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Advancing cancer care

Nurse-led oncology research makes impact on practice

Monday March 24, 2014
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Nalo Hamilton, RN
Note: This is Part 1 of a two-part series. A link to Part 2 is at the bottom of this article.

Whenever you attend a national or statewide nursing conference, you are guaranteed to receive a wealth of information and nursing news at the featured and plenary sessions, and through poster presentations and valuable professional networking opportunities at the exhibit booths and special interest group meetings.

Nurse.com spoke with nurses who presented posters at the 2013 Oncology Nursing Society national conference and with other nurse oncology researchers throughout the country. They shared their research expertise as well as tips for those interested in research practice.

They unanimously agreed that evidence-based practice projects and research in oncology nursing help nurses think about why they are practicing in a certain way and what they can do to improve patient care and outcomes. Nurses don’t need to “go it alone,” they said, because there are numerous opportunities for mentorships and collaboration in research studies.

Nalo Hamilton, RN, PhD, MSN, WHNP/ANP-BC, Robert Wood Johnson Foundation Nurse Faculty Scholar, assistant professor, Jonsson Comprehensive Cancer Center and School of Nursing, UCLA, advises nurses to recognize the contributions they can make to research practice; to not let the barriers of time and finances stop them from engaging in research; and to realize that all research, whether small or large, makes a difference in nursing knowledge and patient care.


Pam Ginex, RN
A great start

Nursing research can run the gamut, whether it be a performance improvement or evidence-based practice project or a qualitative or quantitative research study, and it all starts with a burning clinical or professional question, according to Pam Ginex, RN, EdD, OCN, nurse researcher at Memorial Sloan-Kettering Cancer Center, New York City, who does her own research and mentors nurses in research practice at the cancer center.

Ginex recommends nurses look at what’s available in the literature and try not to reinvent the wheel. “When it comes to deciding how to proceed with your own clinical question, get your team involved to see if there’s enough support from the literature to make practice changes or if you want to engage in some type of research or EBP project,” she said. “You may choose to build upon what others have accomplished, replicate a project or study or look at a clinical question from another angle.”

Build on the literature

At the Hospital of the University of Pennsylvania in Philadelphia Keri McDevitt, RN-C, BSN, OCN, clinical nurse, Mary Denno, RN, MSN, CMSRN, nurse manager, and Kristen Maloney, RN, MSN, AOCNS, clinical nurse specialist, joined interprofessional colleagues Emily Hyman, an engineering student at the University of Pennsylvania, and Sarah H. Kagan, RN, PhD, FAAN, Lucy Walker Honorary term professor of gerontological nursing at University of Pennsylvania School of Nursing, in a research study. Upon review of the literature, the team found increased levels of hospital noise have negative effects on patients and staff, with negative patient outcomes including delays in healing time and increased physical and psychological stress.

Because there was little research on how hospital noise affects oncology patients, they chose to first determine their own nursing staff’s knowledge and perception of hospital noise on an inpatient medical oncology unit at HUP and then implement environmental and practice changes.

An electronic pre-test taken by nursing staff helped determine their baseline knowledge of hospital noise standards and an electronic post-test was administered following educational interventions. Education covered the known effect of hospital noise on patients and staff, the standards of noise levels set by World Health Organization, and specific ways to decrease noise levels. Quantitative measurements of noise levels were collected using a decibel meter to monitor the oncology unit at various points in time.


Kristen Maloney, RN
The ultimate goals

Enhanced patient care and improved patient outcomes often are the ultimate goals when engaging in nursing research, and the HUP nursing staff and their colleagues have seen improved patient satisfaction scores and requests from physicians to work on the unit because of the calm atmosphere, Maloney said. Staff became more aware of how noisy hospitals are and learned that simple noises — such as opening and closing of patient doors — ranked high on a noise-level scale, according to Maloney. She said quiet-time measures including lowered voices, dimmed lights and no overhead paging have been instituted on the unit after 10 p.m.

Carrie Daly, RN, MS, APN, AOCN, oncology nurse manager and advanced practice nurse, radiation/oncology, Rush University Medical Center in Chicago, keeps these same two goals at the forefront of her work.

After 32 years in nursing, Daly still possesses a passion to help patients with cancer, and for the past nine years has been at Rush caring for patients in radiology/oncology.

“Mucositis is one of the most toxic side effects for patients who undergo head and neck radiation,” Daly said. “Unfortunately, over the years companies made promises that their products would reduce or improve the toxic side effects of mucositis, but the products just didn’t deliver improved patient outcomes.”

When attending the ONS conference four years ago, Daly heard about the product MuGard, an oral rinse used for the prevention and treatment of symptoms of oral mucositis. After conducting her own evaluation over the course of the next several years, she presented a poster titled “Outsmarting Oral Mucositis” at the 2013 conference, which summarized results from 128 cancer patients undergoing radiation therapy for head and neck cancer, with and without chemotherapy.


Carrie Daly, RN
Improved patient outcomes

Patients who used MuGard and were compliant with patient instructions experienced significant clinical benefits, with lower grades of oral mucositis, reduced pain, reduced use of analgesics, and better nourishment and weight maintenance. Use of MuGard resulted in a significant reduction in the number of patients who progressed to Grade 3 oral mucositis as measured by the National Cancer Institute-Common Toxicity Criteria.

“After reviewing the 128 charts, I discovered that MuGard served as a very effective preventative solution, of course, along with good oral hygiene,” Daly said.

Patients were instructed to gently swish and swallow 5cc of MuGard four to six times each day, starting on the first day of cancer treatment, and continuing the regimen a week or longer after completion of treatment. The patient’s weight, pain assessment, oral assessment and oral mucositis toxicity were documented.

Daly volunteered her time, and despite the numerous hours and days required to review patient charts and collect data, she said she’d do it all over again. And there’s a practice change at Rush: MuGard has been adopted as the standard of care for patients who are at risk of developing mucositis as a result of cancer therapy.

Note: For much more about nurse-led oncology research, including advice about following your passion in research, interdisciplinary collaboration and other tips, read Part 2 of this story at www.Nurse.com/Article/Nurse-Oncology-Research-2.


Janice Petrella Lynch, RN, MSN, is nurse editor/nurse executive. Send comments to editor@nurse.com or post comments below.