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    Chapters Advocate for Patients and Nurses at Statewide Event in Annapolis
    Cancer healthcare advocacy
    Chapters Advocate for Patients and Nurses at Statewide Event in Annapolis
    July 11, 2019
    Advocacy Grows Through Personality as Well as Profession
    Health Policy
    Advocacy Grows Through Personality as Well as Profession
    June 13, 2019
    Advocate in Your Own Backyard
    Cancer healthcare advocacy
    Advocate in Your Own Backyard
    May 09, 2019
    Health Policy Begins With You: Educate Your Representatives in Cancer Care
    Health Policy
    Health Policy Begins With You: Educate Your Representatives in Cancer Care
    April 04, 2019
    Providing Expert Testimony in the Virginia State Senate
    Cancer healthcare advocacy
    Providing Expert Testimony in the Virginia State Senate
    March 14, 2019
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    The Case of the Explicit Exposure
    Clinical practice

    The Case of the Explicit Exposure

    Mr. Larsen presents to the clinic for his first dose of R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone) for a diagnosis of diffuse large B-cell lymphoma. Elizabeth, his oncology nurse, just started the cyclophosphamide when she is paged to the desk for a call from Mr. Larsen’s oncologist. She quickly removes her face shield and gloves as she hurriedly leaves the room to take the call. After completing the call, she returns to Mr. Larsen’s room to remove her gown.  

    July 16, 2019
    How Music Can Soothe Your Savage Beast—Stress
    Nurse self-care

    How Music Can Soothe Your Savage Beast—Stress

    Where you put your attention matters more than you realize. For example, when you are thinking or talking about work-life stressors, your ability to take in other sensory input is challenged. One way to break out of the mental stress loop is to listen to music. Music can divert the brain’s attention, giving you a break from repetitive thoughts and judgments. The variety of music genres to choose from when looking for ways to shift your attention and enhance mood is ever increasing.  

    June 11, 2019
    The Case of the Terrible Toxicities
    Adverse events

    The Case of the Terrible Toxicities

    After completing neoadjuvant chemotherapy for triple-negative invasive breast cancer, Madeline, age 32, had a bilateral mastectomy with reconstructive surgery. Final pathology showed residual disease in the breast and one lymph node, and her oncologist recommended adjuvant therapy with capecitabine (1,500 mg twice a day for 14 days, off for 7 days). Five weeks postoperatively, she started cycle 1. Eight days later, her husband called the cancer clinic reporting that over the past two days, his wife developed profound weakness, unremitting diarrhea despite using diphenoxylate and atropine as directed, and painful, red, swollen hands and feet. Her symptoms represented a drastic change from her usual routine and energy level.

    May 14, 2019
    Self-Care for the Soles
    Nurse self-care

    Self-Care for the Soles

    The twenty-six bones in the foot are always being stepped on. Getting on one’s nerves takes on a whole new meaning when considering that each foot contains an estimated 200,000 nerve endings. With health enthusiasts recommending 10,000 steps per day, which translates to approximately five miles, is it any wonder that the often-abused soles deserve a little self-care? 

    April 23, 2019
    The Case of the Belated BRCA Test
    Genetics & genomics

    The Case of the Belated BRCA Test

    Eighteen months after completing surgical debulking and chemotherapy for stage III high-grade serous ovarian cancer, 56-year-old Lily experienced a rising CA-125 level. At her oncologist’s recommendation, Lily started an aromatase inhibitor, but it did not stop the rising tumor marker. After she began experiencing symptoms of bloating and mild abdominal pain, Lily and her oncologist decided to proceed with second-line chemotherapy. As she left the office, Lily remarked that she did not complete genetic testing when she was originally diagnosed because she does not have any children or a family history of ovarian cancer and she was concerned that her insurance would not cover the testing.

    April 16, 2019
    Cultivate Cultural Humility in Yourself and Your Practice
    Nurse self-care

    Cultivate Cultural Humility in Yourself and Your Practice

    Oncology nurses interact with other staff, patients, and families, each of whom have various cultural and personal preferences. A person’s culture encompasses race, ethnicity, spiritual practices, social habits, and so much more. 

    February 19, 2019
    The Case of the Gender Gaffe
    Clinical practice

    The Case of the Gender Gaffe

    During the morning shift change, Charlie, an RN, receives a report on Ellis, age 52, who was admitted three days ago for severe abdominal pain and persistent diarrhea after cycle 3 of high-dose ipilumumab and nivolumab.

    When Charlie and the certified nursing assistant (CNA) enter Ellis’s room, the patient is sitting up in bed caressing hands with a woman of similar age. Ellis requests help getting into the shower, so Charlie says to the CNA, “Please, help him shower, and I will finish introductions.” 

    Ellis interrupts Charlie. “I am not a he!” 

    January 15, 2019
    The Case of the Emotional Emergency
    Psychosocial issues

    The Case of the Emotional Emergency

    Sharon, age 40, was diagnosed with invasive ductal carcinoma. Pathologically, her tumor was grade I, estrogen- and progesterone-receptor positive, and HER2 negative. The mass measured 0.5 cm on ultrasound. Sharon has no family history of cancer and is devastated by the diagnosis. One of her close friends recently died from metastatic breast cancer, and she is certain will have the same fate. She tells Jennifer, an RN in the breast center, that she is going home to “get her affairs in order.”

    November 20, 2018
    Laugh Every Day for the Health of It
    Nurse self-care

    Laugh Every Day for the Health of It

    An uproarious guffaw, uncontainable giggle, or a hearty hoot often has a ripple effect, turning a quiet room into a cacophony of sounds collectively identified as laughter. Humor is generally considered a subjective experience. Laughter, however, can be spontaneous or consciously produced by going through the motions (fake it till you make it). Either way, the overall benefits associated with laughter make it a virtually priceless self-care strategy.

    October 08, 2018
    The Case of the CAR T-Cell Toxicity Test
    Clinical practice

    The Case of the CAR T-Cell Toxicity Test

    Wilson was diagnosed with B-cell lymphoma three days after his 63rd birthday. He underwent chimeric antigen receptor (CAR) T-cell therapy after his disease failed to respond to two lines of systemic chemotherapy.

    September 18, 2018
    The Case of the Coercive Consent
    Clinical practice

    The Case of the Coercive Consent

    Betty, age 70, was diagnosed with metastatic colon cancer and started treatment with FOLFOX. Her medical oncologist changed the treatment to capcitabine after Betty developed grade 3 peripheral neuropathy. Because of disease progression, bevacizumab was added to her treatment plan. She lives with her daughter, is insured by Medicare, and receives $800 per month from Social Security.

    July 17, 2018
    Writing for Wellness
    Nurse self-care

    Writing for Wellness

    No reliable method exists for determining how many conscious or unconscious thoughts a person has in a day; estimates range from 12,000–70,000 daily thoughts for an average of 52 thoughts per minute. Journaling your thoughts and feelings is a way of becoming an interested observer of your thoughts.

    June 25, 2018
    The Case of the Blurred Boundaries
    Clinical practice

    The Case of the Blurred Boundaries

    Roxanne, a blood and marrow transplant certified nurse, has been taking care of Jerome, a 20-year-old man diagnosed with acute myeloid leukemia. Jerome is the eldest of seven children; his mother works full-time, and with younger children at home has not been able to make the trip across country to be with her son.

    May 15, 2018
    Establish Healthy Boundaries by Using Your Inner Compass
    Nurse self-care

    Establish Healthy Boundaries by Using Your Inner Compass

    Eating a balanced diet, drinking plenty of water, and following an enjoyable exercise routine are all part of physical self-care. Along with caring for the physical self, emotional and spiritual self-care also play a significant role in living a healthy and satisfying life. Like physical health, emotional well-being has various components. This article describes how to tune into your inner compass and develop the skill of learning how to set healthy limits by using your yes’s and no’s wisely.  

    April 25, 2018
    The Case of the Pain Paradox: Follow-Up and Clinical Trial
    Pain management

    The Case of the Pain Paradox: Follow-Up and Clinical Trial

    The January 2018 case study introduced Vince, a 55-year-old man receiving chemotherapy and radiation for recurrent bladder cancer. He suffers from chronic back pain because of spinal stenosis and has been on opioid therapy for nearly two years.

    March 20, 2018
    The Case of the Pain Paradox
    Pain management

    The Case of the Pain Paradox

    Vince was diagnosed with non-muscle invasive, high-grade bladder cancer at age 54 and treated with intravesical Bacille-Calmette Guerin immunotherapy. He stopped smoking and began a consistent walking program. 

    January 16, 2018
    The Case of the Physical Activity Prescription
    Treatment side effects

    The Case of the Physical Activity Prescription

    Raj recently presented to the emergency department for hemoptysis and shortness of breath. Subsequent computed tomography scan and biopsy reveal metastatic small cell lung cancer. He is a 62-year-old former smoker who is 25 pounds overweight and works as an accountant for a large automobile dealership.

    December 19, 2017
    the medical benefits of healthy sleep
    Nurse self-care

    Sweet Dreams Discourage Inflammation

    Do you consider sleep to be part of your self-care regimen? Does a spinning wheel of thoughts keep you from restful sleep, or do you consciously sacrifice sleep time? If so, you are not alone. The Centers for Disease Control and Prevention (CDC) declared that insufficient sleep is a public health epidemic with an estimated 25% of the United States population suffering from some type of sleep disturbance.

    December 06, 2017
    Late side effects of immunotherapy
    Immunotherapy

    The Case of the Slow-to-Manifest Side Effects

    Mary, age 60, has been diagnosed with stage IIB ovarian cancer. Because she has a strong family history of various cancers, Mary is tested for Lynch syndrome, also known as hereditary nonpolyposis colorectal cancer (HNPCC).

    Her test is positive, and she is told she is at increased risk for developing cancers associated with HNPCC: ovarian, breast, prostate, kidney, endometrial, pancreatic, prostate, and liver.

    November 14, 2017
    Self-Care Mantra to Boost Compassion
    Compassion fatigue

    Use a Self-Care Mantra to Boost Compassion

    Oncology nurses are generally compassionate people and dedicated to helping others live the best they can while experiencing a life-changing illness. Over time, such dedication can lead to compassion fatigue, especially when others suffer.

    October 17, 2017
    Comfort Care Concerns
    Pain management

    The Case of the Comfort Care Concerns

    Phil is a 63-year-old man who is admitted to the inpatient oncology unit for severe pain resulting from metastatic small cell lung cancer. His wife and two daughters are at his bedside. Earlier in the day, the medical oncologist discussed additional treatment options or hospice care. Phil decided on comfort care with the hope of getting his pain managed and going home on hospice.

    September 19, 2017
    Reframe Workplace Conflicts
    Incivility in nursing

    Reframe Workplace Conflicts

    August 21, 2017
    Immunotherapy Inquiry
    Immunotherapy

    The Case of the Immunotherapy Inquiry, Part II

    You may remember Jay, a 62-year-old man with inoperable stage IIIA non-small cell lung cancer (NSCLC), from the case study in the April 2017 issue of ONS Voice. He was symptomatic with a persistent cough, unintentional weight loss, and fatigue.

    July 18, 2017
    Recognize and Release Muscle Tension
    Nurse self-care

    Learn to Recognize and Release Muscle Tension

    Oncology nurses face abundant physical and emotional stressors, which, over time, can result in maladaptive muscle tension. Some degree of muscular tension is necessary to keep the body toned and mobile. However, unnecessary tension can lead to chronic pain and other health problems.

    May 23, 2017
    Immunotherapy Inquiry
    Immunotherapy

    The Case of the Immunotherapy Inquiry

    Jay is a 62-year-old man with newly diagnosed, stage IIIA (T3, N1), unresectable, non-small cell lung cancer (NSCLC) that tested negative for ALK, EGFR, and KRAS mutations. Additionally, PD-L1 (programed death receptor ligand) expression was less than 30%. Jay is symptomatic with a persistent cough, unintentional weight loss, and fatigue.

    April 18, 2017
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    Deborah Christensen MSN, APRN, AOCNS®
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