CLINICAL PATHWAYS IN BREAST CANCER TEACH EVIDENCE BASED PRACTICE AND MONITOR NURSING SENSITIVE PATIENT OUTCOMES

2.50
Hdl Handle:
http://hdl.handle.net/10755/165167
Category:
Abstract
Type:
Presentation
Title:
CLINICAL PATHWAYS IN BREAST CANCER TEACH EVIDENCE BASED PRACTICE AND MONITOR NURSING SENSITIVE PATIENT OUTCOMES
Author(s):
Bryce, Jane; Bell, Carol; Connola, Marianna
Author Details:
Jane Bryce, RN MSN, Research Nurse, National Cancer Institute, Naples, Italy, email: janebryce@hotmail.com; Carol Bell, BSN, Stanford Cancer Center, Palo Alto, California; Marianna Connola, RN
Abstract:
Oncology nurses are challenged to develop programs that promote the planning and delivery of evidence based (EB) care and the evaluation of treatment outcomes. Clinical pathways are tools for planning, documenting and evaluating patient care. The purpose of this project was to implement EB symptom management of breast cancer patients using clinical pathways (CP) with a specific focus on EB interventions and nursing sensitive patient outcomes (NSPO) measurement. A multidisciplinary team at NCI Naples developed CPs for patients undergoing breast cancer surgery, radiation therapy, adjuvant therapy and long-term follow-up. Nursing identified 4 initial priority areas for providing EB symptom management: fatigue, lymphedema, oral mucositis, cognitive dysfunction. Fatigue assessment and interventions were based on the NCCN fatigue guidelines and allow for individualized nursing interventions, facilitated during patient visits with the use of the ONS PEP fatigue card. Lymphedema prevention guidelines were based on physiologic rationale and standardized measurement criteria were integrated with patient education materials. Early diagnosis and prompt referral for lymphedema treatment are key outcomes measures. Oral mucositis guidelines were based on existing systematic reviews and included standard grading and oral care instructions. Cognitive dysfunction is screened using subjective patient reports and thresholds that prompt further investigations based on clinician findings and the mini mental status exam. This process was used as a model for teaching EB practice (and some of its inherent difficulties) to nurses. Some lessons learned: Fatigue interventions must be both EB and individualized for this complex and multifactorial symptom. Lymphedema: rational prevention guidelines may be used in the absence of experimental evidence, simple measurement criteria are important for prospective evaluation. Mucositis: Systematic reviews are helpful in teaching about levels of evidence and little experimental evidence was applicable to our setting. Cognitive dysfunction: In depth testing is impractical in the nonresearch setting but increased clinician awareness permits simplified screening and referral. The clinical pathway model provides a method for planning evidence based care with clear measurement and outcome criteria. The model facilitates teaching nurses the process of evaluation of evidence with its application in clinical practice, links interventions with NSPO when applicable, and permits ongoing review.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2007
Conference Name:
32nd Annual Oncology Nursing Society Congress
Conference Host:
Oncology Nursing Society
Conference Location:
Las Vegas, Nevada, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleCLINICAL PATHWAYS IN BREAST CANCER TEACH EVIDENCE BASED PRACTICE AND MONITOR NURSING SENSITIVE PATIENT OUTCOMESen_GB
dc.contributor.authorBryce, Janeen_US
dc.contributor.authorBell, Carolen_US
dc.contributor.authorConnola, Mariannaen_US
dc.author.detailsJane Bryce, RN MSN, Research Nurse, National Cancer Institute, Naples, Italy, email: janebryce@hotmail.com; Carol Bell, BSN, Stanford Cancer Center, Palo Alto, California; Marianna Connola, RNen_US
dc.identifier.urihttp://hdl.handle.net/10755/165167-
dc.description.abstractOncology nurses are challenged to develop programs that promote the planning and delivery of evidence based (EB) care and the evaluation of treatment outcomes. Clinical pathways are tools for planning, documenting and evaluating patient care. The purpose of this project was to implement EB symptom management of breast cancer patients using clinical pathways (CP) with a specific focus on EB interventions and nursing sensitive patient outcomes (NSPO) measurement. A multidisciplinary team at NCI Naples developed CPs for patients undergoing breast cancer surgery, radiation therapy, adjuvant therapy and long-term follow-up. Nursing identified 4 initial priority areas for providing EB symptom management: fatigue, lymphedema, oral mucositis, cognitive dysfunction. Fatigue assessment and interventions were based on the NCCN fatigue guidelines and allow for individualized nursing interventions, facilitated during patient visits with the use of the ONS PEP fatigue card. Lymphedema prevention guidelines were based on physiologic rationale and standardized measurement criteria were integrated with patient education materials. Early diagnosis and prompt referral for lymphedema treatment are key outcomes measures. Oral mucositis guidelines were based on existing systematic reviews and included standard grading and oral care instructions. Cognitive dysfunction is screened using subjective patient reports and thresholds that prompt further investigations based on clinician findings and the mini mental status exam. This process was used as a model for teaching EB practice (and some of its inherent difficulties) to nurses. Some lessons learned: Fatigue interventions must be both EB and individualized for this complex and multifactorial symptom. Lymphedema: rational prevention guidelines may be used in the absence of experimental evidence, simple measurement criteria are important for prospective evaluation. Mucositis: Systematic reviews are helpful in teaching about levels of evidence and little experimental evidence was applicable to our setting. Cognitive dysfunction: In depth testing is impractical in the nonresearch setting but increased clinician awareness permits simplified screening and referral. The clinical pathway model provides a method for planning evidence based care with clear measurement and outcome criteria. The model facilitates teaching nurses the process of evaluation of evidence with its application in clinical practice, links interventions with NSPO when applicable, and permits ongoing review.en_GB
dc.date.available2011-10-27T12:13:43Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T12:13:43Z-
dc.conference.date2007en_US
dc.conference.name32nd Annual Oncology Nursing Society Congressen_US
dc.conference.hostOncology Nursing Societyen_US
dc.conference.locationLas Vegas, Nevada, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.