Two very different projects in which nurses developed creative solutions to common patient problems and helped to improve patients’ treatment experience were the focus of a session on Friday, April 12, 2019, at the ONS 44th Annual Congress in Anaheim, CA.
Standardizing CINV Treatment
Nancy King, MSN, RN, CPNP, CPON®, of Childrens Hospital Colorado in Aurora, described how using a standardized approach to antiemetic options and creating a patient-specific plan improved compliance, decreased anorexia and electrolyte imbalances, and improved quality of life for patients with chemotherapy-induced nausea and vomiting (CINV).
Inadequate antiemetic management can lead to poor compliance, poor nutrition, and gastrointestinal injury, King said. Although complete eradication of CINV for all patients may not be achievable, nurses have tools that can significantly improve patients’ experience.
King described the principles of a standardized approach to antiemetic therapy.
- Start with a standard plan appropriate to the emetogenicity of the treatment regimen.
- Adjust as needed. One size does not fit all.
- Teach patients and families to respond quickly to breakthrough nausea with as-needed medication before vomiting occurs.
- Teach patients and families that small frequent meals may be better tolerated than large bolus meals.
- Document what works.
Caregiving for BMT Recipients
Ashley Bostyan, BSN, RN, OCN®, BMT-CN, and Kathleen Gander, BSN, RN, of the Mayo Clinic in Rochester, MN, described an evidence-based caregiving skills session (CSS) for patients undergoing bone marrow transplant (BMT) and their caregivers that contributed to lower patient distress and caregiver burden and higher caregiver preparedness.
Caregivers for patients undergoing BMT have significant responsibilities that they may be unprepared for, Bostyan and Gander said. Their study tested the effects on patient distress, caregiver burden, and caregiver preparedness of adding a CSS to the standard education program for caregivers of BMT patients.
Patients and caregivers who received standard BMT education and those who received standard education plus the CSS were similar demographically. Multiple myeloma was the most frequent indication for BMT, followed by myelodysplastic syndrome. All patients in the standard education group received autologous stem cell transplantations, and just over a third of those who received the caregiving skills intervention received allogeneic stem cell transplants. Most patients in both groups were first-time transplant recipients.
The intervention consisted of a one-hour interactive session, which both caregivers and patients could attend, that introduced the Creativity, Optimism, Positivity, and Expert Information (COPE) framework. Attendees then discussed strategies for applying the framework to resolve issues arising in BMT care.
Overall mean scores on the Bakas Caregiving Outcomes Scale improved in both groups. Scores for relationships with family and with the BMT survivor increased the most, whereas scores on time for family activities and time for social activities decreased the most. Participants in the intervention group said that the most meaningful experiences from the intervention were sharing information, hearing others’ stories, and applying the COPE framework.
The study results identified the COPE framework as an effective problem-solving technique and showed that nurses can successfully lead an evidence-based CSS and influence patient and caregiver outcomes, Bostyan said.