Oncology nurses explore how to better combat patient fatigue

They are key members of the healthcare team who face ongoing challenges on how best to provide optimum care to patients affected by cancer. Oncology nurses at The Cancer Institute of New Jersey continually strive to improve patient care and have recently explored how to better combat patient fatigue, the importance of documenting sleep-wake disturbances and the development of a toolkit to help patients better follow their oral treatment schedule during clinical trials. Their research on these specific topics is being presented at the Oncology Nursing Society's (ONS) Annual Congress being held later this week in Washington, D.C. The Cancer Institute of New Jersey is a Center of Excellence of The University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School.

Knowing that fatigue is one of the most common side effects of cancer treatment, nurses at The Cancer Institute of New Jersey identified ways to improve documentation of fatigue management interventions at their center. Documentation of patient care allows healthcare professionals to understand the care being provided, the effectiveness of interventions and any clinical problems that may need further resolution. Leah Scaramuzzo, MSN, RN-BC, AOCN, associate director of nursing and patient education, and Jane Fischer, RN, BSN, OCN, CCRC, a research nurse clinician, led the effort to increase this documentation, which included adding a specific prompt in the patient's chart for nurses to inquire about fatigue, as well as the identification of exercise resources to be shared with patients.

"Research shows that regular exercise can help decrease fatigue in cancer patients, as well as reduce their risk of recurrence," said Scaramuzzo. "A targeted effort to document cancer fatigue will give nurses a better opportunity to offer appropriate intervention strategies to patients, which also can help improve their overall physical health and quality of life." Nurses implemented the effort earlier this year.

Improved assessment, documentation and interventions of sleep-wake disturbances in cancer patients is another area that nurses at The Cancer Institute of New Jersey explored in order to improve the quality of patient care. Disruption of a proper sleep regimen is common in cancer patients (Roscoe, et. al., Oncologist, 2007) with cancer patients having twice the incidence of sleep disturbances experienced by the general population. Between 30 and 75 percent of cancer patients report sleep disruptions that contribute negatively to their quality of life. At The Cancer Institute of New Jersey, modifications to the electronic nursing documentation tool were made, and nurses were educated on the importance of encouraging patients to complete a self-assessment on current sleep patterns as well as incorporating interventions into nursing practice.

"National data compiled by ONS show that fewer than 55 percent of this country's healthcare providers assessed and/or documented sleep disturbance management interventions in cancer patients. As a National Cancer Institute-designated Comprehensive Cancer Center, The Cancer Institute of New Jersey wanted to be on the forefront of strengthening this practice which ultimately will translate into improved patient outcomes," noted Director of Oncology Nursing Services Janet Gordils-Perez, MA, RN, APN-BC, AOCNP, who led the effort to enhance the assessment and documentation process. Gordils-Perez and colleagues Carla Schaefer, BSN, RN, OCN, Jacquelyn Lauria, MS, RN, APN-BC, AOCNP and Patricia Dennigan, BSN, RN, OCN, are looking at opportunities for incorporating interventions into practice.

Oral chemotherapy treatments have become more common in recent years due to their convenience for patients. But because of that ease of delivery, the patient must assume a greater responsibility for making sure the drugs are taken as prescribed. To make that process easier for patients and to improve adherence to the treatment schedule during clinical trials, nurses at The Cancer Institute of New Jersey created a patient-friendly toolkit. Using evidence-based guidelines and gathering patient recommendations and feedback on the topic, nurses developed a screening technique to identify barriers to therapy compliance. When developing the toolkit, nurses added a color-coded pill diary with instructions, individualized calendars specific to a patient's treatment regimen, and an education sheet about taking oral chemotherapy, which reviews safe handling procedures.

"Non-adherence to oral therapy has been shown to reduce treatment success, which could lead to additional doctor visits or even hospitalizations. By providing this set of easy-to-use tools, clinicians can help empower patients during each interaction," noted Yuk (Aggie) Wong, RN, BSN, OCN, MA, who is the lead author of the abstract. Wong, along with colleagues Pamela Scott, RN, OCN, and Heather Camisa, RN, BSN, OCN, will further evaluate the new toolkit via chart audits and patient/staff surveys.

Also at the annual meeting, The Cancer Institute of New Jersey will receive the 2013 ONS Employer Recognition Award in the medium size employer category. The honor acknowledges institutions that support the vision, mission and values of ONS. Receiving personal recognition, Carmela Hoefling, MSN, APNC, AOCNP, an advanced practice nurse at The Cancer Institute of New Jersey, was named as an ONS Foundation Congress Conference Scholarship recipient. She also was asked to share her expertise in caring for patients with melanoma at a pre-conference forum with other nurses from across the country.