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What was the knowledge gained from the article?
“There has been little to no growth in HPV knowledge in the general population in the United States from 2005 to 2018.”
“In 2010, oropharyngeal cancers surpassed cervical cancer as the most common HPV-associated cancer.”
As a chemotherapy nurse, I hadn’t given much thought to the occupational risk that some health care workers have with treating HPV patients.Will the research/information in this article change or influence your practice? If so how? I will educate whom ever will listen about the HPV vaccine. I agree with others it’s difficult to educate adults about the HPV vaccines since the target group are children and young adults. Although there are still individuals in our community who’ve had a small number of sexual partners so this education would still be beneficial to them.
What other questions does the article raise about current practice?
I agree with the others in that providers in the surgical settings should wear a N95 or another means to protect themselves from the virus.
I was discussing this article with colleague who’s worked with derm and she said N95’s were worn during the cauterization of a wart, because of the HPV exposure. So is a N95 not protection enough?
How much does the vaccine cost? Would our health department administer the vaccine to those that 27–45 years?Do you agree/disagree with the conclusions of the author, why?
“The degree to which this exposure increases disease risk is uncertain and likely challenging to estimate accurately.”
I disagree with this statement because those doctors that are cauterizing HPV associated illness day in and day out would have a greater risk of exposure than someone who workers in other areas of medicine.Megan, Have you you found through your career the culture in medicine has changed in regards to pain?
I recall when I started nursing I was told pain is the fifth vial sign and pain is subjective to whatever the patient reports.
I think that we are just beginning to change this culture especially by now asking each patient’s tolerable pain level is.
Mindy- I think a smart phrase for each med/onc group would be helpful. I find even at the breast center the physicians have different approaches to treating bone pain. It would be nice to hear the physicians rationale for their treatment decision.
Hello I’m Patti Gabel from SSCBC infusion. Great articles Mindy
What was the knowledge gained from the article? Elizabeth Joy Mclean reviewed the mechanism of granulocyte- colony-stimulating factors (G-CSFs) which I appreciated this review. That being the cause of bone pain is multifactorial because of the release of histamine and inflammation of bone marrow.
The second article “Risk Factors for bone pain among patients with cancer receiving myelosuppressive chemotherapy and pegfilgrastim” reminded me the importance of reviewing a patients medical history before teaching them about their treatment.Will the research/information in this article change or influence your practice? If so how? Yes both articles will influence my daily practice. Many of the patients I care for receive G-CSF as part of their treatments. I’ll be more mindful of younger patients and their potential of experiencing more intense bone pain from these drugs. I will suggest nonpharmacological interventions for those who experience mild bone pain. Those nonpharmacological interventions being heat application, stretching, walking, or cold application.
What other questions does the article raise about current practice? I agree with you Megan Burke I too have found not all providers agree on the same treatment interventions when it comes to bone pain caused by G-CSF drugs. In the future I’ll be more inclined to ask a provider why they choose one intervention over the other.
Do you agree/disagree with the conclusions of the author, why? I agree with E. Mclean that we should encourage patient to use pharmacological and nonpharmacological interventions when treating bone pain.
The “Risk for bone pain among patients with cancer receiving myelosuppressive chemo and pegfilgrastim” states those that those who have base line bone pain are more at risk to experience bone pain as a side effect I would agree with this conclusion.Mindy- My coworkers and I work really well to make sure that everyone takes a 30 minute lunch and we give each other 15 minutes breaks as we need them. Honestly, my unit is unlike any other I’ve ever worked on before because my colleagues genuine care about each others overall well being.
I’ve worked in the past with those nurses who are perfectionist and can’t let go of the control to take a break or lunch. continue to encourage them to take care of themselves by taking a lunch.Megan, What a great point! I too believe you would see a positive correlation with nurse retention and a medical center’s implementation of RBC or something promoting self-care. Like anything in life the more we invest in something the larger your return will be. The more nurses become a active participant in the relationship based care model hopefully they feel increased job satisfaction and most importantly we see higher patient satisfaction. Patient satisfaction I feel is also directly correlated with nurses job satisfaction.
I’m proud to be a SSCBC infusion nurse and my coworkers have actively created a environment that encourages self care and care of colleagues. The culture on my unit supports a healthy work day by ensuring we get the necessary breaks needed to regroup and give 110% to our patients.
I do strongly believe in the power of a nursing unit and their ability to create a culture that promotes self care and care of colleague. I honestly can say I’m working in just this environment. I hope our inpatient nurses feel the same way because the sky is the limit when a nurse finds this type of unit.
Blackwell- You made some great points. I try to show up everyday thinking “how can I make my work day great?” I will continue to encourage stress reduction techniques to all my nursing colleagues so that I can ensure a healthy work environment during a pandemic.
Greg, I agree coping skills to combat emotional distress need to be taught during nursing school or hospital orientation. New grads need the tools for building resilience so that they can have a long and healthy career.
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What was the knowledge gained from the article? Dr Michael Kelly and Mari Tyson Staff RN reviewed with us the power of compassion and how it is essential to the practice of nursing. They also went as far as saying that it should be implemented with ALL nursing activities. They spoke of the evidence that supports improved patient care when empathetic and compassionate care is provided by the nurse. The article then goes on to state that the nurse is at risk for developing compassion fatigue.
According to Vaclavik (2018) moral distress is when a nurse performs duties that are contrary to what she or he believes is right but feels powerless to change actions.
Both articles identified reasons why a nurse could experience emotional distress due to their profession. They also give us suggestions on how to decrease emotional distress. According to Kelly (2016) mindfulness is a tool to combat stress and burnout because it enhances one’s self-compassion and empathy towards others. Vaclavik (2018) had several suggestions of stress reduction methods that were most successful were work–life balance events and the critical debriefs.
Will the research/information in this article change or influence your practice? If so how? I know that I’m personally going to need to focus on reducing my stress personally and professionally over the next year so I’ve found these articles to be very helpful. I also know from past professional experience the environment in which I work directly impacts my mood so it would be beneficial to me to be an active participant in any kind of stress reduction programs. Currently on my unit one of my colleagues Grace Chapman wanted to help by starting a book club with just this theme.
The book is The Miracle Morning.
What other questions does the article raise about current practice? Many of my friends and family are nurses and a common theme I’ve notice is that none of us are able to get a assigned 15 minute break in addition to our 30 minute lunch. Even more bothersome is many of the nurses I know aren’t even able to get a uninterrupted 30 minute lunch break. Is this the culture in which we live or is this just acceptable in healthcare in the United States? I’ve been asked many times by upper management why nurses aren’t staying at the bedside. How can we participate in debriefings and mindfulness therapy when many inpatient nurses don’t even get a 30 minute lunch. These breaks are even more essential when we are trying to wear masks and socially distance ourselves from colleagues.
Ohio State is wonderful place to work because they provide continuous education and process improvement but do they give us enough time to implement these self care practices.
Do you agree/disagree with the conclusions of the author, why? I agree these methods of stress reduction will work when implemented daily.Mindy,
I agree with Kelly I don’t include lymphedema in my initial chemo teaching. I feel that Chemo teaching is a lot of material to go over. I’ve usually addressed it when surgery is brought up. I guess after reading this article I should bring it up when patients have radiation as well.
Last week I cared for a patient who had a PSH/PMH lumpectomy and radiation. She developed Upper Extremity Lymphedema four years after treatment. She was doing lawn work and unfortunately got several bug bites on the side of her lumpectomy/radiation. She had Upper Extremity swelling initially from the acute trauma which later developed into permanent lymphedema.
I wanted to share this story because it is a low life time risk for these patients. She stated that she has been selective on what shirts she buys because often her arm doesn’t fit into many shirts.
Amoreena- Thanks for the surgical oncology voice when it pertains to these articles. I’ve only worked in infusion and medical oncology so it’s refreshing to hear what is being done on the surgical side.
It sounds from your response we’re very proactive here at the breast center because we do bioimpedence measurements for our patients prior to any surgery that can involve the lymph nodes and then completed at certain intervals after surgery if multiple lymph nodes are removed.
Are these measurements obtained by the lymphedema clinic?
Maybe you could help me, if I have a patient whom I’m concerned about lymphedema I usually get a consult with Physical therapy to be further evaluated? Is there anything else I should be doing to advocate for my patient?1.What was the knowledge gained from the article?
After reading, The Legacy of lymphedema: Impact on nursing practice and vascular access it provoked several questions on whether the my practice will be changed in the future. I think it’s the nurses responsibility to review the risk factors their patient has for lymphedema prior to obtaining peripheral vascular access ie. axillary node dissection, mastectomy, receiving chemotherapy, obesity > 30 BMI, and arm swelling.
Recently a medical oncologist here at SSCBC has questioned our policy on whether or not we should continue to avoid needles sticks on the affected arm due to recent research.
Our Policy:
Avoid IVs on the side of axillary node dissection, after radiation therapy, in the affected arm of
lymphedema or CVA patients or in patients with stage 4 or 5 kidney disease when possible. (Level
VII8)
The article Lymphedema. Clinical Journal of Oncology Nursing maybe question how well I assess my patient for lymphedema? I heavily use subjective symptoms when assessing my patient the only objective assessment I usual do in the infusion unit if the patient has unilateral swelling of the upper extremity.2.Will the research/information in this article change or influence your practice? If so how? I feel I’m going to educate the patient on their overall risk and let the patient be part of the decision on whether or not the affected arm is used.
I think after reading these articles it has helped sharpen my assessment skills for subclinical lymphedema.
3.What other questions does the article raise about current practice? How well do we provide patients with surveillance for lymphedema for those patient’s at risk? Does our surgeons measure the patients arms preop and postop and if so for how long postop do they measure the patients?I feel like this topic is still in a gray area as far as precautions on the affected arm. Personally, I’m always going to the unaffected arm first when any needle stick is needed. Why introduce that risk if it’s unnecessary.
4.Do you agree/disagree with the conclusions of the author, why? I agree with the author Reichart it is essential to have a protocol for Bioimpedance spectroscopy (BIS) and L-Dex device.
I agree with Larocque and and McDiarmid that long-held beliefs with regards to the risks factors and preventative measures need to be challenged, but I believe clinical data needs to be collected to support the use of the affected arm.
Larocque, G., & McDiarmid, S. (2019). The legacy of lymphedema: Impact on nursing practice and vascular access. Canadian Oncology Nursing Journal, 29(3), 194–203.
Reichart, K. (2017). Lymphedema. Clinical Journal of Oncology Nursing, 21(1), 21–25.
