Venous access devices are ubiquitous in nearly every direct care nursing setting. But as technology becomes more complex and new evidence emerges, nurses must evaluate it against their current practice: Should I use saline or heparin to flush this access device? Am I placing this peripheral venous catheter correctly? What does the latest evidence say? Do I need to implement a practice change? 

Less than 20% of National Cancer Institute Community Oncology Research Program practices routinely report collecting sexual orientation and gender identity data, limiting the available evidence to support recommendations for oncology nursing care of a vulnerable LGBTQ+ population that faces biases, stigma, cultural insensitivity, inequities, and disparities. In a 2022 Clinical Journal of Oncology Nursing article, ONS member Georgina T. Rodgers, BSN, RN, OCN®, NE-BC, and colleagues evaluated the latest studies to identify best practices and care considerations for LGBTQ+ patients with cancer.

Disparity. Inequity. Futility. Barriers. Miscommunication. Unacceptance of the inevitable. Ethical and moral challenges perpetuate throughout practice for today’s healthcare workers, particularly oncology nurses in cancer care. As those burdens build up, nurses struggle to sustain their resilience and risk developing burnout or even leaving the profession entirely.

Whether it’s through conferences, podcasts, or journals and other articles, an oncology nurse’s quest for continuing their cancer care learning is ever extensive. Innovative educational methods like gamification can keep training fresh and encourage teamwork.

Equalizing the quality of patient-provider communication for Black versus White patients is one way to reduce the systemic racial disparities prevalent in cancer care, researchers reported in study findings published in the November 2022 issue of the Oncology Nursing Forum. They identified critical opportunities for oncology nurses to improve interpersonal communication with Black patients. Nurses are key drivers to affecting change and cancer outcomes for all patients, they reported.

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.

Immune checkpoint inhibitors (ICIs) enhance immune response against foreign antigens, such as cancer, by manipulating checkpoints that have stopped the body from fighting them. In doing so, they also increase risk of the immune system attacking healthy cells and producing inflammatory side effects, resulting in immune-related adverse events (irAEs).

As cancer care delivery changes, oncology nurses step up to the challenge: they adapt and develop solutions to fuel the future of nursing education, certification, and practice. During the November 2021 ONS Hackathon™, launched in partnership with the Oncology Nursing Certification Corporation (ONCC), teams were tasked to identify methods that address issues in the delivery of cancer care and prepare the future nursing workforce to care for patients with cancer anywhere.

To reduce the disparities affecting maternity health outcomes, the U.S. Department of Health and Human Services (HHS) Office on Women’s Health (OWH) launched the Maternal Morbidity and Mortality Data and Analysis Initiative, an $8 million contract with Premier, Inc., the agency announced in December 2021. The initiative is rallying a network of hospitals to deploy evidence-based best practices in maternity care.

The Oncology Nursing Society (ONS) launched its third ONS–ONCC Hackathon™ in November, designed to create innovative solutions for current and future nurses in the delivery of high-quality, evidence-based cancer care in all possible settings.

As a clinical nurse specialist (CNS) with a cardiovascular background, I have seen the evidence-based benefits of exercise in a variety of settings. However, several years ago, when I was working as a CNS on an acute inpatient oncology unit, I noticed that exercise was not regularly included in care plans. As I learned from staff, this was done out of concern that patients needed to rest to save their energy. 

We have an approximately 14- to 17-year gap between the inception of research discovery and the implementation of findings into clinical practice. As a profession, nurses have a shared responsibility to address the challenge of identifying and overcoming barriers to evidence-based practice (EBP) implementation to provide the best possible clinical care for patients. My primary area of focus as a researcher is on using EBP to improve patient, staff, and organizational outcomes through the Science and Practice Aligned Within Nursing (SPAWN) model, a framework for applying EBP to clinical nursing care.

Evidence-based practice is dual sided: nurse scientists conduct research, and clinical nurses implement those findings into practice. Working together, they improve care by developing cancer survivorship programs, reducing cancer risk, and assessing cancer care in vulnerable populations. The University of Washington School of Nursing’s (UW SoN’s) partnership with Confluence Health, one of the largest healthcare providers in north central Washington, built a novel program to identify gaps in research and implementation and elicit projects that influence healthcare outcomes.

Most nurses have not received formal training in quality improvement (QI) methodology, and many workplaces lack the resources to efficiently implement evidence-based practice (EBP), which results in delays in translating science into practice. But ONS members are overcoming those barriers and leading the way in effectively developing, implementing, and sustaining practice changes.

When ONS reached out and asked me to participate in the inaugural ONS Hackathon, I wasted no time in confirming my interest. I had heard of hackathons before but never a nursing-specific one. It was an exciting experience full of growth for me and the other oncology nurses who participated.

Efficiently running an ambulatory infusion clinic is a complex process that requires evolving strategies to equip staff to provide high-quality cancer care. During the June 2021 ONS Hackathon^TM, oncology nurse innovators created solutions to address ineffective nursing resources in infusion centers across the United States.

My team’s current project to understand communication in ambulatory oncology settings stems from more than a decade of research (Kamimura et al.), in which we have tried to uncover the factors that facilitate high-quality cancer care for patients and a satisfying practice environment for care teams (Friese).

I believe that every nurse is a leader, and we need leaders in all areas of our profession, from academia and research to clinical practice. Nurses must lead from the future and reinvent themselves to achieve their desired career path. Practice in the now, but lead from anticipation of what will happen based on healthcare trends.

Cancer-related fatigue is a serious, debilitating symptom that affects nearly 90% of patients following treatment, with the majority reporting the adverse event at moderate to severe levels. It can prolong hospital stays and limit patients’ ability to complete their treatments and resume daily activities, ultimately affecting quality of life and survival. Despite high prevalence rates, cancer-related fatigue was reported as “inadequately addressed” in findings from a large multisite study.

When a patient comes to the doctor’s office with a generalized symptom such as an ongoing cough or chest heaviness, they are bound to have anxiety. In Wayne’s case, a patient with a lung mass that was identified unexpectedly, his anxiety was further compounded by feeling alone: his wife has dementia and his grown children live out of state. He also lives in a rural area and must drive a significant distance to get to a center for testing and diagnosis.

“If you know other countries and their people, there will be no wars or hatred.” That was the motto I understood when I was younger and I remember participating in international oncology and nursing conferences, exchanging knowledge, resources, and education with other countries. Cancer connects us all, and that maxim has stuck with me and marked my interest in travelling and meeting new people.

Most patients and practitioners associate chemotherapy with cancer treatments, yet the drugs are also used to treat a number of autoimmune diseases, including multiple sclerosis, rheumatoid arthritis, antineutrophil cytoplasmic antibody–associated vasculitis, and systemic lupus erythematosus. 

We’re familiar with the evidence: being active is better for all of us throughout our lives. In fact, regular physical activity is one of the most important things we can do for our health, according to the Centers for Disease Control and Prevention. Physical activity can help to control our weight and reduce our risk of cardiovascular disease, type 2 diabetes, and some cancers. 

For many patients with cancer, surgery is an integral part of the treatment regimen and offers a chance for a cure. This is especially true for patients with pancreatic cancer, where surgery is currently the only potential cure for the disease and a predictor of long-term survival. 

Catheter-associated urinary tract infections (CAUTIs) are associated with significant morbidity and mortality, with an estimated 93,300 urinary tract infections (UTIs) and 13,000 UTI-related deaths occurring each year in acute care hospitals. A preventable cause of UTIs is the use of long-term indwelling urinary catheters, an ideal focus of evidence-based practice initiatives.

The evidence-based practice (EBP) process starts with a clinical question and then proceeds to searching and critically appraising the evidence. Once you have determined that a practice change is necessary, the next step is to integrate that evidence with clinical expertise and patient preferences and values. The last step in EBP is to evaluate the outcomes and disseminate the results. On paper, this flows in an orderly fashion. As clinicians, however, we know that it’s not often that easy or straightforward to change clinical practice. We often face barriers that can make it hard to change, but strategies exist to help facilitate practice change.

One of the most important but often challenging steps in the evidence-based practice (EBP) process is ensuring that the change we wanted to happen actually occurred. After a practice change has been implemented, it’s important to ask if the expected outcome was achieved. Patient-related outcomes can be psychosocial (change in symptoms such as depression or anxiety), physiologic (reduction in catheter-associated urinary tract infections), or functional (increased exercise or mobility). Outcomes can also be process related, such as reduced readmissions or more efficient discharge planning.  

Nursing is often referred to as both an art and a science. Evidence-based practitioners must combine understanding the science of health, illness, and disease with the art of adapting care to individual patients and situations, all while thinking critically to improve patient outcomes.

Changes in technology have brought about significant opportunities in how we identify and manage information. We have access to published research and clinical articles from thousands of journals to answer clinical questions. Finding the right information can be challenging, but building your skills in searching for evidence and synthesizing evidence is critical to becoming an evidence-based practice expert. Here’s how to proceed.

Addressing a clinical problem through evidence-based practice (EBP) involves asking the right questions in the right way, finding the best available evidence, and assessing what practice change may be needed. A core factor in the EBP journey is the development of nurses who possess a spirit of inquiry within a culture that supports a systematic process for asking clinical questions.

That “science, informatics, incentives, and culture are aligned for continuous improvement and innovation” in care delivery through evidence-based practice (EBP) that uses research outcomes, clinical expert perspectives, and patient and family engagement, the National Academy of Medicine Roundtable on Value and Science-Driven Health Care project charter visualizes. By 2020, the goal is to ensure that 90% of clinical decisions are individualized yet supported by the most current, relevant, and best-available evidence and effective tools are in place to measure outcomes. 

Evidence-based practice (EBP) results from the integration of available research, clinical expertise, and patient preferences to individualize care and promote effective care decision-making. Oncology nurses are perfectly positioned to be adopters and promoters of EBP, resulting in practice change for improved quality and safety.

Access devices have been used for decades to administer the complex treatments and supportive care that oncology nurses deliver daily to patients with cancer. As these devices and other products evolve, nurses need evidence-based methodologies for critiquing their safety and effectiveness.