious as to why age 45 is the cut off age for the Gardasil vaccine. I assume more research is focused on the preventable younger population but we still see people over the age of 45 with HPV induced oral cancers. Also, as mentioned in the discussion, OSU has conducted research that concluded those with the HPV vaccine had less reoccurrence than those who did not have the Gardasil vaccine. Could offering the vaccine at a later age offer a different age group benefits?Will the research/information in this article change or influence your practice?
If so how?
The information in the articles encourages me to advocate more for oncology prevention. I will particularly pay close attention to teachable moments I have with patients that arise around the Gardasil Vaccine and HPV prevention and share my information. Not only will I pay attention to teachable moments but I also realize that HPV research continues to expand resulting in me needing to keep current with up-to-date research. Also, I will continue to protect myself during cauterizing procedures and wear and N95.Holly the article you shared was really interesting especially reading that reoccurrence was less likely with patient’s that are already vaccinated. Shawver.25 I agree, I wonder if there is just a lack of research for people older than 45.
Thanks for responding Greg! I agree it is a difficult time to gain trust regarding vaccines. It was mentioned that other countries focus on vaccinating children in the school setting and that has resulted in higher outcomes. Hoping at some point we a country can get there. Does anyone with older kids know if schools offer vaccine clinics for things other than flu or COVID? Also, I have seen commercials recently encouraging HPV vaccinations. Hopefully the topic will gain more attention.
I thought age 45 was interesting as well! I was reading a little further into the vaccine and it mentioned the 26 is the cut off for insurance to cover the vaccine d/t less risky of a lifestyle. Here is a quote from Uptodate that might be interesting,
“For adults 27 years and older, catch-up vaccination is not routinely recommended; the ACIP notes that the decision to vaccinate people in this age group should be made on an individual basis. The likelihood of prior exposure to HPV vaccine types increases with age, and thus the population benefit and cost-effectiveness of HPV vaccination is lower among older patients [22]. However, for some individuals in this age group, such as those with no prior sexual experience or with a limited number of prior sexual partners, the risk of prior HPV exposure may be very low. We offer HPV vaccination to such individuals if they are deemed to have a future risk of HPV exposure (eg, expected new sexual partners). Although supporting data are limited, we also suggest HPV vaccination for health care workers who may be at risk for occupational exposure to HPV, even if they are older than 26 years. (See ‘Health care workers at risk for occupational exposure’ below.)
Studies have suggested that HPV vaccination is immunogenic, efficacious, and safe in women older than 25 years [23-26]. However, clinicians and patients should be aware that HPV vaccination of individuals older than 26 years may not be covered by insurance providers or other payers, and this may affect the decision to vaccinate. In the United States, the HPV vaccine is approved through age 45. It is possible that some individuals over the age of 45 years may also benefit from vaccination, but the benefit has not been well studied, and reimbursement for vaccination of such individuals is even less likely.” https://www.uptodate.com/contents/human-papillomavirus-vaccination?search=HPV%20vaccine&source=search_result&selectedTitle=2~95&usage_type=default&display_rank=1
Greg that is interesting that you have personal experience with weighted blankets. I was curious as to how hard is it to keep up with? Would you be able to use a regular washing machine for the blanket or would you need a larger one like comforters would need?
Michelle mentioned utilizing PCRMs and social workers through out an oncology patient’s clinic visits. Just curious what extra resources do they provide for oncology mental health? I know of support groups but curious on what other options besides support groups, medications, or behavioral therapy. I worry with such a demanding schedule an oncology patient has with scans, treatments, and appointments with so many providers would having more appointment obligations be too much? Reading about weighted blankets as an option seems like a great intervention!
1. What was the knowledge gained from the article?
One thing I learned and found interesting is up to half of distressed older adults with cancer to not received psychosocial services. Seeing first hand patients experience a complete life interruption centering around a very stressful diagnosis makes me worry about their mental wellbeing as much as their physical wellbeing. Knowing nearly half of this population do not seek out services weighs heavy on me. The first article mentions cognitive-behavioral therapy and/or medications to treat anxiety for the older oncology patient population. I often wonder if adding one more appointment to a cancer patient’s schedule may overwhelm even more? However, smaller interventions like weighted blankets are options to help in smaller ways.2. Will the research/information in this article change or influence your practice?
It was pointed out in the first article that anxiety in result to a threat can result in a behavior change. An example of this would be a smoker wanting to make a healthy lifestyle change and quitting smoking. However, this article also mentioned if anxiety is disproportionate to the threat it can be problematic. I learned from this article that as a nurse assessing for problematic behavior I would look for indicators such as avoidance and frequent reassurance in daily activities. Paying closer attention to questions that focus on functional impairments like declining relationships with others or not being able to keep up with small tasks at home could point out that there is an issue with anxiety. After review of OSU’s anxiety screening tool, GAD-7, I realize my current practice does not include utilizing this tool. Utilizing the GAD-7 is my initial screening when a concern arises will help me verbalize my concerns to providers.4. Do you agree/disagree with the conclusions of the author, why?
I agree monitoring and treating oncology patient’s anxiety could benefit the patient’s psychosocial and physical health. Providing an intervention such as a weighted blanket could offer a small amount of support during treatment. With that being said, patients may start to recognize their own response to anxiety. This could lead to further discussions with providers and be helpful in the long run.
