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When the Provider Becomes the Patient: What I Learned From COVID-19

When the Provider Becomes the Patient: What I Learned From COVID-19

The Case of the Late Head and Neck Lymphedema

Clinical practice

The Case of the Late Head and Neck Lymphedema

Our Patients Give Us Peace in Unexpected Circumstances

Oncology nurse pride

Our Patients Give Us Peace in Unexpected Circumstances

Behind Our Masks, I See You, I Hear You

Behind Our Masks, I See You, I Hear You

Connect With Your Patients on a Human Level as Well as a Healthcare Level

Oncology nurse-patient relationship

Connect With Your Patients on a Human Level as Well as a Healthcare Level

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Ethics in nursing

Support Patients’ Autonomy and Cultural Choices

You are the oncology nurse caring for Maria, who has been diagnosed with non-small cell lung cancer (NSCLC). She says she doesn’t understand how she developed lung cancer because she has always lived a clean lifestyle according to her religious practices. You notice that although Maria is initially conversant with you, she allows her husband to speak for her whenever he is present. When you mention your observation to Maria, she tells you that in her religious culture, medical decisions are deferred to the high elders of the church.

Oncology nurse-patient relationship

Use the Evidence to Integrate Ethics in Teleoncology Care

Emily manages a rural clinic associated with an academic cancer center. Patients initially have an in-person consultation with their treating oncologists at the main campus but then use telehealth for subsequent visits. To support patients during teleoncology visits, Emily wants to initiate a plan to collaborate with the clinic staff to identify and address the ethical principles for oncology care using telehealth.

Oncology nurse-patient relationship

Anticipate and Address Anxiety in Survivorship Care

Some people may be overjoyed at the prospect of completing their cancer treatment and returning to normal life, but for many others, fear and anxiety can overshadow feelings of elation. The survivorship phase of a cancer journey can be confusing and uncertain. Comments like, “I don’t know what is next” and “The responsibility for care is now up to me” can alert oncology nurses that patients need additional communication and strategies to transition into healthy survivorship.

Ethics in nursing

Advocate for Equal Access for Next Generation Sequencing and Clinical Trials

Janice is an oncology nurse in a rural community cancer center. Only one of the three oncologists in the practice discusses clinical trials with their patients and typically not until after patients complete two to three lines of therapy. Also, the practice does not have a process for when to order next generation sequencing (NGS). Janice feels it is not ethical that the patients coming to the clinic do not have equal access to those important services.

Oncology nurse-patient relationship

Master the Essentials of Effective Communication

Communication is central to an oncology nurse’s role—with patients and families, within the unit, and across interprofessional teams. The Joint Commission identified poor communication as a causative factor in 80% of medical errors, particularly during caregiving handoffs. Effective communication skills are both a science and an art, but oncology professionals can use a variety of tools and techniques to enhance their practice.

February 15, 2022

Oncology clinical trials

The Case of the Clinical Trials Consultation

Don, age 72, was diagnosed with borderline resectable pancreatic adenocarcinoma more than a year ago. Genetic testing indicated a BRCA2 variant. He completed 12 cycles of FOLFIRINOX followed by a pancreaticoduodenectomy (Whipple procedure). He had no evidence of disease for six months until a liver lesion seen on surveillance imaging tested positive for metastatic pancreatic cancer. His medical oncologist suggests a clinical trial targeting the BRCA2 variant.

December 21, 2021

Nurse well-being

Live a Life in Balance

Although you may not always believe it, living a balanced life is not out of reach. Nurses have a variety of ways to achieve daily balance and well-being, both informally and through dedicated programs. Today, institutions and nursing organizations alike are prioritizing initiatives to support and strengthen nurses’ well-being.

November 25, 2021

End of life (EOL)

The Case of the End-of-Life Evaluation

Ron, your 73-year-old patient, decides to transition to hospice care after receiving lung cancer treatment for three years. His partner finds Ron’s decision to move to hospice difficult to accept and encourages him to look for a clinical trial or try alternative treatments. You suggest that the couple speaks with a hospital chaplain, and Ron agrees. His surprised partner says, “Why do you want to talk with a chaplain? We’ve never been religious!”

October 19, 2021

Nurse well-being

Can Compassion Bust Burnout and Restore Resilience?

Stress is a normal and necessary part of life. However, prolonged emotional tension takes stress to a new level for many people, including oncology nurses. But what is the antidote to cumulative pressure? The evidence for compassion’s benefits during stress is compelling.

September 30, 2021

The Case of the Triple-Negative Breast Cancer Targeted Treatment

Ophelia is a 42-year-old patient who has been diagnosed with triple-negative breast cancer (TNBC). She completed neoadjuvant chemotherapy with dose-dense doxorubicin and cyclophosphamide, followed by paclitaxel and carboplatin. Her postsurgical pathology shows residual disease in the tumor (3.5 cm down from 4 cm) and 12 out of 18 lymph nodes that are positive for cancer. Ophelia tells you that she is very discouraged and expected a better treatment outcome.

September 21, 2021

Nurse well-being

The Seven Dimensions of Rest

Sleep and rest are two different concepts. Society focuses on sleep, but rest is just as important, and not just for the physical body. Rest allows us to nurture our physical, mental, emotional, sensory, creative, social, and spiritual self. Each of those dimensions needs to be consciously rested for a person to truly feel restored.

The Case of the Mysterious Myalgia

Randi is a 57-year-old patient who identifies as female. She was diagnosed with clear cell metastatic renal cell carcinoma (mRCC), and her past medical history includes mild hypertension managed with amlodipine and a two-year history of transient musculoskeletal pain managed with tramadol. She reports a family history of cardiovascular disease and rheumatoid arthritis (RA). Her primary care physician suspects Randi is at the beginning stages of fibromyalgia but has not made a conclusive diagnosis because she hasn’t experienced additional symptoms.

Clinical practice

The Case of the Weight Loss Wishes

Craig was diagnosed with colorectal cancer after a routine colonoscopy and subsequent colectomy. He meets with Lacey, the oncology nurse, to discuss managing the side effects of his FOLFOX chemotherapy. Lacey notes that Craig’s age is 71, weight is 255 lbs., and body mass index (a body fat ratio based on weight and height) is 38. Craig describes his activity level as “walking to the mailbox and exercising my fingers on the remote control. This cancer treatment will help me knock off some of this extra weight.”

Patient Support

The Case of the Transgender Considerations for Cancer Screening

Sally, a nurse practitioner in a cancer survivorship clinic, is preparing to discuss screening and surveillance guidelines with Jonah, a 32-year-old survivor of Hodgkin lymphoma. Sally reviews Jonah’s patient history form and notes that Jonah uses he and him pronouns. His gender identity is male and sex assigned at birth was female. Jonah’s surgical history includes gender-affirming surgery on chest tissue (also known as top surgery), and his current medications include supplemental testosterone. Jonah also specifies that he is transmasculine—an umbrella term used to indicate that Jonah feels a connection with masculinity.

Nurse well-being

Don’t Get Trapped in the Pitfalls of Perfectionism

Having high expectations can motivate you to achieve your very best. In the extreme, however, aiming for perfection can be dangerous to your mental health. In a 2015 TED Talk, self-proclaimed perfectionist Petra Kolber passionately revealed that despite being at the top in her field in the fitness industry, she felt her best was never good enough and she lived a joyless life.

Survivorship care plans

The Case of the Sensitive Staging System

Marianne, an oncology nurse navigator, is preparing a cancer treatment summary and survivorship care plan for Sylvia, who finished breast cancer treatment six weeks ago. Sylvia was treated with neoadjuvant therapy followed by mastectomy, reconstruction, and radiation. Her tumor was characterized as multifocal invasive ductal carcinoma, grade 2, estrogen and progesterone positive, and HER2/neu negative. Sylvia has no family history of breast cancer. Marianne notices that the oncologist recorded Sylvia’s cancer as a stage IB. Marianne wonders if the stage was determined before or after chemotherapy and surgery.

February 15, 2021

Patient Support

How to Manage Survivor Guilt During a Pandemic

Pandemics have a tremendous impact on societies and individuals alike. From incidence rates to death tolls, financial hardship to job loss, and anxiety to isolation, we’ve all been affected in one way or another—although some much more than others.

February 11, 2021

Clinical practice

The Case of the Targeted Therapy Toxicities

Three years ago, Tony, a 42-year-old man, began FOLFOX chemotherapy treatment for stage III colon cancer and achieved a complete response. Two years later, a biopsy of an intraabdominal lesion uncovered metastatic disease, and he was prescribed the epidermal growth factor inhibitor (EGFRi) cetuximab. Alex, the oncology nurse educating Tony on the side effects of EGFRi therapy, understands that skin toxicities are common with the class of drugs and looks for national guidelines for prevention and management direction.

January 19, 2021

Interprofessional issues

How to Accept Criticism With Class

Quick: what’s your first reaction when you hear the word criticism? Do you brace yourself for feelings of failure and put up a defensive wall? It’s hard to respond otherwise, but try to look at it differently. Criticism can be positive if we accept it with class and let it help us gain knowledge about ourselves.

January 14, 2021

Clinical practice

The Case of the Virtual Venture

Staff in an oncology infusion unit located in an urban healthcare system watched as patient and caregiver stress increased during the COVID-19 coronavirus pandemic and the November 2020 U.S. presidential elections. During a team meeting, Holly, one of the nurses, brought up a study she read about that used virtual reality (VR) as a distraction for patients undergoing chemotherapy. The staff was interested in implementing a similar program at their institution but wasn’t sure how to start. What would you do?

December 17, 2020

Clinical practice

The Case of the Chronic Cancer Condition

Lisa, a 32-year-old tax accountant, completed treatment for stage III triple-negative breast cancer 18 months ago. During a follow-up appointment, Lisa reported worsening headaches and difficulty concentrating at work. A magnetic resonance imaging scan and subsequent biopsy revealed a solitary brain lesion. She completed stereotactic brain radiation two months ago.

November 16, 2020

Nurse well-being

How Will You Define Your New Normal?

The phrase “a new normal” is used in the oncology setting to describe the changes a person faces as a result of cancer and its treatments. Physical and emotional scars plus activity limitations are examples of adjustments cancer survivors make as they define what will be their new normal. But in today’s media, the new normal is being used to label the changes the world’s population is facing as a result of the COVID-19 coronavirus pandemic.

September 24, 2020

Clinical practice

The Case of the Delicate Discussion

Over the past three years, Sharon, age 38, has been intermittently receiving treatment for ovarian cancer. She was initially treated with carboplatin and paclitaxel and remained in remission for 20 months. She responded well to second-line therapy (carboplatin, gemcitabine, and bevacizumab), remaining on bevacizumab maintenance until she experienced a relapse eight months later.

September 15, 2020

Nurse well-being

If You’re Trying to Be Productive, Stop Multitasking

When it comes to the human brain, the ability to effectively multitask is a myth. Although computers can run two or more programs simultaneously, our brains must task-switch, and in the transfer of attention, time and productivity are lost. Monotasking, or single tasking, is now considered a way to increase productivity and actually maximize time.

Clinical practice

The Case of the HPV-Positive Perk

Warren is a 50-year-old man recently diagnosed with human papillomavirus (HPV)-positive oropharyngeal cancer. He and his wife meet with a radiation oncologist and develop a plan of care. Lisa, the radiation oncology nurse, meets with the couple to provide education and answer questions. Darren tells her that two of his “hard living” uncles died from head and neck cancer and the treatment was horrible. He says, “I’ve only had two sexual partners and never smoked—is this cancer really worth treating?”

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To discuss the information in this article with other oncology nurses, visit the ONS Communities.

To report a content error, inaccuracy, or typo, email pubONSVoice@ons.org.

Deborah Christensen MSN, APRN, AOCNS®

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