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Advancing cancer care, part II

Nurses' practice interests pay off in oncology research

Monday March 31, 2014
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Michele Niland, RN
Note: This is Part 2 of a feature on nurse-led oncology research. To read Part 1, including information about getting started, building on the medical literature and setting research goals, visit www.Nurse.com/Article/Nurse-Oncology-Research.

A second-degree nurse who practiced for 15 years as an oncology nurse, Michele Niland decided to switch her focus to cancer research. Niland, RN, BSN, OCN, CCRP, clinical research nurse for the melanoma program at the IU Simon Cancer Center, Indianapolis, sees patients who are in various clinical trials for the treatment of melanoma.

“Immunotherapies are a relatively new treatment option for our patients with melanoma, and we are seeing better and longer response rates,” said Niland, who added that the clinical research role is exciting.

“Half of my time is spent caring for and educating patients and their families. I am able to build relationships with them because I see them over an extended period of time, and it’s always great to see them respond positively to the new FDA-approved therapies.” Niland spends the rest of her time gathering information for the data managers.


Marilyn Haas, RN
Passion in practice

Often those clinical pearls, where nurses ask why we are doing something, arise out of their passions in practice, said Marilyn L, Haas, whose unique role as a nurse practitioner in integrative health gives her the opportunity to look at patient outcomes with complementary therapies compared with traditional medicine.

Haas, RN, PhD, CNS, ANP-BC, Mission Health, Asheville, N.C., and her colleagues investigated the effects on the parasympathetic nervous system of four holistic nursing modalities — healing touch, aroma therapy, guided imagery and massage — on oncology patients by certified holistic nurses. Secondarily, the investigators looked at which of the four modalities would be chosen by oncology patients during hospitalization or radiation treatments, examined the changes in vital signs and correlated participants’ self-reported evaluation of anxiety, nausea or pain.

With 442 participants, all modalities were statistically significant with the exception of aromatherapy, which did not decrease diastolic blood pressure.

“After our analysis of the data, we were able to show to our nursing and interprofessional colleagues that the four HN modalities are effective in relieving pain, nausea and anxiety symptoms and in lowering blood pressure, pulse and respiration,” said Haas, who wants to examine other outcomes, such as whether the HN modalities decrease length of stay or the use of other medications.


Sally L. Maliski, RN
Interdisciplinary collaboration

“There is little that just pertains to nursing; most everything we study involves other healthcare members like social workers, MDs, psychologists, and their input opens up different perspectives and helps us in implementing change,” said Pam Ginex, RN, EdD, OCN, nurse researcher at Memorial Sloan-Kettering Cancer Center, New York City, who also recommends that RNs seek advice from interprofessional colleagues.

Sally L. Maliski, RN, PhD, FAAN, associate dean for academic affairs, and associate professor, UCLA School of Nursing, advises nurses to form partnerships with experienced researchers early in their research practice.

“Find an interdisciplinary team with an established track record where you can contribute your professional expertise and nursing experience,” said Maliski, whose National Institutes of Health-funded research studies have been nationally recognized and replicated. “Besides joining those from other disciplines, we know that academicians, researchers and those in service need to collaborate with one another for better patient outcomes.”

Maliski also was involved in the statewide prostate cancer treatment program, IMProving Access, Counseling & Treatment for Californians with Prostate Cancer, which paid for prostate cancer treatment for uninsured men with incomes under 200% of the federal poverty level.

Maliski has examined barriers to accessing care for Latino men who have prostate cancer, working with urologists, nurses and healthcare specialists in the study. She has been involved in multiple other studies that have examined the meaning that Latino men with prostate cancer attributed to incontinence and erectile dysfunction; the impact of prostate cancer on Latino couples; and communication about prostate cancer among Latino families.


Judith Johnson, RN
Practical tips

Linda Dial, RN, MN, AOCN, nurse educator; Judith Johnson, RN, MSN, OCN, nurse educator; and Melissa Powell, RN, MS, former nurse educator at the Vanderbilt University Medical Center in Nashville, Tenn., wanted to evaluate whether a teaching strategy produced positive outcomes with resource-intensive training. Their ultimate objective was to have nurses demonstrate effective communication when conducting chemotherapy education.

In their evaluation, trained non-medical personnel acted as patients, and RNs provided patient education and used teach-back to validate patient understanding. Human standardized patients and instructors provided targeted, immediate feedback to nurses following online learning and training through the use of human simulation.

Forty-five nurses indicated a perceived value in patient education training to their future nursing career, with an average score of 9.2 on a Likert Scale. Qualitative analysis of interviews with 23 nurse learners confirmed the value of this experiential, simulated learning environment. Dial and Johnson hope to implement a longitudinal follow-up study to identify whether the intent to integrate learned communication and teach-back skills into practice has been achieved and sustained.

Based on their experience, Dial and Johnson offered some words of advice in a joint interview with Nurse.com: “We learned that more was possible than what we thought when we started. So give people the opportunity to say ‘yes’ and see what they can contribute. Ask questions and think outside of what is possible. Spread the passion, fuel the fire and continue to network. Develop your own skills and align with APNs who have doctorates and can enhance professional practice work. Capitalize on those who possess PhDs; use their energy, volunteer time and engage them in your work.”

Dial added that a fair amount of resources have been allocated for oncology clinical trials, so collaboration with medical researchers provides a rich partnership in the development of research that will help understand patients’ responses and manage the effects of treatment.

Ginex suggested that in early studies, it might be best to apply for smaller funding until “you get your feet wet”; usually the application process requires a written summary of the plan in place and the details of the study, such as the background, reason, methods and implementation.

Many organizations, such as the Oncology Nursing Society, Sigma Theta Tau International, American Nurses Association and the American Cancer Society, not only offer funding possibilities, but also expert advice, Ginex said.


Linda Dial, RN
Showcase research

Nalo Hamilton, RN, PhD, MSN, WHNP/ANP-BC, Robert Wood Johnson Foundation Nurse Faculty Scholar and assistant professor, Jonsson Comprehensive Cancer Center and School of Nursing, UCLA, first received her doctorate in biochemistry and then decided to become a nurse practitioner.

“I knew that by becoming an NP I would be able to better affect the health of women,” said Hamilton, who has spent much of her time studying the genetic components of cancer in African-American and Caucasian women.

Engaged in biological research, Hamilton goes from “tube to patient,” studying patient samples and cell cultures and then applying that knowledge to patient care. She is involved in RWJF-funded research, studying the specific biomarkers for estrogen receptor-negative breast cancer, which she said can be used as screening tools and as targets for therapeutic treatment.

“As nurses, we can examine how we can improve our nursing interventions and showcase what we do in our research,” Hamilton said. “For example, we are great at healthcare prevention and can demonstrate through our research how, for example, patient education improves medication compliance and patient outcomes.”

More information on nurse-led oncology research, examining the concept of Medihoney: http://news.nurse.com/article/20140310/PA01/303100069#.UzGUxVeRceU


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