Oncology Nursing Society

ONCOLOGYNURSINGFORUM–VOL34,NO2,2007473

1825PLEURX CATHETERS VERSUS TRADITIONAL CHEST TUBES FORMALIGNANTPLEURALEFFUSION:ANOUTCOMESMEASUREMENT.Marie Swisher, MSN, RN, OCN®, Sidney Kimmel Cancer Center atJohns Hopkins Comprehensive Cancer Center, Baltimore, MD; andEmily Marshall, BSN, RN, Sidney Kimmel Comprehensive CancerCenteratJohnsHopkinsHospital,Baltimore,MD.

TheuseofPleurX™Pleuralcatheter,alongtermindwellingcath-eterformanagementofrecurrentmalignantpleuraleffusions(MPE)wasrecentlyintroducedinthisNCIdesignatedComprehensiveCan-cerCenter.TreatmentofMPEwasmanagedinthepastbychesttube(CHT)insertionanddrainageoftenusingvideoassistedthorascopy(VAT) and mechanical and/or chemical pleurodesis, with varyingsuccessrates.Atourinstitution,CHTplacementinvolvedanadmis-siontothehospital,averagelengthofstay(LOS)of6.5days,atanaveragehospitalcost(HC)of$41,000.Inaddition,patientsexperi-encedpainoftenrequiringpatientcontrolledanalgesics(PCA).TheintroductionofthePleurX™,whichinpreviousstudiesallowedforoutpatientmanagement,hasofferedanotheroptioninthemanage-mentofMPEforcancerpatients.Previousstudieshaveshownthatthesecathetersareeffectiveat relievingdyspnea,decreasingHCs,andreducingsignificantdiscomfortexperiencedbypatientsprimar-ilyrelatedtoasmaller,moreflexiblePleurX™.

ThepurposeofthispresentationistodescribethisCancerCenter’sexperienceusingthePleurX™duringthefirst12monthsofimple-mentation.ThiswillincludeoutcomemeasurementsofLOS,HCs,painanduseofanalgesics,complications,andhomemanagementis-suesinthisgroupofpatients’comparedtopatientswhohadreceivedtraditionalCHTmanagement.

AnoutcomesdatabasewasdevelopedwithapprovaloftheInsti-tution’sInternalReviewBoard(IRB).OutcomemeasuresfromanequalgroupofpatientsmanagedwithCHTandPleurX™werecom-pared.Acasescenarioapproachwillbeutilizedtoprovideareviewofatypicalpatient’sPleurX™treatmentcourse.

Ananalysisoftheoutcomesmeasurementswillbecompleted.Basedontheseresults,nursingrecommendationswillbedevelopedandin-cludedinpatient&familyandstaffeducationaboutthisnewtherapy.

Asmembersofthemultidisciplinaryteam,oncologynursesareinauniquepositiontostudytheimpactofnewtreatmentmodalitiesonpatientsandassociatednursingcare.Thisreviewcanhelptoquicklyadaptnewteachingmaterials,notonlyforpatientsandtheirfamilies,butalsoforstaff.Developmentofanongoingdatabasewillallowforcontinuedmonitoringoftheeffectivenessofthisnewtechnology.

1841DEVELOPMENTOFAHOSPITAL-BASEDCLINICALRESEARCHDATA-BASE.RosemarieTucci,RN,MSN,AOCN®,LankenauHospital,Wyn-newood,PA.

Investigator-initiatedoncology research in a communityhospitalrequiresdatacollectionbestcompletedwithnursingoversight.On-

cologynursesinterfacewithbasicscientists,physiciansandcomput-erprogrammerstoidentifydatapointstobecollected,theirimpor-tancetodiseaseinitiationandclinicaloutcome,toworkinbuildingtheprogramandthentestit.

Ascommunityhospitalsbecomehybridsofprivatepracticeandhos-pital-basedphysicians,datacollectionforresearchisdifficult.Nurs-ingisthecommonalityofallsettingsandcentralizesdatacollectionbetweenpracticesandthehospitalitself.Whetherfindinganexistingprogramthatwillanswerneedsorbuildingone,amulti-disciplinaryteamisneededtogettherightoneandnursingisakeymember.

Thenursing representativewas identifiedby themulti-disciplin-aryteamastheimmediatecontactand“go-to”personforquestionsandtestingofmodels.Allinformationtobecollectedwasdiscussedbetweenclinicians,basicscientistsandthenurseandthenformattedintospreadsheetsforusebythecomputerprogrammers.Asthesys-tembecamefunctional,thenursepopulatedthesystemwithpracticepatientstotestthesystemfor:easeofdatainput,availabilityofdatainroutineMDchartingandqueryingthedataformissingdatapointsandexpectedresearchquestions.

Oncologyclinicalresearchrequiresspecializedknowledgetoun-derstandtheuniquepatientpopulationsandthemanyendpointsthatcanbeusedtoevaluatecancertreatments.TheClinicalCancerAna-lyticResearchDatabase(CCARD)wasdevelopedtocollectdataon6diseasesites,withafocusonthedatabeinginformationneededtoanswerpotentialquestionsforcombinedinvestigator-initiatedbasicscienceandclinicalresearch.Additionalsiteswillbeaddedastimeandneedsarise.

Ascommunityhospitalsgrow,manybegintoadoptanacademicmodel,which includes investigator-initiated research.Building re-searchprogramming that responds to theneedsofbasic scientistsandclinicalphysiciansneedsapointpersonwhohasknowledgethatbridgestheknowledgerealmsofcomputerprogrammersandcancerspecialists.Theoncologynursefitsthatrolebest,assomeonewhocanspeaktoclinicalissuesinlay-personterms.

1847LDI:THAT’SONESMALLSTEPFORANURSE,ONEGIANTLEAPFORA CANCER CENTER. Camille Servodidio, RN, MPH, CRNO, OCN®,CCRP,HartfordHospital,Hartford,CT.

LeadershipDevelopmentInstitute(LDI)providedtheopportunity,motivation,andtheskillsetforonenursefellowtoworkwithcancernursingcolleaguesonayearlongproject.

ThepurposeoftheLDIprojectwastodevelopandimplementarewardsandrecognitionprogramforcertifiedoncologynursesinacommunityhospital’scancercenter.Noformalcertificationrecogni-tionprogramwasinplace.Implementingachangeinhospitalsettingcanparallelthelandingonthemoon.

A needs assessment survey was developed and distributed to 50nursesinthecancerprogram.19(38%)ofthesurveyswerereturned.Cancerprogramnursesidentifiedplaquesandpinsastwoofthepre-

TheabstractsappearexactlyastheyweresubmittedandhavenotundergoneeditingortheOncologyNursingForumEditorialBoard’sreviewprocess.Ifanyerrorsoromissionshavebeenmade,pleaseacceptourapologies.

Abstractsthatarenotbeingpresenteddonotappear.

Oncology Nursing Society 32nd Annual Congress Podium and Poster Abstracts

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ferredrecognitionitems.DuringNurses’Week,nursingleadersthrewamocktailparty(cocktailswithouttheETOH)andtheVicePresidentofNursingandCancerCenterDirectordistributedOCN®pinstocerti-fiednurses.Certifiednurseswerealsorecognizedfortheiraccomplish-mentsduringtumorboard.NamesofcertifiednurseswerepublishedinNursingSpectrum.Perpetualplaqueswereorderedforeachunittorecognizecertifiednurses.ONCCemployerrecognitionplaqueswereorderedforthethreeunitsthathadgreaterthan50%ofnursescerti-fied.A“100%party”washeldtorecognizethethreeunitsthathadachieved100%OCN®certification.Certifiednurseswerehighlightedincancerprogramnewsletter,hospitalnewsletter,andhealthcareteamnewsletter.The2007ONCCEmployerRecognitionAwardapplica-tionforrecognizingcertifiednurseswassubmitted.

Smallstepsasoutlinedabove,whentakentogether,playanimportantroleinmovinganentirecancercenterforwardthroughimprovedpro-fessionalism,morale, andcelebration.Seniornursing administrationhassupportedthisprojectandhasagreedtofinanciallysupportOCN®reviewcourseaswellastheOCN®testforthosewhopass.Thiscon-cepthasalsobeenadoptedbyotherdepartmentswithinthehospital.

Similartothefirstlandingonthemoon,thisprojectisthebegin-ningofamuchlargervision.Tovaluecertificationistovalueprofes-sionaloncologynurseswhotakethechallenge,maketheleap,andpositivelyimpactoncologypatientcare.

1856ALLA-BOARD:THEEVIDENCEBASEDPRACTICEJOURNEY.CynthiaBriola,BS,RN,OCN®,AndreaM.Barsevick,DNSc,RN,AOCN®,KaronMartyn,RN,BSN,OCN®,NancyFell,RN,OCN®,KathleenMacDonald,RN,BSN,OCN®,andThereseInnamarato,RN,OCN®,FoxChaseCan-cerCenter,Philadelphia,PA.

Amongall health caredisciplines, thevalueofbasinghealth carepractice on high quality evidence is unchallenged. However, due towidevariationineducationalprogramsofrecentRNsandhighnumbersofexperiencednurseswithouteducationaboutevidence-basedpractice(EBP),manynursesdonotknowhowtoengageinthispractice.

TheEBPCouncilatacomprehensivecancercenteracceptedthechallengeandplannedmandatoryEBPeducationforallRNs.Thegoalsoftheprogramwereto:1)supportacultureshiftfrom“tradi-tion” toward EBP, 2) educate nurses about EBP principles, 3) in-creasenurses’comfortaccessingEBPresources,and4)incorporateevidenceintoclinicalpractice.

Afour-phaseeducationalprogrambeganinJanuary2006.InPhaseI,anurseeducatorpresentedanoverviewofEBPincludingbasicprin-ciples.EmbracingEBPincludesthedevelopmentofanewskillset.InPhaseII,EBPCouncilmembersconductedaninteractiveguidedposter presentation of five EBP nursing projects. Small groups ofnursesgatheredaroundeachposter;councilmembersusedaquestion-answerapproachtoconductdiscussionofeachproject.InPhaseIII,librariansintroducednursestoEBPresourcessuchasonlinesearchengines and taughtprinciplesof conducting a searchusingnursingexamples.InPhaseIV,groupsofnurseswillconductunit-basedEBPprojects,withallnursingstaffencouragedtoparticipate.Toassisttheunits,guidelinesareavailable;EBPCouncilmemberswillassistwithprojects.TopicswillbeidentifiedbyJanuary,2007andcompletedbyApril2007.PosterswillbedisplayedinAprilandMay2007.

Attendanceatmandatory sessions isbeingcomputed.Educationondemandorbytaped-videosessionswillensurethatfuturenursingstaffwillbebroughtuptodate.Criteriaforevaluationincludethenumberofclinicalareasandthenumberofnursesoneachshiftwhoparticipate.Evaluationcriteriaforposterswill includeformulationofasearchquestion,evaluationoflevelofevidence,andintegrationintoclinicalpractice.

Thechallengetoshiftournursingculturefrom“traditional”toEBPwasexciting.Welookforwardtoevaluatingtheimpactononcologynursingpracticeandpatientoutcomesinthecomingyear.

1858REDUCINGNOISELEVELSONABUSYONCOLOGYUNIT.KiraRash-ba,BSN,RN,andReedyAnita,RN,MSN,OCN®,JohnsHopkinsHos-pital, Baltimore, MD; and Ilene Busch-Vishniac, PhD, James West,PhD,andMarkMcLeod,JohnsHopkinsUniversity,Baltimore,MD.

Hospitalnoise levelshave increased inrecentyears.This ispar-tiallyattributedtotechnologysuchasmonitors,infusionpumpsandbedalarms.Alarms,combinedwithcall systemsandstaffconver-sations,make foranoisyenvironment.TheWorldHealthOrgani-zation (WHO) and Environmental ProtectionAgency recommendnoiselevelslessthan40-45decibels(dB)duringthedayand35dBatnight.Elevatednoiselevelsmakeitdifficulttohearconversationsbetweenhealthcareproviders,increasingtheriskformedicalerrors.Highernoiselevelsalsocausestressamonghealthcareworkersandpatients have difficulty resting. Oncology units are at a particulardisadvantageasaresultofinfectioncontrolpracticesrequiringhardsurfacematerials.

Noise level on this busy NCI-designated comprehensive cancercenter’shematologyoncologyunitwasirritatingandcauseddifficul-tyonmorningroundsandthroughouttheday.Patientscomplainedofseeminglyconstantalarms,intercomcallsandvoicenoise.Noiselevelsontheunitweremeasuredat70dB,aboutthatofastreetcarpassing,wellabovetheWHOrecommendations.Thepurposewastodecreasesoundlevelsontheunit.

Noisereductionpanelsweredesignedbyacousticalengineersandwereapprovedbynursing,infectioncontrolandhousekeeping.Twoinchfiberglasspieceswerecoveredwithsoundabsorbingmaterialsandwereinstalledonwallsandceilingsofworkareas.Panelsweredesignedtobeeasilyremovedandcleaned.

Acousticalengineersmeasurednoiselevelsbeforeandafterthein-stallationofnoisepanels.Quantitativeandqualitativemeasuresweretaken:noiselevelsandreverberationtimesweremeasuredandpatientandstaffsurveyswerecompleted.Quantitativemeasuresshowedthataftersoundpanel installationnoise levelsdroppedbymore than15dBandreverberationtimesdecreasedbynearlyafactorofthree.Bothstaffandpatientsurveysdemonstratedalessenedperceptionofnoise.

Afterinstallationofnoisereductionpanels,bothpatientsandstaffrealizedanew,quieterenvironment.Hospitalscanintervenetode-creasetheamountofenvironmentalnoise,thusdecreasingtheriskofmedicalerrors,stressofstaffandinterruptionofrestinthehos-pitalizedpatient.

1859INCREASING PATIENT WOC NURSE RESOURCES IN AN ERA OFCOSTCONTAINMENT.ConstanceEllis,MS,RN,CWOCN,OCN®,Uni-versityofTexasM.D.AndersonCancerCenter,Houston,TX.

Thisposter/podiumpresentationwilldiscusshowtwoWound,Os-tomy Continence nurses as a major oncology institution extendedtheservicesofthecertifiedWOCnursesat their institutionandintheircommunity.Thisinformationshouldserveasaguideforothernurses facing the same problem.The problem, an increase in thedemandfortheexpertiseoftheWOCnursesservicesandthelackofeducatednursesortimeorfundstosendthemtotheWOCNurseEducationPrograms, ledto thedevelopmentandpresentationofa“BasicOstomyandWoundCareWorkshop”(Bows).

These8hourworkshopsweredesignedandmarketed(viainhousebrochures,freejournaladvertising,andtheinternet)tonursesinhos-pital,outpatient,longtermcare,andhomecaresettingsoftheHous-

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tonmetroplex.Thecoursefeeof$75coveredacontinentalbreak-fast,lunch,coursematerialsandCNEcredit.

The content of the workshop was divided into 2 four hour seg-ments.TheAM portion focuses on ostomy care covering generalprinciples of assessment and management of patients undergoingGIandGUostomysurgery.Suggestionsaregivenfordealingwithsimple stoma and peristomal complications. Each participant pre-paredandworeapouchuntiltheendoftheday.Thesecondsegmentreviewed basic wound assessment, management and documenta-tionfocusingonpressureulcersandlowerextremityulcers.Usingagamingtechnique/casestudy,woundcareproductswerereviewedandtheparticipantswererewardedprizesfortheirparticipation.

BOW’shasnowbeenpresented10timeswith200nursesattend-ing.InformalsurveysofcertifiedWOCnursesinhospitalandnon-hospitalsettingsreportanincreasednumberofpatientneedsbeingmetinamoretimelymanner,decreasedstressoftheCWOCNsandincreasedjobsatisfactioninthenewlyeducatednurses.

Our oncology patients being treated with surgical interventionssuch as ostomies have psychosocial and physical needs requireknowledgeableandskillednurses.Theseworkshopsopenthedoorto resources for thosenurses andencourage them todevelopnewskillsfortheirpatients.

1865SEXUALITYANDCANCER:HOWONCOLOGYREGISTEREDNURS-ESASSESSPATIENTS’SEXUALITYINCLINICALPRACTICE.JoannMick, RN, MSN, MBA, AOCN®, UT M.D. Anderson Cancer Center,Houston,TX.

Sexuality can be negatively affected by cancer when illness ortreatmentscausedisturbancesinself-conceptand/orbodyimageorresultindifficultieswithsexualfunction.

Adiagnosisofcancerraisescriticalissuesregardingsexualitythatmust be assessed, including: motherhood, fatherhood, femininity,masculinity,andfertility.

A hermeneutic phenomenological approach was used to exploreoncologynurses’experiencesofperformingsexualityassessmentswhencaringforoncologypatients.

Theresearchwasconductedatalarge,comprehensivecancercen-terinthesouthwestUnitedStates.Dataweregatheredthroughase-quenceofaudiotapedinterviewsof20practicingoncologynurses,whichweretranscribedandanalyzed.

Studyresultsrevealedthatsexualityassessmentisadilemmathatnurses face in their practices. Most nurses verbalized understand-ingof the importanceof sexuality assessment.Whilenurseswereable toaskpatientsfor informationaboutmanyothersensitive is-sues,personalconstraintsoftenpreventedthemfromaddressingthetopicof sexuality.A listof identified,often self-imposed,barrierswasrevealedthatprohibitednursesfromassessingpatients’sexual-ity.Nurses’practicesregardingsexualityassessmentoccurred inamilieuthatconsistedoftheirconceptualizationofsexuality,personalworld-views,andindividualeffortstosearchforacomfortlevelthatwouldmakediscussingsexualitymorefeasible.Mostnursesopenlyadmittedtheydidnotdoagoodjobwithsexualityassessment.Somenurseswere able tooffer ideasor suggestions to improvenursingpracticewiththesensitivetopicofsexuality.

Evidencederivedfromthisstudyindicatedthatsimple,shorttermeducational programswill be ineffective inovercoming themajorbarriersthatnursesidentifiedregardingtheopportunityandabilitytoinitiatesexualassessment.Programstoincreasesexualityassess-ment must address factors, such as nurses’ personal comfort withsexuality,individualknowledgelevels,andlanguageskillstoenableroutine initiation of dialogues with patients about sexuality. Pro-

gramsneedtobeongoinginnatureandnursesmustbesupportedastheyreframetheirconceptofsexualityandengageinanewskill.

Researchthatidentifiesstrategiestoenhanceperceivedfacilitatorsanddecreaseperceivedbarriersrelatedtonurses’assessmentofpa-tients’sexualityconcernsshouldcontinuetobeanessentialgoalfornursing.

FundingSource:OncologyNursingSociety

1877PELVICANDVAGINALRECONSTRUCTION:THEROLEOFTHEAM-BULATORY CARE ONCOLOGY NURSE. Nasrin Vaziri-Kermani, RN,CPSN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Certainadvancedcancersofthevagina,ovaries,rectum,andvulvarequire extensive surgical resectionwhichoften leaves thepatientwithalargesurgicaldefectinthepelvic,perineal,andvaginalregionalong with emotional scarring. Specialized reconstructive proce-duresarenowavailabletocorrectthesurgicaldefect.Patientsunder-goingthesecomplicatedproceduresrequireextensivepreoperativeand postoperative education and psychosocial support. Oncologynursesplayanessential role inhelpingpatientsand their familiesmeettheseneedsandininsuringtheyhaveasmoothtransitionfromtheirhospitalstaytotheirhomecaresetting.

Oncologynursesmustbewellinformedaboutthecomplexissuesrelated to pelvic resection followed by pelvic and vaginal recon-structiontoprovideoptimalpatientcare.Experiencednursesplayanimportantroleinsharingtheirknowledgeandeducatingthosenurseswhohavelessexperiencewithregardtothenumerousphysical,psy-chosocial,andeducationalneedsofthesepatients.Thispresentationwilldescribehownursescanbestmeettheneedsofthesepatients.

Nursing interventions focusoncontinuousphysical andpsycho-social assessment and patient and family education. Nurses needto prepare patients for what to expect postoperatively and how tocarefor themselvesathome.Issuessurroundingpotentialchangesinbody image, physical and sexual activity, and altered sensationatthesurgicalsitesneedtobereviewed.Dependingonthespecificsurgicalprocedure,educationinostomyandurostomycaremaybeindicated as well as care of the flap. Patients should be aware ofpotentialcomplicationsincludingileus,flaploss,andinfection.Pa-tientsarealsoathighriskfordevelopingemotionalproblemsinclud-ingdepression,anger,ordisappointmentandmayrequireareferralforcounseling.

Uponpatientdischarge,thenursemakesfrequentfollow-upphonecallsandschedulespostoperativevisitsasneededtoallowongoingevaluationof thepatients’physicalandemotionalprogressand tomakeappropriatereferralsasindicated.

Thisinformationwillprovideoncologynurseswithamorethoroughunderstandingofthespecificneedsofthispatientpopulationandtheappropriatenursinginterventiontoadequatelymeettheseneeds.

1880IMPROVINGTHEQUALITYANDSAFETYOFCAREFORPATIENTSRE-CEIVINGHACE.JeanImler,RN,Queen’sMedicalCenter,Honolulu,HI;CarrieGuyette,BSN,OregonHealthandScienceUniversity,Portland,OR;andJoanneItano,PhD,UniversityofHawaii,Honolulu,HI.

Hepaticarterychemoembolization(HACE)iscommonlyusedtotreatunresectablehepatocellularcarcinoma(HCC).Tomanyoncol-ogynurses,HACEisaninfrequenttreatmentprocedurewithacom-plexpre-procedureprotocolrequiringahighdegreeofcoordinationwiththeMDoffice,radiology,IVteam,pharmacyandnursingstaff.ThiscategorizesHACEasalowvolume,highriskprocedure.

IncreasethequalityandsafetyofcareforpatientsreceivingHACEbyimprovingnursingstaffknowledgeofthecareofpatientsreceiv-

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ingHACE.ThePDCA(Plan,Do,Check,Act)modelwasusedtoguidethisproject.

Basedonextensivereviewofliterature,a30minutein-servicewaspreparedonlivercancer,itstreatments,andnursingcareofthepa-tient receiving HACE pre- and post-procedure and important dis-chargeinstructions.Thein-servicewaspresented3timescoveringallshiftsand50%ofthenursingstaffattended.Foodwasprovidedtoencourageattendance.

Evaluationconsistedofapreandposttestandademographicsec-tiontogatherdataonyearsofexperienceandpreviousexperiencewithHACEpatients.ThepreandposttestmeasuredknowledgerelatedtothecareofpatientsreceivingHACE.Therewasa34%increasefrompretoposttestscores.Thedatawasalsoanalyzedbyyearsofnursingexperience and prior experience with patients receiving HACE.Anincreaseinknowledgeinallgroupswasobserved.

Basedonthesuccessofthisproject,thecareofthepatientreceiv-ingHACEhasbeenaddedtotheannualcompetencyassessmentofallRNstaffandtotheorientationchecklistforallnewRNhires.Acopyofthein-servicematerialswasprovidedtoallstaffandtheauthor is identified as the unit resource.The next step is to meetwiththeradiologyscheduler,MDofficesandbedcontroltoensuretimelyadmissionofpatientsreceivingHACE.ThefinalphasewillbetomonitortheimpactofthisinterventiononpatientsadmittedforHAC,i.e.delayinprocedure,increasedlengthofstayandincreasedtimespentbynursingstafftocoordinatecare.

1881DEVELOPMENT OF A TEACHING TOOL FOR PATIENTS RECEIVINGBRACHYTHERAPY RADIATION AND NON-RADIATION NURSES.DonnaStamatis,RN,BSN,OCN®,andSheilaBrown,RN,BSN,OCN®,MassGeneralHospital,Boston,MA.

Brachytherapyorhighdoseradiationhasbeenaroundfor15-20years.Withnewtechnologyitisnowdoneinanoutpatientsetting.Duetothesechanges,nursesingeneralhaveverylittleexperiencewiththenewtechnology.Therewasaneedforcommunicationbe-tweenradiationnursesandothersinthecancercenter.

Toprovidecommunicationthroughateachingmodelonradiationbrachytherapyfornurseswhocareforthesepatientsastheytravelthrough the cancer center. Developed booklet for teaching.Thesewereimplementedforteachingpatientswithcervical,endometrial,andprostate cancers.The ability toprovide information tonursesoutsideofradiationoncologyinordertoworkcollaboratively.

Teachingtoolprovedinvaluabletopatientsandnon-radiationnurs-es.Patientshadbetterunderstandingoftheirtreatmentandpotentialsideeffects.Nursesfeltmorecomfortablewiththispopulationandwerebetterable tounderstandsideeffectsandsymptommanage-ment.

Patients receiving brachytherapy require teaching and symptommanagementwhichwillprovidecontinuityofcare throughout thecancercenter.Thisrequiresknowledgeandunderstandingofallin-volvedintheircare.

1883IMPLEMENTINGANANTINEOPLASTICHYPERSENSITIVITYPROTO-COL:ANURSINGPERSPECTIVE.CarolWilliams,RN,BSN,OCN®,andShannonPhillips,MS,RN,AOCNS,JamesP.WilmotCancerCenter,Rochester,NY.

Manycancerpatientsreceivemedicationsthathavethepotentialtocausehypersensitivityoranaphylacticreactions,specificallycertainchemotherapyandbiotherapyagents.Efficientlymanagingthesere-actionsiscritical tothepreventionofpatientinjuryordeath.Thismanagementcanbeaccomplishedbyprovidingnurseswithaproto-

colcontainingspecificdruginformation,standingorders,andakitcontainingemergencymedicationsandsupplies.

Thepurposeofthisprojectwastoevaluatenursingstaffknowledgeabout,useof,andsatisfactionwithaprotocoltomanagehypersensi-tivity/anaphylacticreactionstoantineoplasticagents.Theprotocol,whichincludesarequirement toenteraneventreportfor trackingpurposes,wasdevelopedbypharmacyandapprovedbythemedicalandnursingleadershipofalargeoutpatientcancertreatmentcenterinWesternNewYork/FingerLakesRegion.

Datawasobtainedfromnursingstaffviaananonymousselfreportsurvey.Responseratewas100%(N=18).Questionsincludedknowl-edgeofprotocol,useofprotocolinthelast6months,andperceptionsofchangeinpracticesinceimplementationoftheprotocol.Addition-ally,eventreportsforallhypersensitivity/anaphylacticreactionswerereviewed in the six months since protocol implementation (N=26);agentswere38%rituximab,35%taxanes,and27%others.

Themajority of nurses (67%) reportedhaving read theprotocolandknewthelocationoftheprotocolandkit.Themajorityofnurses(89%)reportedthattheprotocolallowsforfasteradministrationofemergencytreatments,hasincreasedtheirawarenessofpotentialforreaction(72%),andhas increased theircomfort levelwithadmin-isteringchemotherapy/biotherapy (77%).Twelvenurses (67%) re-portedcaringforapatientwithareactioninthepastsixmonths,11acknowledgedusingtheprotocoland10enteredaneventreport.

Surveyfindingsindicatethenursingstaffaresatisfiedwiththepro-tocolandreportapositiveimpactontheirpractice.Staffuseoftheprotocolandthegenerationofaneventreportneedstobeincreasedto100%ofthetimewhenapatientexperiencesareaction.Overall,implementationoftheprotocolhasbeensuccessful,andfurtheredu-cationwillbeprovidedbasedonprojectresults.

1890ASSESSING NURSES’ ATTITUDES TOWARD DEATH AND CARINGFOR DYING PATIENTS. Michelle Lange, BSN, RN, OCN®, BridgetteThom,MS,andNancyKline,PhD,RN,CPNP,FAAN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Oncology nurses care for patients in all stages of disease, fromdiagnosistodeath.Patientsatendoflifepresentuniquechallenges,frombothemotionalandphysicalperspectives.Aspreviousresearchsuggests,implementinganeducationalprogramtailoredtooncologynurses’needsmaybeusefulinhelpingtoprovidequalityendoflifecare.However,priortodesigning,testing,andimplementingsuchaprograminahospitalsetting,itisnecessarytofirstdeterminehowthenursesemployedtherefeelaboutcaringfordyingpatients.

Thepurposeofthisstudywastogaininsightintotheissuesthataf-fect,challenge,andconcernoncologynurseswhencaringfordyingpatients, and tomake recommendations for an appropriate educa-tionalinterventiontobedevelopedandtested.

TheNursingRoleEffectivenessModelisbasedonthestructure-pro-cess-outcomemodelofqualitycare.Themodelanalyzesthenurseandpatientvariablesthatmayimpactnurses’roleperformanceandsubse-quentlyinfluencepatientoutcomes.Nursestructuralvariables,suchaseducationandworkexperience,areshowntohavepositiveeffectsoncommunication,contributingtoimprovedpatientoutcomes.

Registerednursesemployedthroughoutthehospitalwereinvitedto complete anonymous, voluntary surveys that consisted of twovalidandreliable instruments, theFrommeltAttitude towardCareoftheDyingscale(FATCODformB)andtheDeathAttitudePro-fileRevised(DAP-R),andabriefdemographicquestionnaire.TheKruskal-WallisandtheMannWhitneyUtestswereusedtocomparedifferencesamongdemographicgroups,withpost-hoctestingusingtheTamhaneandDunnettT3tests.

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Preliminaryfindingsindicatethatageandyearsworkingatthein-stitutionappear tobe strong influencesonattitudes towardsdeathandcaringfordyingpatients.RNswithpreviousworkexperienceincaringfordyingpatientshaveamorepositiveattitudetowardcaringforthesepatients,whilelesspositiveattitudestowardcaringfordy-ingpatientscorrelatedwithmorefearandavoidancetowarddeath.Iftheresultsremainconsistentatthetimeoffinalanalysis,recommen-dationsforanend-of-lifeeducationalprogramwillbedeveloped.

1894MANAGEMENT OF TRIAPINE-INDUCED METHEMOGLOBINEMIA: ACASESTUDY.AikoKodaira,RN,MS,OCN®,andMauraKadan,RN,BSN,JohnsHopkinsHospital,Baltimore,MD.

TriapineisanovelribonucleotidereductaseinhibitorthathasbeentestedinvariousphaseIandIIclinicaltrialstotreatbothsolidtumorandhematologicalmalignancies.Triapineadministrationcancausemethemoglobinemia,andcanbedetrimentalinpeoplewithG6PDdeficiency. On the leukemia unit at this NCI designated Compre-hensiveCancerCenter,nursesbecameawareofseveralsignificantcasesofhypoxemiaaccompaniedbytransientmethemoglobinemiainpatientswithoutG6PDdeficiency.Inthesepatients,themonitor-ingparametersandoptimalmanagementforthisalteredstateofhe-moglobinhavenotbeendetermined.Clearguidelinesformanagingthesepatientsarenecessary.

Thepurposeofthiscasestudyistoidentifyandexplorekeyfac-tors of nursing management for triapine induced methemoglobin-emia inpatientswithmyeloproliferativedisorders(MPD),chronicmyelogenious leukemia in accelerating phase (CML-AP) or blastcrisis(CML-BC),andaggressivechronicmyelomonocyticleukemia(CMML)inordertoprevent,monitor,andmanagethesymptoms.

One patient’s episode of triapine-induced methemoglobinemia isusedasanexampletohighlightthemajorchallengesinmanagingthisissue in theabovepatientpopulations.Aliteraturereviewwascon-ductedtoobtainexistinginformationregardingthiscomplication.

Throughout the case study, the patient’s symptoms, oxygen re-quirements, labvalues, andmedical andnursing interventions areanalyzed.Itisclearthatmanagementofmethemoglobinemiaispar-ticularlychallenginginthesepatientsduetothehighnumberofblastcellsandassociatedanemia.

Inthispatientpopulation,someuniqueissues,suchasleukostasis,hyperleukocytosis-associated anemia, limitation of red blood celltransfusion,andtheincreasedtendencyofcapillaryleakemerged.Ad-ditionalquestions,suchaswhetherorwhenaserummethemoglobinlevelshouldbechecked,orwhentheantidote-methlyeneblue-shouldbeadministered,arealsodiscussed.Thiscasestudyprovidesnursesanopportunitytolearnaboutthislesserknown,butserious,sideeffectoftriapine.Italsoprovidesnurseswiththechancetocriticallyana-lyzethesephenomenainthishighlyuniqueandcomplicatedpatientpopulation,andtostandardizetheinterventionsforamoreconsistentapproachinmanagingtriapine-inducedmethemoglobinemia.

1896ASSESSMENTOFRECOVERYPOSTTRAM(TRANSVERSERECTUSABDOMINISMYOCUTANEOUS)FLAPBREASTSURGERY.DeenaDell,MSN,RN,AOCN®,BC,CarolynWeaver,MSN,RN,AOCN®, JeannieKozempel, PT, MS, and Andrea Barsevik, RN, DNSc, AOCN®, FoxChaseCancerCenter,Philadelphia,PA.

Preparingpatients aboutwhat to expect afterTRAMflapbreastreconstructioniscriticaltorecovery.Aliteraturereviewrevealedalackofstudiesexaminingrecovery.Patientsareusuallytoldthattheywillbeabletoreturntopreviousactivitiesin6to8weeksalthoughthe evidence base for this prediction is lacking. Quality, effective

nursingcareincludesprovidingpatientswitharealisticexpectationofrecoverybasedonevidence.

Studyobjectivesincluded:determiningthedurationandintensityofpainandinterferencewithactivitiesat4and8weeksafterTRAMbreastreconstruction;identifyinginterventionswhichaidinrecov-ery;anddeterminingtheeffectofnursingeducation/informationonthenursesensitivepatientoutcomeofpatientsatisfaction.

Roy’s Model ofAdaptation provided the conceptual framework.Providing patients with evidence-based information and effectivepainmanagementshouldpromoteadaptationwhilelackofknowl-edgeandprolongedpaincould lead tomaladaptive responsesanddelayrecovery.

Aconveniencesampleof25womenwhohadTRAMreconstructionbreastsurgeryagreedtoparticipateinthestudy;thisreportincludes16participantswhoprovidedcompletedata.Theself-administered“Base-lineAssessmentofPain”andphysicaltherapist-completed“Physical/OccupationalTherapyAssessment”(POTA)instrumentswereusedtocollectdatapre-operatively.An“AssessmentofRecoveryPost-TRAMFlapBreastSurgery”questionnairewascompletedat4and8weeks.ThePOTAwascompletedagainat8weeks.Informationsuchaspainsites,painintensity,andpaininterferencewithsevenareasoffunction-ingweremeasured.Variablesincludingpreviousbackpainandtypeofsurgery(freeversuspedicled; immediateversusdelayed)weremea-sured.Descriptivestatisticsandt-testswereusedforanalysis.

Mostwomenhadhigherthanbaselinepainandinterferencescores4weeksaftersurgery;scoresat8weekswerealmostbacktobase-line.SignificantfindingsrevealedthatabdominalpainwashigherforwomenwithfreeTRAMs(p=0.027)andwomenwithpreviousbackpainreportedmorelowerbackpain(p=0.02).Opiods,followedbyNSAIDs,werethemostcommoninterventionusedtorelievepain.Patientswereoverwhelmingsatisfiedwiththeinformationprovidedby thenurse.Nursescanpositively influencepatientoutcomesbyeducatingpatientsabouttypicalrecoveryandusefulinterventions.

1902DEVELOPMENT OF AN ONCOLOGY-SPECIFIC DISCHARGE FORM:SMOOTHING THE TRANSITION BETWEEN HOSPITAL AND HOME.AnitaGrenier,RN,OCN®,DukeUniversityHealthSystem,Durham,NC.

Dischargeneedsofhospitalizedmedicaloncologypatientsareof-tenverycomplex.Thenursingstaffofourunitbelievedthegenericdischargeformprovidedtopatientswasinadequateindocumentingpatientneedsandeducationprovided.Wefeltthataformspecifictotheneedsofoncologypatientswouldimprovethepatientandcare-giver’sabilitytomanageathomeafterhospitalization.Identifyingkeyinformationforreviewaidsnursesinprovidingconsistentandcontinuingeducationupondischarge.

AccordingtoPressGaneysurveyresults,patientsatisfactionscoresonthedischargeprocessandreadinessfordischargehaddeclinedJuly2005–January2006from95%to78%.Believingpreparedpatientsaremoresatisfied,itwasdecidedtopursueaprojecttoincreasepatientandcaregiverknowledgeofandcompliancewithposthospitalizationcare.Thisposterdescribesaspecializedoncologydischargeformcre-atedtoensureconsistencyinoncologynursingpracticeandevaluatethepatient’scomprehensionlevelatthetimeofdischarge.

Afterreviewingasimilarformusedbyacardiologyunit,theformwasmodified to address theneedsof theoncologypopulation.ThecontentiscomprisedofuniteducationalresourcesincludingliteraturefromtheNationalCancerInstituteandclinicalpharmacologymaterials,andincludesstandardizedsections(“Education”,“Post-ChemotherapyInstructions”and“WhentoCall”)uniquetoindividualpatientneeds.Adraftofthedischargeformreceivedfavorablereviewsfromunitstaffaswellasthehospitaloncologyclinicalpracticecouncil(CPC).

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Thecompleteddocumentwasreviewedandendorsedbythehos-pitaloncologyCPCandunitmedicaldirector.Fellowstaffmembersverbalizedtheirconcerns/suggestionsandappropriatechangesweremade.PressGaneyscoresshoweda5-8%increaseaftertheformwasimplemented.Additionally,atelephonesurveyshowedoverwhelm-inglypositiveresponses,with85%statingtheyfeltverypreparedtocareforselfathomeafterdischarge.

Byfocusingontheindividualizedneedsofoncologypatients,wehavecreatedaconsistentandsatisfyingapproachtopreparingpa-tientsandfamiliesfortheirreturnhomeaftertreatment.Otheron-cologynursesmayusesimilarapproachestoincreasepatientsatis-factionbyprovidingconsistentandcontinuingeducationtopatientsuponhospitaldischarge.

1910OUTCOMES OF ONCOLOGY NURSING CRITICAL CHECKS. PatriciaGeddie,RN,MS,AOCNS,M.D.AndersonCancerCenterOrlando,Or-lando,FL.

Nursesresponsible foradministeringantineoplasticagents,man-agingtreatmentrelatedsideeffectsandemergenciesarerequiredtohave specializedexpertiseandclinical competency todelivercareinasafeandappropriatemanner.Over theyears, thenumberandcategoriesofagentsandsideeffectprofileshaveincreased.Nursesenteringintothespecialtyofoncologynursingcanbeoverwhelmedbytheamountofclinicalknowledge,competencyandresponsibilitythattheyareexpectedtopossess.

To reduce the number of oncology care related errors and im-provenursingsatisfactionbyprovidingaconcisechecklist,“CriticalCheck”forthedeliveryoftreatmentandcaremanagementofoncol-ogypatients.

CriticalcheckswerewrittenanddevelopedbyOncologyClinicalNurseSpecialisttoprovideachecklistforcommonproceduresandcare issues for oncology patients: Chemotherapy administration,spills and extravasations; Radiation therapy; Neutropenia, Ane-mia,Thrombocytopenia;andOncologicEmergencies.TheCriticalChecksareprovidedanddiscussedintheoncologynursingcoursesandarealsoavailableforprintingonthehospital’sintranetoncologynursingsite.Atthebottomofeachcriticalcheck,astatementisin-cludedthatthecriticalcheckisnotallinclusiveandrefersthenursetoseekoutmoreinformationisneeded.

Verbal feedback from nurses have indicated that the criticalchecks are a useful tool to guide them in the care of the oncol-ogy/hematologypatient.Thehospital’scomputerdepartmentwasnot able to track thenumberofnurseswhoaccessed the criticalchecksontheintranetsite.Theoncologycriticalcheckshavebeeninexistencesince2002.Thecriticalcheckshavebeenre-evaluatedandupdatedbyacommitteeofoncologynursingstaff,educatorsandadvancepracticenursesforcontentandrelevance.In2006,thehospital’s intranet dedicated a site for all nursing critical checksandothernursingdisciplineshavepostedtheircriticalchecksthereaswell.

Critical checks for oncology nursing care are a way to providestandardandorganizedinformationaboutessentialstepstoprovideanddelivercare.Acommitteeofadvancedoncologypracticenurses,staffnurses,educatorsandleadershipmustbecommittedtotheon-goingevaluationandupdatingoftheinformation.

1911IMPLEMENTINGATOBACCOCESSATIONTRAININGPROGRAMFORSTAFFNURSESINACOMMUNITYHOSPITALSETTING.PamelaMat-ten,RN,OCN®,St. JosephHospital ofOrange,Orange,CA;EuniceChung, PharmD, Western University, Pomona, CA; Dana Rutledge,

RN, PhD, St. Joseph Hospital of Orange, Orange, CA; and Siu-FunWong,WesternUniversity,Pomona,CA.

Approximately85%oflungcancerisattributedtocigarettesmok-ing.Smokersofferedadvicefromanursewere50%morelikelytoquitcomparedwithsmokersnotofferedsuchadvice.Veryfewpro-gramsareavailabletoempowernursestoprovidetobaccocessationeducationtopatients,andfewnurseshavebeenexposedtosuchcon-tentintheirnursingeducation.

Todescribeatrainingprogramdesignedtoeducatebedsidenursesinacommunityhospitalwithtools,knowledgeandconfidencenecessarytoprovidepatientswithinitialtobaccocessationinterventions.

Rx for Change: Clinician-Assisted Tobacco Cessation Program,designedforpharmacyschoolsasa7-8hourcurriculum,wasmodi-fied intoa3hourprogram, incorporatingboth lecture (behavioralcounseling and pharmacotherapy) and role-playing. The trainingprogram,taughtbyanoncologynurseandapharmacist,istailoredforinpatientnursesandemphasizesthefirstfourof5A’s(Ask,Ad-vise,Assess,Assist,Arrange).

A pilot study from one training session with 20 nurses showedthatnurseattendeeshadgoodtoverygoodratingsofoverallabilityto help patients quit tobacco and that 49% found the informationtobecompletelynew.At6monthsfollow-up,allrespondentshadcounseledorreferredatleastonepatienttoaquitsmokingprogram.Thepilotindicatedthatknowledgegainswerenotmaintainedover6months.

Knowledgemaybeimprovedbyaddingsomemethodofrefresherinformation tohelpwithknowledgeretention.Thiscoursewillbeamandatoryinserviceforallnursesatthecommunityhospital;ap-proximatelythreeyearswillberequiredtoeducateallnurses.Nurs-estakingthecourseduring2007willbeinvitedtoparticipateina1yearclinicaltrialevaluatingtheeffectofapretestonknowledgeand attitudes.This presentation will describe the modified Rx forChangecourse.

1913NURSINGRECOGNITION&RETENTION:HOWONEUNITRECOG-NIZES AND PROMOTES ONCOLOGY NURSING CERTIFICATION.AnnaGiallo-Uvino,RN,BSN,OCN®,SuzanneSweeneyGornell,andMaryG.Boyle,RN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Oncology nurses at a comprehensive cancer center identified aneed to promote certification among its nursing staff.Although anumberofnurseshadobtainedthecertification,anequalnumberofnurseswerenotcertified.Withtheincreasingcomplexityofcancertreatments,certificationprovidesameasureofexcellence.

Developingaformalprocessofrecognizingandencouragingnurs-estobecomecertifiedhelpswithjobsatisfactionandretention.Thispresentationwilldescribethestepstakentoacknowledgeoncologynursingcertificationandineffectenhancetheoncologynurses’pro-fessionaldevelopmentinoneoutpatientdepartment.

Aspartofthesharedgovernancecommitteestructure,theRecruit-ment,RecognitionandRetentionCommitteewasformed in2006.One of the goals of this task force was evaluating the number ofcertifiednursesinthefacility.Wesurveyedthenursesinourgeni-tourinary medical oncology and urology department via an emailquestionnaire.Resultsindicatedthat21of42staffnursesarecerti-fiedinoncologynursing.Torecognizethisachievement,threeoftheoutpatientnursesorganizedanumberofactivitiessuchasobtainingacertificationplaquefromtheOncologyNursingCertificationCor-poration(ONCC),aplaquededicationparty,andpublicrecognitionofthenurses’accomplishmentsintheNursingSpectrum.Ourplaqueisdisplayedinourlobbyforallpatientstosee.

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Certificationinoncologynursingisaspecificwaytoensurethatnurseshavetheeducation,skillandknowledgetopracticeinacom-petent manner. Certification promotes professional development,opensdoorstonewcareeropportunities,andisvaluedbyemployersand patients. By highlighting the accomplishments of the depart-ment’scertifiednurses,wecanpromoteandmentormorenursestopursuetheircertification.

OCN®certificationisaprofessionalachievementthatnursingad-ministrationbelievesinandsupports.Encouragingdialogueoftheprocessbetweenstaff,postingdeadlinesforthetestandtheappli-cationprocess,timeofffortesttaking,ahospitalapprovedreviewcoursearewaystosupportstaffinthisendeavor.Thisproject,thoughsmall inscaleresulted inpositivelyaffecting thepursuitofoncol-ogynursingcertification.Sincetheproject’sinitiation,3additionalnursesinourunithavesuccessfullytakenthetest.

1914EYEONTHECOMMUNITY:THEROLEOFACANCERTELEHEALTHNURSINGSERVICE IN IMPROVINGPATIENTANDFAMILYEDUCA-TION,ACCESSTORESOURCESANDCLINICALTRIALENROLLMENT.RebeccaEggleston,RN,OCN®,UniversityofMichiganHealthSystem,AnnArbor,MI;andKimberlyZapor,RN,BSN,OCN®,AnnetteSchork,RN,BSN,OCN®,andJeanCampbell,RN,UniversityofMichiganCan-cerAnswerLine,AnnArbor,MI.

Individualswhohavebeendiagnosedwithcanceraswellastheirfamily members and friends often seek a comprehensive resourceforcancer information,andmayneedassistance innavigating thecancercaredeliverysystem.CancerAnswerLine,acancertelenurs-ingservice,invitesthoseaffectedbyacancerdiagnosistocalltollfreeorsubmitanonlinerequesttocommunicatewithanexperiencedoncologynurse.

Thepurposeof thisposterpresentation is todescribe the impactof a singular cancer telenursing serviceon thepatient, andhealthprofessionalcancercommunity.

Establishedin1995,CancerAnswerLinehasbeenmarketedthroughprint,radio,webandoutdoorvenueswiththevisionofincreasingpublicawarenessofatrustedanduniquecommunityserviceavail-ableforinformationseekerswithquestionsaboutcancerprevention,diagnosis,treatmentandaccesstoclinicalresearch.ThoseseekinginformationneednotbepatientsattheUniversityofMichigan.Pro-gramrequirementsincludeanestablishedriskmanagement,policyandproceduresprogram,HIPPAcompliantsoftwareforinteractiondocumentation,andasecureonlineemaildatabaseprotectingsensi-tivepatienthealth information.NursesstaffingCancerAnswerlinehaveextensiveoncologybackground,andareexpectedtobefamiliarwithandcomprehendcurrentcancerrelatedissues,pursueoncologycontinuingeducationcredits,andoncologynursingcertification.As-sessment of service and value to the cancer community has beenmeasuredthroughdirectmailcustomersatisfactionsurvey,spokenandwrittencomment,establishedpartnerships,benchmarking,anddatacapturedthroughbothtelephoneandsoftwarefunctionality.

CollectionandinterpretationofdataevaluatingtheoverallimpactofCancerAnswerLineonthecommunityisinprogress.Datarep-resentingcallerdemographics,reasonforcall,cancersite,numberof cancer related service and clinical research referrals, total call/emailvolume,andpatient/familydirectmailsurveyresultswillbepresented.Alsoprovidedwillbesubstantiationofourcollaboratoryrelationshipsandbenchmarkingexperienceswithinthehealthpro-fessionalcommunity.

Acancertelenursingserviceoffersthecancercommunityauniqueopportunitytoreceiveinformationtailoredtospecificneedfromanexperiencedoncologynurse. It fulfills thepublicneed for reliable

cancereducationandimprovesaccesstoappropriatecancercareandsupportservices.Asuccessfulcancertelenursingprogramenhancescommunicationbetweenhealthprofessionalsandthecommunityandservesasanintegralelementofthecancercaredeliverysystem.

1917GENDERANDETHNICITY:ARETHEYINFLUENCINGCANCERPAIN?Eun-OkIm,PhD,MPH,RN,FAAN,WonshikChee,PhD,EnriqueGue-vara,MSN,YiLiu,MSN,andHyun-JuLim,MSN,UniversityofTexasatAustin,Austin,TX;andHsiu-MinTsai,PhD,ChangGungInstituteofTechnology,Taipei,Taiwan.

Studieshavereported inconsistentfindingsongenderandethnicdifferences in cancer pain experience, and the inconsistency sug-gestsfurtherinvestigationsonthistopicforappropriatecancerpainassessmentandadequatecancerpainmanagement.

Thepurposeofthestudywastoexploregenderandethnicdiffer-encesinpainexperienceoffourethnicgroupsofcancerpatients.

Afeministperspective theoreticallyguided theresearchprocess:genderandethnicitywereviewedasimportantfactorsthatinfluencedcancerpainexperiencewithintheU.S.multiculturalcontexts.

Thiswasasurveystudyamong480multiethniccancerpatients.Theinstruments includedquestionson sociodemographiccharacteristicsandhealth/illnessstatus,threeunidimensionalcancerpainscales,twomultidimensionalcancerpainscales,theMemorialSymptomAssess-mentScale,andtheFunctionalAssessmentofCancerTherapyScale.Thedatawereanalyzedusingdescriptiveandinferentialstatistics.

Certaingenderandethnicdifferencesintypesofpainandsymp-tomsthatpatientsexperiencedwerefound.Also,thefindingsindi-catedstatisticallysignificantgenderdifference in functionalstatusandethnicdifferencesincancerpainandfunctionalstatus.Womenreported higher cancer pain, symptom, and functional scores thanmen.Comparedwithotherethnicgroups,Asiansreportedthelow-estcancerpainscoresandpainreliefscores;AfricanAmericansre-portedthelowestsymptomscores;andHispanicsreportedthehigh-estfunctionalstatusscores.Thefindingssupportgenderandethnicdifferences incancerpainexperienceandsuggest further in-depthnational-scopestudiesonthistopic.

1918THE DECISION TO CREATE AN OFF-CAMPUS, HOSPITAL-BASEDCHEMOTHERAPYSATELLITE.MarciaGruber,RN,MSN,MS,DebraSmith,RN,OCN®,NancyBertran,BSN,OCN®,andMelissaTherrien,BS,RoswellParkCancerInstitute,Buffalo,NY.

As thedemandforcancercare increases,hospitalsmustaccom-modatemorepatientswhorequirechemotherapy.Weexperienceda12%increaseinpatientvisits,anincreaseinaveragetreatmenttime,long wait times for treatment starts, and staff overtime costs thatmorethandoubled.Eventually,allspaceandstaffingoptionsinourexistingInfusionCenterwereexhausted.Beforethegrowingvolumecompromisedpatientsafety,administratorsandcliniciansalikebe-lieveditwastimetolookforexpansionoptions.

To maintain our quality of care and improve service delivery, ateamofclinicians,administrators,decisionsupportandfacilitypro-fessionalscarefullyexaminedtheadvantagesandchallengesofcre-atingaremotechemotherapylocation.

The multidisciplinary team assessed the financial and operationalimpact,patientpreferences,patientdemographicsandregulatoryis-suesandrecommendedthatanoff-campussatelliteofficebecreated.Abusinessplanandsiteselectioncriteriaweredeveloped.Thenurseandphysicianteammembersdeterminedwhichdrugscouldbesafelyadministeredoff-campus.Theproportionofresearchversusstandardprotocolappointmentsandthenumberofpatientswhorequiredsame-

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day labs and concurrent transfusions were determined. Nurses anddoctorswereaskedwhatissuestheymighthaveaboutanoff-campuslocation.PatientFocusgroupswereheldandtheliteraturereviewedforevidence-basedbestpractices.TheFacilitiesrepresentativeseducatedusonregulatoryandbuildingcodes.ThisinformationledtheTeamtorecommendthatanoff-sitechemotherapyclinicbedeveloped.

Thebusinessplandemonstratedthattheprojectwasviableandasuitablelocationwasfoundthatmetallcriteria.TheCenteropenedtoenthusiasticreviewsinOctober2006andthePatientSatisfactionSurveyresultsrevealhighlysatisfiedpatients.

Thenurseswere integral indescribing theoperationalprocessesandpatientsafetyconsiderationsthathadtobeconsideredthrough-outthedevelopmentofthebusinessandoperationsplans.Ateachpotential location,oneor twonursesassessedaccessibility,safety,throughput potential, and the work environment. Once a locationwasselected,theexpertiseoftheoncologynursebecameevenmoreimportantinthedesignofthespaceandoperationalprocesses.1928AN EXPLORATION OF HOW CONTEXTUAL FACTORS INFLUENCETHEHISPANICCANCERPATIENTS’ATTITUDESTOWARDINTERNETCANCERSUPPORTGROUPS (ICSGS). EnriqueGuevara,MSN,RN,Eun-OkIm,PhD,RN,MPH,CNS,FAAN,andWonshikChee,PhD,Uni-versityofTexasatAustin,Austin,TX.

Cancer accounts for 20% of deaths in Hispanics in the UnitedStates.Internetcancersupportgroupshavebeenshowntobebenefi-cialinhelpingpatientswithcopingstrategies.Hispanicparticipationinsupportgroupsislacking.

The purpose is to explore how contextual factors influence theHispanic cancer patients’ attitudes toward Internet cancer supportgroupsthroughasecondaryanalysisofqualitativedatafromalargerstudyoncancerpainexperienceofpatientsintheUnitedStates.

The feministperspective forms the theoreticalunderpinnings forthisstudy.

Asecondaryanalysisofthedatacollectedfromalargerstudyoncancerpainmanagementwasconducted.The study includedbothquantitativeInternetsurveyandqualitativeonlineforums.Forthissecondaryanalysis,onlineforumdataamong15Hispaniccancerpa-tientswereevaluatedusingathematicanalysistoexplorecommonthemesintheirattitudestowardInternetcancersupportgroups.Also,the Internet survey data among the 15 participants were analyzedtodescribetheirsociodemographiccharacteristicsusingdescriptivestatistics.Theparticipantsoftheonlineforumwererecruitedamong105HispanicInternetsurveyparticipantsofthelargerstudyusingaconveniencesamplingmethod,andtheonlineforumdatawerecol-lectedusing10discussiontopicsrelatedtocancerpainexperience.TheInternetsurveydataanalyzedinthisstudywerecollectedusingInternetsurveyquestionnaireincludingsociodemographicquestionsandself-reportedhealth/diseasestatus.

ThreethemesrelatedtoHispaniccancerpatients’attitudes towardICSGs emerged from this preliminary on-going analysis. First, theculturalvalueoffamilisminfluencedcancerpatients’attitudestowardICSGs.Duetofamilism,thefamilyoftentooktheplaceofthefor-malsupportgroupamongHispaniccancerpatients.HispaniccancerpatientstendedtohavenegativeattitudestowardICSGsbecausetheInternet requiresnon-face-to-face interactions.Second,manyof theparticipantsofthestudywerenotabletoparticipateinICSGsduetothelanguagebarriers.Lastly,HispanictraditionalgenderroleshadanimpactonHispanicwomen’sparticipation in ICSGs.The research-er should know the strengths and weaknesses of using the InternetmethodforsupportgroupstructureamongHispaniccancerpatientsinordertofurtherresearchwiththeInternetcancersupportgroups.

1929THELEADERSHIPROLEOFTHECNSINONCOLOGYPROGRAMDE-VELOPMENT.KarenStephenson,RN,OCN®,MSN,MBA,MercyHos-pital,Miami,FL.

This poster describes the Clinical Nurse Specialist’s leadershiproleinbuildinganoncologyservicelinethroughtheadvancementofnursingpractice,programimprovementinitiatives,andstaffeduca-tion.Thisadvancedpracticenurseleadseffortstodevelopstaffandprogramstoprovideevidence-basedoutcome-guidedpractice.

Wedesignedourcancerprogram“pyramid”onastrongfounda-tion–themissionandvisionoftheorganization;financialviability;innovative,cuttingedgecancertechnologies;andnursingandphysi-cianexcellence.Our“pyramid”includesbasicandcriticalbuildingblocks:evidencebasedpractice,patientcareservicesacrossthecon-tinuum,collaborationwithcommunityliaisons,andhealthandwell-nessprograms.Somechallengestogrowingthisservicelineincludeprovidingcaringpracticesinamulticulturalhospital,promotingourreputationandlongstandingcommunityrelationships,andidentify-ing,defining,andpromotingcancerservicestoourcustomers.

Duringourprogramexpansion,theCNScreatedanenvironmentthrough mentoring and system change that empowered nurses toserveaspatientadvocates.

ThroughtheleadershipoftheCNS,incollaborationwithmembersofthehealthcareteam,ourorganizationiscommittedtoprovidingandcoordinatingqualitycancercareforourcommunity.

1932DEVELOPMENT OF AN ADVANCED PRACTICE ONCOLOGY NURSEFELLOWSHIP.JoyceDains,DrPH,JD,RN-BC,FNP,NAP,CarolDall-red,RN,MSN,WHCNP,JoyceNeumann,RN,MS,CNS,OCN®,andBarbara Summers, PhD, RN, U.T. M.D. Anderson Cancer Center,Houston,TX.

Preparationforadvancedpracticenursing inoncologywaschal-lengedwhenthestateBoardofNurseExaminersceasedtorecognizeoncologynursingasanadvancedpracticespecialty.Wedevelopedayear-longpost-graduatefellowshipinoncologynursingtoprovideadvancedpracticenursestheopportunitytodevelopexpertiseincan-cercare.

The purpose of the fellowship is to promote advanced practicepreparationinoncologynursingandtoenhanceexpertiseincancercareattheadvancedpracticelevel.Fellowsgainin-depthknowledgeandexperienceinevidence-basedclinicaloncologypracticethrougha structured curriculum, and grow into increasingly independentpracticeundertheguidanceofAPNpreceptors.

Chiefelementsofprogramdevelopment includedgainingsupportofstakeholders,partneringwithaschoolofnursing,establishingamultidisciplinary curriculum, identifying appropriate outcomes andevaluationcriteria,marketingtheprogram,andimplementingacom-petitiveselectionprocess.Uniquetothisprogram,fellowsarehiredasemployee-traineesinfullsalariedpositions.Allfellowscompleteacorecurriculumlasting4-6monthsthatincludesmandatoryrotationsandclassesthatcoverthefullspectrumofcancercare,bothinpatientandoutpatient,and9hoursofpostgraduatecreditat theschoolofnursing.Eachfellowselectsaspecialtyfocusfortheremainderofthefellowshipforconcentratedclinicalpracticeandexperiences.

Weweresuccessful inbringing thefellowshipfrominception toimplementationinlessthanayear.Thecompetitiveprocessensuredselection of fellows with the skills, motivation, and flexibility es-sentialtotheirsuccess.Theemployee-traineestatusenablesfellowstoparticipateinallaspectsofpatientcare,congruentwithrolesandfunctionofAPNsattheinstitution,andtoenjoyfullemployeeben-efits.Fellowsareexpectedtocompleteanevidence-basedpractice

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project and disseminate project results. Fellows are expected topursueAOCNP/AOCNS certification. Formal program and fellowevaluationareongoing.The fellowsagree that theexperienceandopportunities are unparalleled, and the institutional response hasbeenenthusiastic.

Thelength,depthandscopeofthefellowshipmakeitunique.ThefellowshipfillsaspecialneedinthedevelopmentofAPNswithex-pertise in cancer care and contributes to workforce enhancement.Programexpansionisplanned.1936INTRAPERITONEALCHEMOTHERAPYANDINTRAPERITONEALCATH-ETERCARE:ANURSINGMANAGEMENTPERSPECTIVE.EvelynMa-rinas,RN,BSN,OCN®,andStellaDike,RN,UniversityofTexasM.D.AndersonCancerCenter,Houston,TX.

A clinical trial conducted by the Gynecologic Oncology Group(GOG), revealeda significant increase in thenumberof survivingpatients who received chemotherapy through Intraperitoneal (IP)Chemotherapy when compared to outcomes of administration viathetraditionalintravenousroute.Intraperitoneal(IP)Chemotherapyisamethodtodirectlyinfusechemotherapyintotheabdominalcav-itywheremostovariancancercellscirculateandspread.Thebenefitappears to be approximately a 12-month improvement in medianoverallsurvival(range0-16months).Chemotherapyagents,suchasCisplatinandPaclitaxelcanbeadministeredviaanexternalintraper-itonealtunneledcatheter(Tenckhoff)orasubcutaneouslyimplantedintraperitonealport.AnincreaseinnumberofpatientswithIPcath-etersonagynecologyoncologyunitcreatedaneedforanevidence-basedpolicyandprocedureforIPcathetercare.

The purpose of this project was to develop a standardized, evi-dence-basednursingprocedure/policytoguideclinicalnurses’prac-ticewithcathetercareandmaintenance

TheNursingPracticeCongress(NPC)governancestructureinourcomprehensivecancercentersupportsprofessionalnursestoinflu-encepracticeoutcomesanddevelopevidence-basednursingprac-ticestandards.ProfessionalActionCoordinatingTeams(PACTs)arecreatedtodiscussanddevelopresolutionstoissuesidentifiedattheprimary level of care.Theneed for a standardizednursingproce-dure/policyforpatientsreceivingIPchemotherapywaspresentedtotheNPCandaPACTwasformed.InterdisciplinaryIPPACTteammembersreviewedavailable literatureandguidelinestodeterminebestpracticesforIPcathetercare.

The completed IP chemotherapy policy/procedure has been pre-sented to the NPC for approval and will be communicated to thenursingcommunityasapracticeguide.

ThePACTidentifiedthatpatients’IPchemotherapyhadbeendis-continued in other settings due to complications such as catheterblockage,catheterleakandcatheterinfections.Basedonthereviewofliterature,theIPPACTdraftedanIntraperitonealMedicationAd-ministrationPolicy/Procedure.Recommendationsincluded:(1)As-sessthecatheterorportforpatencybyflushingwithnormalsalinetoensurethereisnoresistanceorleakage.(2).Recheckpositionofthehueberneedleandre-accessifleakageoccurs.(3).Useaseptictechniqueforcathetermanagementstopreventcatheterinfection.

1938EFFECTS OF AN EDUCATIONAL INTERVENTION ON BREAST CAN-CERSCREENINGANDEARLYDETECTIONINVIETNAMESEAMERI-CANWOMEN.Tuong-ViHo,RN,PhD,M.D.AndersonCancerCenter,Houston,TX.

CanceristheleadingcauseofdeathfortheAsianAmericanpopu-lation. Breast cancer is the most common cancer in Vietnamese

women,andtheyareoftendiagnosedwithbreastcanceratayoungerage.About50%ofthewomenareyoungerthan50yearsofageattimeofdiagnosiswithadvancedstages,whichmakesoptimaltreat-mentdifficult.Educationoftheimportanceofearlyscreeninganddetectioncouldpossiblyimproveandsavelivesinthispopulation.

Thepurposeofthisstudywastoevaluatetheeffectsofacultur-allysensitiveeducationalinterventiononbreastcancerknowledge,breast cancer health beliefs, breast-self-exam (BSE) knowledge,BSEpracticesanditsconfidencelevels,mammogramactivities,andclinicalbreastexaminagroupofVietnameseAmericanwomenliv-ingintheHoustonvicinity.

TheHealthBeliefModel(HBM)andcomponentsofLeininger’stransculturalnursingtheorywereusedasthetheoreticalframework.

MethodsandAnalysis:Thiswasanexperimentaltwo-grouppre-test/post-teststudy.Usingchi-squareandone-wayANOVAstatisti-cal analysis, demographic data and the effects of the interventionwereevaluatedinasampleof94VietnameseAmericanwomenwhowererandomizedtocontrolandexperimentalgroups.Datawasob-tainedatbeforeand3monthsaftertheeducationalintervention

TwocomponentsoftheHBM(perceivedseriousness,p<0.01,andperceivedbenefitp<0.01)werefoundtobesignificantlydifferentbetweenthe2groups.ThereweresignificantincreasesinthelevelofBSEknowledge (p=0.005), levelofconfidence inperformingBSE(p=0.009),ahigherself-reportofBSEpractice(p=0.007),andanincreaseinbreastcancerknowledgewithintheinterventiongroup(p=0.000).Nosignificantchangeswerefoundinself-report-edmammogramactivitiesandclinicalbreastexam.However,about80%of theparticipantsreportedthat theyhadmadeappointmentsformammograms.

Thesefindings indicate thataculturallysensitiveeducational in-terventiongivenbyanoncologynursehadapositiveimpactonthehealthbeliefs andpractices related tobreast cancer screeningandearlydetectioninthispopulation.Thisinterventioncanbeusedasamodelforotherethnic-specificoncologyeducationalprograms.

1939ASHAREDGOVERNANCEMODEL—THENURSINGPRACTICECON-GRESS.DeborahCline,BSN,RN,OCN®,andPatriciaJohnston,RN,MHA,OCN®,UniversityofTexasM.D.AndersonCancerCenter,Hous-ton,TX.

Implemented in February 2006, the Nursing Practice Congress(NPC)hasempoweredtheclinicalnursesatalargecomprehensivecancerinstitutetohavecontrolovertheirpractice.

Basedonasharedgovernancecongressionalmodel,the34peer-electeddelegateshavebeenpresentedwithover45clinicalnursingissues.EachissueisevaluatedbytheNPCandifthereisnoexist-ingcommittee inplace to resolve the issue,aProfessionalActionCoordinatingTeam(PACT)isformed.EachPACTisashortterm,multidisciplinarycommittee,chargedwithresolvingtheissuewithinatimelineformulatedbythegroup.InadditiontoameetingstructuredesignedbythePACTtoencourageattendance,thePACTshavetheuseof anelectronicbulletinboard to increase theparticipationofoff-shiftstaffandthosewhoworkatoff-sitelocations.Theconclu-sionsarethenpresentedbeforetheNPCandaredirectedtotheap-propriateareaforimplementation.

Acasestudyworkflowofaclinicalissuewillbeincluded.Fromtheidentificationoftheissuetotheconclusion,thestructureforre-solvingnursingpracticeissueswillbedetailed.

An additional charge of the NPC has been to increase nurse’sawarenessofcurrentnursingpracticeissues.Workingwithourin-formationsystemsdepartment,auniquedatabasewasdevelopeden-ablingnursestosubmitnewissues,trackcurrentissues,andreview

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resolvedissues.Monthlynewslettersandupdatesareprovidedbythepeer-electeddelegatestotheirconstituency.

Staffparticipationhasbeentrackedanddemonstratesanincreaseintheparticipationfromalllevelsofnursingwithinourinstitution.Additionally,aquantitativestudyisindevelopmenttomeasuretheeffectivenessofthesharedgovernancestructure.

The implementation of a new shared governance structure takestimebut,withtherighttoolsinplaceandthroughmanagementsup-port,our institution is leading theway inempowering theclinicalnurses.Todate,22PACTshavebeenformedandhavecompletedorareworkingtowardsissueresolution.

1940FACTORS AFFECTING PROSTATE CANCER SCREENING DECISION-MAKINGAMONGBLACKS.RandyJones,PhD,RN,RichardSteeves,PhD,RN,FNP,FAAN,andIshanWilliams,PhD,UniversityofVirginia,Charlottesville,VA.

Blackmenare2-3timesmorelikelytobediagnosedwithprostatecancerthanWhites.Culturalbeliefsplayamajorroleinscreeningbehaviors.Thesebeliefsmayassistinthedecisionwhetherornottobescreenedforprostatecancer.Toprovideculturallysensitivecare,healthcareprofessionalsmustbeawareofthesebeliefs.

Thepurposeofthisstudyistounderstandprostatecancerscreeningdecision-makingamongruralBlacks.Thestudy’sgoalistoconductanin-depthanalysisofbeliefsonprostatecancerscreeningamongruralBlacks.Howthesebeliefsandattitudesmayormaynothaveinfluencedtheirhealthdecision-makingprocesswereexploredalso.

Thisstudyusedaqualitativedesign.Thedatathatisbeinganalyzedutilizesthehermeneutic/phenomenologicalapproachtoexplorethe“livedexperiences”oftheparticipants.The“livedexperiences”re-latedtotheparticipants’viewsonprostatecancerscreening.

Thesampleincludesage40andolderBlackmenwhoneverbeendi-agnosedwithprostatecancer,butmayormaynothavebeenscreened.Participant recruitment takes place at rural community centers (i.e.barbershops and churches). Semi-structured interviews exploredhealth status, demographics, prostate cancer screening knowledge,healthcare providers and family interactions, and religious beliefs.Datacollectionwillbe terminateduponmomentofdatasaturation.Datawillbeanalyzedusingqualitativeanddescriptivemethods.

Thestudyisstillunderway.CurrentfindingsincluderuralBlackmennotbeingawareoftheincreaserisksofbeingdiagnosedwithprostatecancer,and the importanceof family indeciding tohaveaprostatescreening performed.These men reported it was much later in lifeuntiltheyheardaboutprostatecancer.Morefindingswillemerge.

Theresultswillgivehealthcareproviderscluesinhowtosustainand improve care they deliver to this vulnerable population. Thefindingswillaidinthedevelopmentofaculturally-sensitivedecisionaid.The studyhasgreat promise to improve interactionsbetweenhealthcareprovidersandpatientsandpromoteunityamongthecom-munityandhealthcaresystems.

1941EMPOWERINGTHEONCOLOGYNURSEANDCARINGFORTHEFAM-ILY CAREGIVER: MEETING CRITICAL NEEDS BY ESTABLISHMENTOFAFORMALPROGRAMOFBEREAVEMENTSUPPORTONTHEIN-PATIENTONCOLOGYWARDS.VirginiaLeBaron,RN,ACNP,AOCN®,UniversityofArizonaCollegeofNursing,Tucson,AZ;andSaraMoore,MA,LPC,GeorgetownUniversityHospital,LombardiCancerCenter,Washington,DC.

Familycaregiversofoncologypatientswhodieinthehospitalmaybeatparticularriskfordifficultgriefandisolation.Commonlytheycareforpatientswithrecalcitrantdisease,whohavenotelectedhos-

piceforavarietyofreasons.Consequently,thesefamilycaregiversarenotautomaticallyenrolledinhospiceprogramsofbereavementfollow-up.Oncologynursescaringforpatientsatend-of-lifeoftenexpressasenseofhelplessness,andareinauniquepositiontopro-motefamilycaregiverbereavementsupport.1)Toconductapilotprojectofa formalprogramofbereavement

supporttargetingcaregiverswhoselovedonesdieontheoncol-ogywards.

2)Toempowertheoncologynursebyprovidinganopportunitytoparticipateinfamilycaregiverbereavementsupport.

3)Toimprovefamilycaregiversatisfaction,becausepriortothispi-lotprojectnosuchserviceexistedinthehospital.

1) Developed booklet of educational materials about the grievingprocessandcommunity/hospitalresources.

2)Identifyprimarycaregiversofoncologypatientswhodieontheoncologywards.

3)Oncologynurseprovidesbooklettoprimaryfamilycaregiverattimeofdeathandcompletescaregivercontactinformationcard.

4)Familycaregiver information is entered intoadatabase forbe-reavementfollow-up.

5)Palliativecarenursepractitioner,chaplain,oroncologynursecon-tactfamilycaregiver:phonecallatoneweek;letterandphonecallat1month;letterat6months;andcardat1year.

6) Invite all family caregivers toparticipate in a6weekhospital-basedgriefsupportgroupledbycancercenterchaplains.

6monthand1yeartimepointsincludeabriefevaluationsurveyforthecaregivertoreturntotheprojectcoordinators.Datacollectionison-going,butinitialsurveyresultssuggestthisisahelpfulinter-ventionforfamilycaregivers. It ishopedthatresultswillserveasabenchmarkfor implementationofsimilarbereavementprogramsthroughoutthehospital.

Supportingfamilycaregiversisanessentialroleofoncologynurs-ing.Initiationofasimple,effectivebereavementprogramtargetingcaregiverswhoselovedonesdieinthehospitalprovidescriticalas-sistancetovulnerablecaregivers,andenablestheoncologynursetoproactivelyengageincaregiversupportattheend-of-life.

1944STEREOTACTIC RADIOTHERAPY PLUS AMIFOSTINE IN PATIENTSWITHLOW-GRADEPROSTATECANCER.ElaineMontchal,RN,AlanJ.Katz,MD,andMatthewWitten,PhD,WinthropHospital,Mineola,NY.

Radiationtherapy(RT)forlocalizedprostatecancerisassociatedwithboweltoxicitiesthatadverselyaffectlong-termqualityoflife(QOL).Robotic stereotactic radiotherapy (Cyberknife®) uses x-ray imagingtoenablereal-timecorrectionsbasedonorganposition.Althoughthistechniquereducesradiationexposureofnormaltissues,protectingtheanterior rectalwall remainsdifficult.Amifostine isa radioprotectantthathasbeenshowntoreducetoxicitytorectaltissueswhenadminis-teredtopatientsreceivingRTforlocalizedprostatecancer.

Weinvestigatedtheefficacyofintrarectalamifostineadministeredbefore RT for reduction of symptoms of bowel/rectal toxicity inpatientsreceivingCyberknifeasprimaryorboostRTforlocalizedprostatecancer.

Amifostine (1500 mg/40 cc normal saline) was administered 20minutesbeforeeachsession.InpatientsreceivingCyberknifeaspri-maryRT,35Gy(7Gy×5fractionswithin7days)wasadministered.PatientsreceivingboostRThadpreviouslyundergoneexternalbeamradiation(45Gy;1.8Gy×25fractions),thenreceivedRT(18Gy;6Gy×3fractionsoverconsecutivedays).

Patientscompleted thebowel subscaleof theExpandedProstateCancerIndexComposite(EPIC)questionnaire1to3weeksbefore

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treatmentinitiation,attreatmentcompletion,and3monthsposttreat-ment.MaximumpossibleEPICscoreis100;higherscoresindicatefewer symptoms and better QOL. Of 41 patients completing RT,3-monthfollow-updataareavailablefor4patients in theprimaryRT group (n=22; mean age, 68.1 y) and 3 in the boost RT group(n=19;meanage,69.4y).AllprimarypatientshadabaselineEPICscoreof100;meanbaselinescorefortheboostgroupwas57(range,41–73.2).PosttreatmentEPICscoresshowedreducedbowel func-tionforprimarypatients(mean,62;range19.6–87.5),andslightim-provementfortheboostpatients(mean,64.6;range,42.8–82.1).At3-monthfollow-up,meanscoresincreasedinbothgroups(primary:87.5,range,80.4–92.8;boost:96.4,range,94.6–98.2),indicatingre-coveryofbowelfunctiontonear-normallevels.

Althoughintrarectaladministrationofamifostineisinvestigation-al,theseresultssupportfurtherstudyofCyberknifewithamifostinepretreatmentinthemanagementoflocalizedprostatecancer.

1947WEAVING GOLD: TRANSITIONING NURSING PRACTICE FROM AMEDICALMODELTOANURSINGMODEL.NancyThompson,RN,MS, AOCNS, Swedish Cancer Institute, Seattle, WA; and MarilynHammer,DC,RN,UniversityofWashingtonSchoolofNursing,Se-attle,WA.

Asmorehealth care institutions andoncologydepartments seekmagnetstatusasastep inoptimizingevidencebasedpatientcare,increasing numbers of nursing departments are transitioning theirnursingpracticefromamedicallydrivenmodelbasedprimarilyonphysiologicdatatoanursingdrivenmodelseekingamoreholisticapproachthatbetterreflectsactualnursingpractice.Formanynurs-es,thistransitionrepresentsamajorchangeinpractice,leavingthemwithafeelingofdisorientation,confusionandfrustration.

Using the transitions model byWilliam Bridges andAssociates(1998)helpsnursestoadjusttothechange,normalizetheirfeelingsandassureapositiveoutcome.Theprocessofchangecanbeviewedasathree-stepprogressionwhichincludes1)endingacurrentstruc-ture,2)transitioningtothenewmodel,and3)enteringthenewbe-ginningof theremodeledsystem.It iswithin the transitionphase,orneutralzone,inwhichproblemscanarisewhichmaynegativelyaffectproductivity,morale,andoutcomes.

Toovercomethesebarriers,thishospitalbasedoncologyclinicpro-videdunitbasededucationonBridgestransitiontheoryincludingex-ercises to identify lossesandlearnfourpossibleresponses:replace,redefine, reinventor relinquish.Staffnurseswereencouraged tobepartofthemodelchangeprocesstogainthebenefitofthecreativityassociatedwiththeneutralzone.Partofeachstaffmeetingwasde-votedtotalkingthroughthefeelingsassociatedwiththeprocess.

Thefullintegrationofthenursingmodelisnotyetcompleted,buteducationofBridgestransitionmodelhasallowednursestonormal-ize their feelings, tofeelapartof theprocess,and tofacilitate itsapplicationforapositiveoutcomeand improvedpatientcare.TheBridges Model of transitions could be applied to many differentchangesthatoccurinOncologycaresuchaschangesinequipment,administrative structures, safe handling practices, and/or patientevaluationandfollow-up.

Althoughtransitioningfromamedicalmodeltoanursingmodelcanbedisconcertinginanoncologysetting,involvingnursingper-sonnelintheprocesscanbeagoldenopportunityinweavingholisticbasednursingpracticeintoevidence-basedpatientcare.

1949PATIENTEDUCATIONCHECKLISTTOOL:IMPLEMENTINGAMETH-OD TO PROVIDE CONSISTENT PATIENT EDUCATION. Victoria Vu,

RN,UCSD/MooresCancerCenter,LaJolla,CA;andRNs fromtheMooresUCSDCancerCenterClinic/Inf,UCSD,LaJolla,CA.

TheMooresUCSD(UniversityofCaliforniaSanDiego)CancerCenter opened in 2005, combining four different infusion areasat UCSD into one. The Center’s combined staff of more than 50Clinic and InfusionCenterRNscare forpatients as theynavigatebetweenClinicvisitsandInfusionCentertreatmentsessions.TheseRNsbroughtintopracticemanydifferentperspectivesaboutpatienteducationcontentandwhoshouldprovidethatcontent.Therefore,patienteducationpracticesneededtobeinclusive,consolidatedandstreamlinedtoimprovecommunicationamongCancerCenternursesandbetterfocuseducationcontentforpatients.

Tocreateaprototypepatienteducationchecklisttool,listingtopicstoincludeinthepatient’sfirstClinicvisitandduringInfusionCen-tertreatmentappointments.ThetoolguidesallRNscaringforthepatientabouteducationcontentreviewedorneedingre-review.Thetoolalsoservesasadocumentationofpatienteducationcovered,aswellasameansforqualityassurance.Byusingthetool,RNscan,inpart,easethepatient’slevelofanxietyaboutdiagnosis,symptommanagement and treatmentbyprovidingorganized and consistenteducation.

AjointRNtaskforceinitiallyestablishedtopicstobeincludedonthechecklisttool.TopicsincludedorientationtotheClinicandInfu-sionCenter,druginformation,symptommanagement,parkingpoli-cies, social servicesandcontact information.Fromthe task force,both Clinic and Infusion Center RNs were surveyed about whichtopicsshouldbe listed.Resultsconfirmedwhich topics to includeand whether Clinic or Infusion Center RNs should initially coverthematerial.

Ofthe30surveysdistributedwith50%return:priortofirstdayofinfusion,60%infavorofCaseManager(CM)givingpatientspecif-icdruginformation;80%infavorofInfusionNursegivinggenericsymptommanagement information; 100%agreed thatCMshouldhandleMDfollowups.

Furtherevaluationofthetoolshowedthat1)RNsusedthetool;2)Patientsreceivedinformationconsistently.

1950MEANINGANDEXPERIENCESOFDIGNITYTOURBANPOORWITHADVANCEDCANCER.AnneHughes,RN,MN,AOCN®,FAAN,LagunaHondaHospitalandRehabilitationCenter/SFDPH,SanFrancisco,CA;and Maria Gudmundsdottir, RN, PhD, and Betty Davies, RN, PhD,FAAN,UniversityofCaliforniaSanFrancisco,SanFrancisco,CA.

Vulnerablepopulations,suchastheurbanpoor,aredisproportion-atelyaffectedbycancer.Poorpersonsfacebarriersaccessingqualitycancercareandwhenreceivingcare,mayexperienceinsensitivitytotheirplight.Dignityisaubiquitousconceptinbioethicsandtheol-ogy,andisoftenmentionedinthecontextofprovidingcaretoolderadults,thedisabled,andtothosewhoaredying.Theeverydayex-periencesoftheurbanpoorlivingwithadvancedcancerarelargelyinvisibleintheliteratureandthepsychosocialandexistentialconse-quencesoftheirillnessandtreatmentrarelydescribed.

Thepurposeofthisstudyistounderstandthemeaningofdignitytotheurbanpoorandtodescribetheirexperienceslivingwithad-vancedcancer.

Interpretivephenomenologyisthequalitativeapproachusedtoun-coverthemeaningsofdignityandtodescribetheexperiencesoftheurbanpoorwithadvancedcancerthroughtheirownstories.

Patientswererecruitedfromproviderscaringfortheurbanpoor.Datawerecollectedfromin-depthinterviewswhichwereaudiotapedandtranscribed.Patientswereinterviewed1-3times.Interviewtran-scriptsandfieldnotesarethedatasourcesforthisanalysis,which

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ispartoflargerproject.Researchersidentifiedandanalyzedthemesbothwithinandacrosscases.

FourteenpatientswithstageIIIorIVsolidtumors(lung,breast,colorectal,etc.)participatedinthestudy.Thesampleof6menand8women,rangedinagefrom38-69years,halfofthesample(50%)were persons of color (5AfricanAmericans and 2 Hispanic/Lati-nos).A central finding for this urban sample coping with seriousillnesswas thatmost persons, even thoseonlyweeks fromdeath,focusedonlivingnotondying.Moreover,participants’descriptionsoftheirexperiencesfocusednotondignitybutratheronindignity.Theirindignitystories,suchasbeingtalkeddowntoornotlistenedto and the embarrassment of fecal or urinary incontinence, weredescribedinvividdetail.Thisresearchconfirmstheimportanceofpersoncenteredcommunicationthatrecognizesthehumanityofthepatientregardlessoftheirpsychosocialcircumstancesandtheneedtoexpedientlymeethygieneandtoiletingneedstodecreasethreatstotheirdignity.

1952ANINNOVATIVEAPPROACHFORDECREASINGTHEINCIDENCEOFFALLSINONCOLOGYPATIENTS:THEPATIENT/FAMILYFALLSPRE-VENTION VIDEO. Escel Stanghellini, MSN, BSN, RN, Brigham andWomensHospital,Boston,MA;MartieCarnie,AD,VolunteerPatientand Family Advisory Council, Dana-Farber/Brigham and WomensCancerCenter,Boston,MA;MrinaliniGadkari,MPHSA,Dana-FarberCancer Institute,Boston,MA; andLelaTatarouns,RN,BSN,SusanMcDonald,RN,OCN®,andJoanDeary,RN,BSN,BrighamandWom-ensHospital,Boston,MA.

Theriskforpatientfallsisaconstantconcernforoncologynurs-es,particularlyonin-patientunits.Anincreaseinpatientfallswithinjuryon the inpatientunitsofourNCI-designatedCancerCenterrevealedthatpatientssometimesneglectedtoaskforhelpfromthenursingstafftogetintoandoutofbed,eventhoughappropriatefallprevention interventions may have been in place. Not wanting torelinquishtheirusual levelof independenceandnotrealizinghowmuchtheirtherapies,procedures,surgeries,orillnesscouldweakenthem,manypatientsexperiencedafallduringtheirhospitalizationbecausetheytriedtogetoutofbedortothebathroomwithoutas-sistance.Toaddressthisproblem,ournursingstaffincollaborationwithpatientsdevelopedafalls-preventionvideo.

Avideo,whichfeaturedre-enactmentofpatientfallsandstoriessharedbypatients,withlessonslearned,wasdevelopedtouseasateaching toolwithpatientsat risk for falland their families.Con-ceptsfromadultlearningtheoryguidedthisproject.

Apatientfromourinstitution’sPatientFamilyAdvisoryCouncilnarratedthevideo,whichprovidedinformationaboutfallriskfac-tors, re-enactmentsof threepatient-fall cases, an interviewwith apatientwhorecentlyfellandasummaryofreasonswhypatientsareatrisk,stressingtheimportantroleeachpatienthasinpreventingafall.Thevideo,availableinEnglishwithclosedcaptioningorSpan-ishsubtitles,willbeshowntoallpatientswhoareatriskforfall.

Patientfeedbackaboutthevideohasbeenpositive;ongoingmoni-toringof fall rates/trendswill providedata tomakepre- andpostinterventioncomparisons.

Innovativepatienteducationstrategiescanimprovepatientsafetyandriskmanagement.Staffnurses,nurseeducatorsandnurseman-agerscanapplyourmethodtodeveloptheirownuniquepatientedu-cationtools.

1953ANEVIDENCE-BASEDAPPROACHTOREDUCINGNIGHTTIMENOISEONONCOLOGYINPATIENTUNITS.EscelStanghellini,MSN,BSN,RN,

BrighamandWomensHospital,Boston,MA;MartieCarnie,AS,Pa-tientandFamilyAdvisoryCouncil,Dana-Farber/BrighamandWomensCancerCenter,Boston,MA;MrinaliniGadkari,MPHSA,Dana-FarberCancerInstitute,Boston,MA;andNancyMahan,RN,OCN®,CatherineBenedict, RN, BSN, and Christine Leonard, RN, BSN, Brigham andWomensHospital,Boston,MA.

Nighttimenoise (any sound that patients identify asbothersomeor thatdisturbs theirsleeporotheractivities) isa frequentpatientcomplaint on acute care oncology units despite recommendationsontheacceptablenoiselevelsfromtheUnitedStatesEnvironmentalProtectionAgency.Anevidence-basedpractice (EBP)projectwasdesignedbynursestoaddressthisproblemonthein-patientunitsofanNCI-designatedCancerCenterlocatedintheNorthEast.

Thepurposeof thisprojectwas todevelopevidence-basedstrat-egies to reduce the nighttime noise levels on the inpatient oncol-ogyunits.APlan-Do-Study-Act(PDSA)cyclewasusedtoanalyzepatientcomplaintsaboutnoise,developnoisereductionguidelines,andpilot theiruseontwoadultHematology/Oncology/BoneMar-rowTransplantpatientunits.

Amasters-preparedoncologynurseledtheInpatientQualityIm-provementTeamthatcarriedoutthisEBPproject;theteamincludedstaffnurses,ahealthandsafetytechnologist,aqualityimprovementspecialist, and a representativeofpatients and their families.Evi-dencewereusedtodeveloptheguidelinesincluded:benchmarkingdata, expert opinion, patient/family input, published research andotherliterature.Alearningpacketcontainingtheguidelinerecom-mendationsfornoisereductionwasdistributedtothenursingstaffvia email and hard copies. In-services were provided to facilitatediscussion. Posters and small flyers with reminders to limit noisewerepostedinthepatientcareareas.

Initialpatientsatisfactiononnoiselevelafterguidelineimplemen-tation,measured,bythePress-Ganeysurveyinstrument,showedanincreaseof1.5%ononepilotunitbuta3%decreaseinsatisfactionontheotherpilotunit.Thisdatawillcontinuetobecollectedandanalyzed toevaluate theeffectivenessofongoingnoise reductionefforts.Thenextstepistotracktheprocessmeasurestogaugecom-plianceandusageofnoisereductionguidelines.

Nursecliniciansandmanagerscanusetheinformationfromthisproject in two ways: to implement these guidelines for nighttimenoise reductionon theirpatientcareunit(s)and touse thismodelfordevelopingandimplementingevidence-basedguidelinesthatad-dressotherissuesofconcerntooncologynursesandtheirpatients.

1954EVIDENCE-BASEDPRACTICE:“BLOODPRODUCTADMINISTRATIONPUMP VERSUS GRAVITY.” Rochelle Contreras, RN, BSN, CynthiaMurphy,RN,BC,MS,andMihaelaFetea,RN,OCN®,UTM.D.Ander-sonCancerCenter,Houston,TX.

Thenursing resourcepool (NRP)at a largecomprehensivecan-cercenterinthesouthwesternUnitedStatesprovidessupplementalstaffingtoallinpatientnursingunits.Whileprovidingstaffingcov-erage,NRPnursesidentifiedavariationinnursingpracticewiththeadministrationofpackedredbloodcells(PRBCs).Over37,000unitsofPRBC’sareadministeredannuallybynursesatthecancercenter.Nurses’practices forblood transfusion includedadministrationbyvolumetricpumporbygravity.

Theevidence-basedpractice(EBP)processwasutilizedtoidentifysupportingliteraturefortransfusionofPRBCsviavolumetricpumpasastandardpracticeatourcancercenter.

In2005,theorganizationimplementedanevidencebasedpracticeprogramforclinicalnursestobuildnursingcarepracticeonevidenceratherthantraditionalstandards.Clinicalnurseswerechallengedto

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learntechniquestosearchtheliterature,developevidencetables,andimplementpracticessupportedbyevidencebasedresearch.TheEBPprocess was utilized by the NRP team to examine the practice ofpackedredbloodcelladministration.

APICOquestionwasdevelopedandliteraturereviewwascon-ductedtodetermineifarecommendationforbloodadministrationvia volumetric pumps was supported by evidence.The first stepwastodetermineiftheredbloodcellsadministeredbypump,de-gradedduringtransfusiontherebyaffectingthepatienttherapeuticbenefit.Themanufacturerofthepumputilizedatthecancercenterwas contacted regarding independent research that evaluated theriskofhemolysisand itssignificancewithbloodproductadmin-istration.

Theliteraturereviewrevealedverylittleresearchsupportingbloodadministrationviaavolumetricpump.Severalreferencesandnurs-ingstandardssupporteduseoftransfusionbypump,aslongas,thepump manufacturer provided supporting evidence.Administrationofbloodproductsataconsistentratewasnotedtopreventfluidover-loadanddecreaseriskofcontamination.Theteamidentifiedthesefactorsaspatientsafetybenefits

TheteamwillsharetheEBPjourneyfordevelopmentofapracticerecommendation.Basedontheliteraturereview,arecommendationwasmadetouseavolumetricpumpforPRBCtransfusion.

1955NEUTROPENIC DIET WITH LEUKEMIA PATIENTS. Alison Gardner,PhD,RN,M.D.AndersonCancerCenter,Houston,TX.

Neutropenia continues to be a significant problem for leukemiapatientsreceivingchemotherapy.Variousprecautionshavebeenin-stitutedoncepatientsbecomeneutropenic.Oneofthese,theneutro-penicdiethasbeenverycontroversialwithvaryingpracticesamonginstitutionsandphysicians.Thepracticestartedabout30yearsagowhenPseudomonaswascultured fromtomatoes.Therehavebeenvarious surveys regarding hospitals that use the neutropenic diet,buttherehasnotbeenarandomizedclinicaltrialstoevaluateinfec-tionratesbasedontheneutropenicdietversusadietincludingfreshfruitsandvegetables.

Thepurposeofthisstudyistoevaluatetheinfectionanddeathrateofleukemiapatientswhoeataregulardietincludingrawfruitsandvegetablescomparedwithpatientswhoeataneutropenicdietwhichexcludesrawfruitsandvegetables.

Theinclusioncriteriaincludesnewlydiagnosedpatientswithacutemyelogenous leukemia or myelodysplastic syndrome who are re-ceivingfrontlinechemotherapyintheprotectiveenvironment(PE).Exclusioncriteriaincludespatientswithapneumoniaorbacteremiaonadmissionandthosewhorefusetoeatrawfruitsorvegetables.Patients were randomized according to an ERM (early risk mor-tality) score and were asked to keep a diary of their food intake.Questionnairesweredoneweeklytodocumentfever,bacteremiaorpneumonia.Thestudywillbeconductedfromthetimethepatientinitiateschemotherapyuntiltheyaredischargedfromthehospitalortheirabsoluteneutrophilcountisover1000.

Thestatisticaldesignisaposteriorandpredictiveprobabilitycom-putationtoevaluateforinterimmonitoring.AChi-Squarewasusedtocomparetheinfectionanddeathratesbetweenthetwotreatmentarms.Presently150patientshavebeenenrolledon thestudy.Theinfectionrateintherawfruitandvegetablegroupis29%with16bacteremiaand2pneumonia.Theinfectionrateintheneutropenicdietgroupis32%with9bacteremiaand12pneumonia.Therewasonedeathintheneutropenicgroup.

Infectionratesinbothgroupsaresimilarraisingthequestionofthenecessityoftheneutropenicdiet.

1957KEEPINGTHELIDONPRESSURE:AQIPROJECTMONITORINGTHEMANAGEMENTOFHYPERTENSIONDURINGINFUSIONOFHEMATO-POIETICSTEMCELLSFROMMATCHEDUNRELATEDDONORS.Rox-annBlackburn,RNOCN®,JoyceNeumann,RN,BSN,MS,APN,OCN®,andJoAnnMick,RN,MSN,MBA,PhD,UTMDACC,Houston,TX;GeriWood,RN,PhD,UniversityofTexas,Houston,TX;andJoyMok,RN,BSN,MS,APN,OCN®,UTMDACC,Houston,TX.

Patients undergoing hematopoietic stem cell transplants frommatchedunrelateddonors (MUD)atauniversity-basedbonemar-rowtransplantunitwerenotedtohaveahigherincidenceofacutehypertension during infusion of cells. Acute hypertension in thispopulationcanbelifethreateningduetoprofoundthrombocytope-nia and the subsequent risk of central nervous system bleed. CellproductsfromMUDsarecollectedthemorningoftransplant,trans-portedtothepatientandinfusedlaterthesameday,somanyoftheseinfusionsoccurintheeveningwhenthereislessclinicalsupportintheinstitution.

Toprovideguidancetothenursesforthemanagementofinfusionrelated hypertension a multidisciplinary group developed a physi-cianordersetthatincluded“whatif”ordersforhypertensionoccur-ringduringMUDinfusions.

MedicalrecordsofpatientsreceivingMUDcellinfusionsarebeingreviewedtodeterminehowoftentheordersetisusedandtoevaluateifBPismaintainedwithinnormalrangewhentheordersetisused.

Datacollection isongoing.Preliminary informationcollectedon85patientchartssuggeststhatimplementationofinterventionsintheordersetishelpingtomanagehypertension.Additionalinformationwillbeaccumulatedandpresented.

Acutehypertensioncanbealife-threateningeventinpatientsre-ceivinghematopoieticstemcellinfusions.Whennurseshavestand-ingorderstotreatinfusionrelatedhypertensionbloodpressurecanbemaintainedwithinanormalrange.

1969PATIENTTREATMENTORIENTATION101:EMPOWERINGPATIENTSTOBECOMEACTIVEPARTICIPANTSOFTHEIRHEALTHCARETEAM.LeahScaramuzzo,MSN,RN,C,AOCN®,CancerInstituteofNewJer-sey,NewBrunswick,NJ.

Severalmandatedstandardsandguidelinesindicatenurseshavealegal,moral,andethicalresponsibilityforpatienteducation.Oncol-ogynursesatanoutpatientNCI-designatedComprehensiveCancerCenterprovidedone-on-oneteachingduringpatients’initialcancertreatmentsandfoundtheywereoftenanxiousandoverwhelmedbytheamountandcomplexityofinformation;thisdecreasedtheirabil-itytocomprehendandretaininformationessentialtoself-careman-agement. Inaddition,nurseswerechallengedto integrate in-depthteachingintotheirbusyschedulesandnumerouspatientsunderuti-lizedsupportresources.

ThepurposeininitiatingatreatmentorientationprogramwastoprovidepatientswithageneralunderstandingofcancertreatmentsandspecificinformationabouttheCenterandavailableresourcesusingprinciplesofadultteaching-learning.Evidencedemonstratesthatknowledgedecreasesdistress,andthereforefacilitatescopingandadaptationtoacancerdiagnosisthusenablingpatientstobe-come active participants in their healthcare, a goal of JCAHO’s“Speak Up” program. Effective patient education can increasecompliancewithtreatmentregimens,facilitaterecognitionofad-verseevents, improveclinicaloutcomes,anddecreasehealthcareexpenses.

Programcontentwasdevelopedthroughliteraturereviews,indus-trybenchmarking,sessionswithinterdisciplinaryexperts,andfocus

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groupsofpatientsundergoingtreatment.Patients/familiesarenowoffereda90-minuteclasswheretheylearnabouttheCenter,rolesoftheirhealthcareteam,evidence-basedself-carestrategies,andsup-portresources.Theprogramconcludeswithatourofthetreatmentfacility,Q&A,andnetworkingopportunitieswithothersnewlyfac-ingtreatment.

219 written evaluations revealed participants felt less anxious,moreinformed,andbetterprepared.Stafffeedbackhasbeenover-whelminglypositive,astheprogramhasimprovedeffectivenessandefficiencyoftheeducationprocess.Reducedvariabilityinteachingcontentandincreasedcompliancewithdocumentationofpatiented-ucationhasbeenfoundsincetheprogram’sinception.Nursingfeed-back;patientsnowaskmorequestions,utilizesupportiveservices,andparticipateinhealthcaredecisions.

Oncologynursesareinakeypositiontodevelopandimplementthis“best-education”didactic templateas thenursingshortage re-ducestimeavailableforpatienteducation.Theorientationprogramparadigmiscurrentlybeingadaptedfornewpatientsreceivingcarein the surgical and radiationoncology sectionsandvariousmulti-mediaalternativesarebeingexplored.

1970CONSUMER KNOWLEDGE: THE ROLE OF THE ONCOLOGY AD-VANCEDPRACTICENURSE.TracyKrimmel,RN,MSN,AOCN®,APN-C, Beth Knox, RN, APN-C, AOCN®, and Kristen Fessele, MSN, RN,APN-C,AOCN®,CancerInstituteofNewJersey,NewBrunswick,NJ.

TheOncologyNursingSocietyidentifiedimportantissuesfacingadvancedpracticesnurses(APNs)inAprilof2001.OneissuethatwasaddressedwastheroleambiguityoftheAPN.Moreover,are-centpollsuggestedthatonly25%ofconsumerswhenaskedknewwhatanadvancedpracticenursewas.Thisroleambiguityisacauseofconcernforadvancedpracticenurses.

Thepurposeofthisstudyistoutilizeapreandpost-testinstru-menttoevaluateconsumerknowledgeregardingtheroleoftheAd-vanced Practice Nurse (APN) in an oncology practice before andafterthedistributionofaninformationalbrochure.Thespecificre-searchquestions thatwillbe investigatedare1)What is thebase-linelevelofknowledgeofCINJpatientsregardingadvancepracticenurses?2)DoesthenumberofvisitswithanAPNatCINJincreasethepatient’sknowledgeoftheroleoftheoncologyAPNatCINJ?3)Doesaneducationalinstruction,increasepatient’sknowledgeabouttheroleofoncologyAPN’sindependentofthenumberofvisitswithanoncologyAPNatCINJ.

TheconceptualframeworkthathasbeenchosenforthisstudyisfromtheworkofMalcolmS.Knowles’adultlearningtheoryandra-gogy.

This is a quasi-experimental, descriptive study using a pre-test,post-testdesignstrategytoinvestigatethelevelofconsumerknowl-edgebeforeandafterandeducational intervention.Twogroupsofpatientswillbeinvitedtoparticipantinthestudy.Foreachgroup,thosereturningtheconsentformwillberandomlyassignedtoeitherthe interventionor controlgroupuntil the required sample size isreached.TheinterventiongroupwillreceiveCINJ’sAPNbrochureandthecontrolgroupwillnot.Thepatientswillbeaskedtoanswerasetofquestionsattwotimepoints:preandpoststudy.These10sub-questionswillbesummarizedbythetotalnumberofquestionsan-sweredcorrectlyforincreasedstatisticalpower,easierinterpretationandtoavoidthemultipletestingissue.Thedescriptivestatisticsforeachofthe10sub-questionswillbeprovided,however.Thesecondpartispatients’knowledgeoftherequirededucationforAPN.

ThisstudyiscurrentlyindataanalysisphaseandwillhopefullybecompletedbyCongress.

1972FILLING THE GAP: CREATING A COMMUNITY ASSISTANCE PRO-GRAM.BrendaJoGillund,RN,MS,OCN®,AltruHealthSystem,GrandForks,ND;andSarahHeitkamp,Gap,Inc.,GrandForks,ND.

Qualityoflifeforcancerpatientsissoimportant,yetoftenhardtoquantify,makingithardtoachieve.Workingwithcancerpatientsisbothrewardingandempowering,ascaregiverstrytohelppeopleenjoyeveryminuteofeveryday.Whenthenecessityforadditionalassistance forourcancerpatientsbecameapparent,aplan tohelpsolvetheproblemevolved.Ourpatientsoftenaskedfordirectioninthree major areas of financial burden: transportation, housing andnutritionalsupplements.

Usingcriticalthinkingskills,planning,implementation,andevalu-ation,wehavebeenabletoeffectivelyimproveourpatients’qualityoflife.

Thepurposeofthispresentationis:• Toassistothernursestoidentifypatient/familyneedsintheirarea

ofpractice;• Todescribetheprocessoffindinggrantavailability;• Todescribeprocessofwritingagrant;• Toidentifyhowtoinitiateacommunityassistanceprogram.

Weidentifiedthepatients’needs,exploredgrantsavailabletofa-cilitate change,wrote agrant, received funding, and implementedthe“FillingtheGap”program.BrendaJoandSarahcanspeakaboutadvocacy forourcommunity, andhowagreat ideacanbecomeareality.

Patientshavebeenutilizing the“Filling theGap”programsinceOctoberof2005.Wehaveassistedover250patientswithgascards,housing assistance, and nutritional supplements. Patient surveysare used to review perceived quality of life improvement, as wellastrackingnutritionalresponse,includingweightgain,loss,orsta-bilization.

ManyareasoftheUSAarecomprisedofruralareas,somehundredsofmilesawayfromcancertreatment.Inourcommunity,servicestoprovidefinancialassistancewithgasmoney,lodgingandnutritionalsupplementswerenon-existent.TheFillingtheGapprogramwascre-ated tohelpease thefinancialburdenwhileofferingsupport toourcancerpatientsandfamiliesthroughoutdiagnosis&treatment.

Nursesandfamilymembersareoftentheoneswhohear thepa-tient’sstoryofhowadiseaseaffectstheirwholelife.Wehelpmakeadifference in their liveseveryday,andsometimesasimpleplancansnowballintoanamazingjourney...helpingourpatientseverystepoftheway.

1975FAILURE MODE EFFECT ANALYSIS TEAM FACILITATOR: A NOVELROLEFORTHEONCOLOGYNURSETOIMPROVECHEMOTHERAPYSAFETY.NormaSheridan-Leos,RN,MSN,AOCN®,CPHQ,M.D.An-dersonCancerCenter,Houston,TX;andStevenHartnaft,MPH,CPHQ,CityofHope,Duarte,CA.

Chemotherapyisassociatedwithseriousandpotentiallylifethreat-ening side effects, and thus has a high risk of causing significantpatientharmwhenerrorsoccur.Throughoutthechemotherapypro-cess,fromprescribingtopatientmonitoring,thereisahighriskforlifethreateningerrorstooccur.TheJointCommissiononAccredi-tationofHealthcareOrganizationsexpectshealthcareorganizationsto conduct an annual proactive risk management activity for highriskprocesses.FailureModeEffectAnalysis(FMEA)isaproactiveriskmanagementassessmentthathasbeensuccessfullyusedinthenon-healthcare industry topreventerrors fromoccurring.Becauseoncologynurseshavemanyrolesinthechemotherapyprocess,theyareinauniquepositiontoimprovethisprocess.

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Thepurposeofthisprojectistodescribehowanoncologynursefacilitated theFMEAprocess toproactively improve thesafetyofthe chemotherapy process. The Oncology nurse facilitator used avariationoftheFMEAprocessdevelopedbythemanufacturingin-dustry.Usingthisprocess,allofthestepsinvolvedinchemotherapywerestudied,failuremodeswereidentified,riskanalysisandpriori-tizationofriskwerecompleted.Thenriskreductiontechniqueswereusedtoproactivelyimprovethechemotherapyprocess.

FMEAisusefulinidentifyingpotentialerrorsthatoncologynursesandotherhealthcareteammembersmaynotrealizeexistattheorga-nization.AlthoughconductingaFMEAcannotensurethattheche-motherapyprocesswillbe“fail-safe,”FMEAparticipantsstronglyfeltthattheFMEAprocesshas:1.Reducedthelikelihoodoferrorsoccurring,2.Helpedthemfeelmoreconfidentinthechemotherapyprocess,3.Improvedunderstandingofthechemotherapyprocess,4.Improved the working relationship with other members of the

chemotherapyteam.Promotingacultureofsafetyinvolvesshiftingfromerrormeasure-

menttoaproactiveassessmentofpotentialharm.Becauseoftheirpivotalroleinchemotherapy,oncologynursesareideallysuitedtoimprovechemotherapysafety.

1979THEEXPERIENCEOFHOPEINWOMENWITHADVANCEDOVARIANCANCER.AnneReb,RN,PhD,NP,U.SMilitaryCancerInstitute/HenryJacksonFoundation,Washington,DC.

Womenwithadvancedovariancancer(OVCA)experiencesignifi-cantlossesandqualityoflifeconcernsuponrealizingthattheyhavealife-threateningillness.Maintaininghopemaybeadifficultchal-lengegiventheongoinguncertaintyandfearsofcancerrecurrence.Greaterfocusisneededonthepsychosocialimpactofthisillnesstoidentifynursinginterventionstofacilitatehopeinthispopulation.

ThepurposeofthisstudywastodescribetheexperienceofhopeinwomenwithadvancedOVCA.

Modifiedgroundedtheorymethodologywithinterviewapproachguidedthisresearch.Theconceptualorientationwasbasedonsym-bolic interactionism and constructivist paradigms, which seek todiscovertheparticipants’meaningthatarisesthroughsocialinterac-tions.

Purposive samplingwas employed to collect dataon20womenwithadvancedOVCAwhohadnotexperiencedarecurrence.APer-sonalDataForm(PDF)andfocusedinterviewguidesupporteddatacollection.ThePDFaddresseddemographicandillnessinformation;theinterviewguideincludedopen-endedquestionsabouthope.Datawere analyzed using the constant comparative process includingtheoreticalcodingandmemoing.

“Facingthedeaththreat”emergedasthewomen’smainconcern;thecorevariableindealingwiththisconcernwas“transformingthedeath sentence.” Three distinct phases emerged: (a) shock: rever-berating from the impact, (b) aftershock: grasping reality and (c)rebuilding: living the new paradigm. Hope, provider communica-tion,andspiritualityinfluencedwomen’sabilitytomovethroughthephases.Fourdimensionsofthecorevariablewereidentifiedinrela-tionshiptotwokeyvariables,perceivedsupportandcontrol.Womenwithlowperceivedsupportandcontrolalignedwiththedimension“trappedintheillness,”andhaddifficultymovingthroughthephas-es.Womenwithhighsupportandcontrolseemedmosthopefulandabletofacethedeaththreat.Focusingonattainablegoalsandfindingmeaningintheexperienceenhancedperceivedsenseofcontrol.

Thisstudysuggestsaneedforimprovedprovidercommunicationstrategiesandscreeningmeasuresassessingdistressandsymptoms.

Phase-specificinterventionsareneededtotargetconcernsatcriticaltransitionpointsduringtheillness.Futureresearchshouldevaluatecreative interventions includinggroupsupportandcomplementarytherapyapproachestoenhanceperceivedsupport,control,andhopeinthispopulation.

FundingSources:ONSFoundation,ONCCResearchGrant

1981TURNINGLICENSEPLATESINTOCLINICALBREASTEXAMS.AndriaCaton,RNOCN®,NortheastGeorgiaMedicalCenter,Gainesville,GA.

In the State of Georgia, health disparities exist for women whoareindigent,rarelyorneverscreened.SeveralcountiesinNortheastGeorgiahaveoverallpovertyratesabout13%,LatinoandAfricanAmerican populations where poverty rates are higher than otherraces,andcountieswherenomammographyfacilitiesorcommunityhospitalsexist.

Inanefforttoreducesomeofthedisparities,theStateofGeorgiadesignedaBreastCancerlicenseplatewhichcanbepurchasedfor$25.$22ofthespecialfeeforthelicenseplatefundsbreastcancerscreeningandtreatmentservicesforGeorgiansinneed.

In2006,fifteen$50,000grantsfundedfromthesaleoftheBreastCancerlicenseplateswereawardedtovariousorganizations.

The Medical Center Foundation of Northeast Georgia MedicalCenter was awarded one of these grants entitled “Clinical BreastExamTraining”.

NurseswillbetrainedinCBEusingMammaCareTrainingofferedthroughtheUniversityofFlorida.Withthistraining,thenurseswillbeabletoperformCBEatcommunityscreenings,offices,andclin-ics,teachCBEtonurses,students,andBSEtocommunitygroups.

Increasing thenumberofBSEprogramsandCBEnurses in theregionwillhelpdetectbreastcancersatanearlierstage,improveac-cesstoqualitycareforwomenthatareindigent,andrarelyorneverscreened.

15nurseswillbeselectedtoparticipateintheCBETrainingPro-gram.Nursinginstructors,LanierONSmembers,andcommunity-basednurseswillbeconsideredfortraining.

Nurseswill performCBEat screenings, clinics, or offices, trainnursingstudentsornursestoperformCBE,and/orteachcommunitygroups.A.TrainnursesinCBE

1.NumberofCBESpecialists2.NumberofnursestrainedinCBE

B.TrainfuturenursestobeCBEproviders1.NumberofCBEtrainingprograms2.NumberofstudentstrainedinCBE

C.ProvideCBEtoindigent,rarelyorneverscreenedwomen1.NumberofhoursspentperformingCBEinclinics/offices2.NumberofcommunityCBEscreeningsprovided

D.ProvidebreasthealthandBSEeducationtocommunity1.NumberofBSEeducationeventsprovided2.Numberofwomenreferredforscreeningmammography

Promoting theearlydetectionofbreast cancer, andempoweringandeducatingwomenathighriskareveryimportantrolesforoncol-ogynurses.

1983CANCERSCREENINGINITIATIVESWITHINACOMMUNITYCANCERPROGRAM.TaraBaney,RN,MS,AOCN®,MountNittanyMedicalCen-ter,StateCollege,PA.

TheAmericanCancerSociety(ACS)hasestablishedthatearlyde-tectionexamsandtestingcanhelpsavelivesduetocancersofthebreast,colon,rectum,cervix,prostate, testis,oralcavity,andskin.

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Thefive-yearrelativesurvivalforpeoplewithcancersforwhichtheACShasearlydetectionrecommendationsis82%.

As a comprehensive community cancer center accreditedby theAmericanCollegeofSurgeons,education/screeningactivitiesarearesponsibilityofourprogram.BasedontheACSrecommendations,disease statistics, and community needs, our cancer programs haschosen to provide screening for prostate, skin and head and neckcancers.

The screenings areheldonce ayearwith coordination from theOncologyClinicalNurseSpecialist(CNS)andvolunteerassistancefromphysiciansandhealthcareprofessionals.Thescreeningspro-videafocusedexamandprevention/earlydetectioneducation.Overthepasttenyears,theprostateprogramhasprovidedthousandsofex-amsandPSAtests,withthisyear’sscreeninghaving95participants.Theskincancerandheadandneckcancerscreeningshaveonlybeeninplaceforthelastthreeyears,yethaveprovidedscreeningto86and39participantsrespectively.In2006,allofthescreeningshadparticipantsthatrequiredfollowup.13(14%)menwerereferredforelevatedPSAand/orabnormaldigitalrectalexams,8(32%)partici-pantswerereferredforabnormalskinlesionsand6(29%)requiredfollowupforabnormalheadandneckexams.AllofthoserequiringfollowupwereprovidedwithcontactinformationfortheCNSwhocouldassistwithappointmentsandfinancialresources.

Other screenings are being explored since these programs havebeensuccessful.Inpreviousyearsthecancerprogramhasbeenin-terestedinacolorectalcancerscreening,butduetophysicianlimi-tations, itwasnotpossible.However,withnewer resources in thecommunity, the cancer program will be exploring this possibilityonceagain.

Approximately80%ofcancercareisprovidedwithincommuni-ties. Therefore, community programs must identify the screening/earlydetectionprogramsthatwillbethebeneficialtotheircommu-nities.Withthevastknowledgethatoncologynurseshaveregardingthecancer, theyareprimarycandidates todevelopand implementtheseprograms.

1985PATIENTCOMPLIANCE/INCENTIVESTUDY.RheaDebari,RN,MSN,OCN®, Hartford Hospital, Cancer Clinical Research Office, Hartford,CT;andCamilleServodidio,RN,MPH,OCN®,MariaPalomares,BA,MariaRodriguez-Furlow,andIleneStaff,PhD,HartfordHospital,Hart-ford,CT.

Earlyscreeninganddetectionofbreastandcervicalcanceriscriti-calandofgreatinteresttoOncologyNurses.Theopportunitytobescreenedhowever, requires attendance at scheduled appointments.Careprovidersneedtoexaminestrategiestoincreasepatientcom-plianceinattendingappointmentsasameanstoimproveincostef-fectivenessandresourceutilization.

Thepurposeofthisstudywastodetermineifawardinganincen-tivegifttowomenenrolledintheCenterforDiseaseControl(CDC)ConnecticutBreast andCervicalCancerEarlyDetectionProgramwouldincreasetheadherencerateforattendingappointments.ThestudyiscongruentwiththeONSResearchAgendahealthpromotiongoalandtargetspriorityindigentwomen.

The theoretical framework is theTran theoreticalModeland theProcessesofChangeconcept.Prochaska’smodelhaspromotesop-timalhealthbypromotingbehavioralchange.Theauthorshopedtoaffectpositivechangesinbehavior,anddemonstrateanincreaseinthe appointment compliance rate for clinical breast exams, mam-mographyandPapscreening.

Womenschedulinginitialorannualappointmentswerepresentedwiththeopportunitytoparticipate.Afterverbalconsent,participants

weresequentiallyassignedtoeitherreceiveanincentivegift,ortonot receive an incentive gift when arriving for their appointment.Participantswereawareoftheirassignment.TheincentivegiftwasabeautygiftprovidedbyAvonwithafive-dollarvalue.Theprospec-tiverandomizedcontrolgroupdesignstudycomparesastandardofcaregrouptoasecondgrouptoldtheywillreceiveanincentiveinadditiontothestandardmaterialswhentheyarrivefortheirsched-uledappointment.Theoutcomemeasurewaswhetherornotthepa-tientmaintainedtheappointment.

Theincentivedidnotstatisticallyincreaseadherencerates.Therewas no statistical difference demonstrated in either group. Bothgroups were similar in the percentage of attendance. The non-in-centive group still received the incentive gift without knowing inadvance.Authors attribute several possibilities for the increase inattendanceinbothgroupsincludinginformationsharingamongen-rollees,andextraattentionduringverbalconsentprovidingamorepersonalized approach.Opportunities exist for further researchonmorepersonalizedapproacheswithappointmentscheduling.

1986COLLABORATINGTODEVELOPEVIDENCE-BASEDSYMPTOMMAN-AGEMENT GUIDELINES IN A COMMUNITY ONCOLOGY PRACTICE.MiriamScholl,RN,MSN,SandyPurl,RN,MS,AOCN®,LaurelBarbour,RN,MS,AOCN®,MaureenGibbs,RN,MS,NP,MaryBethMardjetko,RN, MN, Abigail Dillon, RN, BSN, OCN®, and Rossini Dy, PharmD,OncologySpecialists,ParkRidge,IL.

Many patients have problems with symptoms related to cancertreatment despite significant advances in supportive care options.Theliteraturesuggeststhatnewknowledgeisinconsistentlyappliedin theclinical setting.Onestrategy for improving this situation istheimplementationofevidence-basedsymptommanagementguide-lines.OncologySpecialistsispartoftheAIMHigherInitiative,de-signedtoaidintheassessment,informationprovision,andmanage-mentofcancertreatment-relatedsymptoms.Wearea10-physiciancommunityoncologyprivatepracticewith3locationsinthenorthandnorthwestsuburbsofChicago,eachofwhichutilizesaprimarynursingmodel.

Thepurposeofthisquality-improvementprojectwastostandard-izetheassessment,education,management,anddocumentationofsymptomsinourpracticethroughtheuseofevidence-basedpractice(EBP)guidelines.AChemotherapyandBiotherapy-InducedNauseaandVomiting(CBINV)guidelinewasthefirsttobedevelopedandbecamethetemplateforothersymptomguidelines.

Ourprocessbeganwithaliteraturereviewandthedevelopmentofamultidisciplinarytaskforce.TheNationalComprehensiveCancerNetwork(NCCN)(v.1.2006)andtheMultinationalAssociationofSupportive Care in Cancer (MASCC) (2004) guidelines providedEBPdatatoupdatethepractice’spreviousCBINVguidelines(writ-ten in1998andfirstupdated in2003).Abaselinechartauditwasperformed toassessadherencewithandeffectivenessof theprac-tice’spreviousCBINVguidelines.

Datafromthechartauditrevealedtherewasaninconsistentandinadequatenursingstandardforassessing,educating,managing,anddocumentingCBINV.Theanticipatedoutcomeofthisprojectisim-proved symptommanagement fornauseaandvomitingaswell asgreater adherence to the practice’s new CBINV guidelines. ChartauditdatawillbecollectedsixmonthspostimplementationoftheCBINVpocketguide.

Evidence-based guidelines are tools that empower clinicians tomake appropriate decisions. We used a collaborative approach todevelopguidelinesforCBINVandsubsequentlyfordiarrhea,con-stipation,andhypersensitivityreactions.

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1987MULTIDISCIPLINARYDEVELOPMENTOFPALLIATIVECARESYMP-TOMMANAGEMENTGUIDELINES.KerryMahar,RN,MSN,AOCN®,Nancy Murphy, RN, and Eileen Molina, RN, Brigham and WomensHospital,Boston,MA.

Evidence-based symptommanagement is important for all areasofoncologynursingpractice,butespeciallyinpalliativecarewhereworsening symptoms can significantly decrease patients’ qualityof life.Prior toopeninganacutepalliativecareunitwe formedamultidisciplinaryteamtodevelopevidence-basedguidelinesforthesymptomscommonlyseeninthepatientstreatedinourPainandPal-liativeCareprogram.Nursesfromseveralroles(staffnurse,nurseeducatorandpalliativecareNP)werepartofthisteam.

Thegoalwastodevelopasetofevidence-basedguidelinestoman-agefivesymptoms:painemergency,nausea,dyspnea,constipationanddelirium.Sinceoncologynurses(throughinformationpublishedbytheOncologyNursingSociety)areveryfamiliarwithevidence-basedguidelines,theyareoftenhighlyvaluedmembersofguidelinedevelopmentteams.

Aftertheguidelinesweredevelopedweimplementedthemonthein-patientpalliativecareunit.Wheneverapatientontheunitexperiencedoneormoreofthesymptoms,amemberofthepalliativecareteam,(physiciansandnursepractitioners),wroteanordertoimplementtherelevantguidelinesothatallofthestaffwouldmanagethatpatient’ssymptomsaccordingtoprotocol.Nursessoonbecameaccustomedtoreferringtotheguidelineswhencommunicatingwiththemedicalin-ternsaboutasymptomandtherecommendedcourseofaction.

The nursing staff found the guidelines easy to use and very ef-fective in managing their patients’ symptoms. Being an integralpartofthedevelopmentteam,thenursingstaffreadilyacceptedtheguidelines,evenwhenrecommendations requiredmoreaggressiveinterventionstomaintainpatientcomfort.TrackingofPressGaneyscoreswereusedtocomparepatientsatisfactionpre-andpostguide-line implementationandbetween thepalliativecareunitandnon-palliativecareunits.

Theprocessthatwefollowedtodevelopandimplementevidence-basedguidelinestomanagethesesymptomsonourinpatientpalliativecareunitmayhelpotheroncologynurseswithguidelinedevelopment.Involvementoftheend-usersandadvocatesforoptimalpatientcareinthepalliativecaresettingwaskeyinthesuccessofthisprogram.

1990ADDRESSING THE CHALLENGE OF INCREASING FRONTLINE ON-COLOGY NURSES’ INVOLVEMENT IN COMMITTEE WORK. LillianPedulla,RN,BSN,MSN,andMarshaFonteyn,PhD,RN,Dana-FarberCancer Institute, Boston, MA; and Katherine McDonough, RN, MS,TheMcDonoughGroup,Norwood,MA.

Many health care institutions struggle with the dilemma of howto attract and sustain staff nurse participation in committee work.Basedonshareddecision-making,theNursingCouncilatouraca-demicambulatoryoncologycenterinherentlydependsuponnursingstaffinvolvement.SeveralcommitteechairpersonsreportingintotheCouncilexpressedconcernregardinglowattendanceandparticipa-tion among the staff nurses. Data on staff nurses’ membership inhospital based committee work showed that approximately 10%wereactivemembersofmultiplehospitalwidecommittees,whiletheremaining90%hadminimaltonoinvolvement.

Toaddresstheproblemoflowstaffnurseinvolvementoncommit-tees,theCouncilaskedtheEvidenceBasedPractice(EBP)Commit-teetoexploretwoprimaryquestions:Whatfactorsmotivatenursingstafftobecomeactivelyinvolvedincommitteework?Whatfactorsimpedeparticipation?

The EBP Committee found minimal evidence in published nurs-ingliteraturetoanswerthesequestions.Consequently,thecommitteedecided to obtain (expert opinion) evidence by implementing focusgroupsinterviewswithnursingstaffwhowereactivemembersofmul-tiplecommittees.TheEBPCommitteedevelopedaseriesofopen-end-edquestions.Nursesbelongingtomultiplecommitteeswereinvitedtoattendoneoftwoninety-minute,focusgroupsessions.TwoEBPCom-mitteemembersfacilitatedthesessionsandathirdmembertooknotes.Byconsensus,thesessionswereaudio-taped.Synthesisofinformationfromthesesourcesprovideddetailedinformationaboutwhatfactorsmotivateandimpedenursingstaffinvolvementoncommittees.

The project successfully provided answers to the two questionsposedtotheEBPCommittee.Severalrecommendationswerepresent-edtotheNursingCouncil,includingthere-examinationoftheCouncilandcommitteestructure.Todate,numerouspracticechangeshaveoc-curredandhavecontributedtoincreasedstaffparticipation.

Informationgainedfromfocusgroupscanbeanexcellentsourceofevidencewhenthereislittleavailableinthepublishedliterature.Thedescriptionofhowwecollectednewevidencethroughfocusgroupswillbeusefultonursesinavarietyofspecialtiesand/orsettings.

1992CONFLICT OF INTEREST: MORE THAN YOU THINK. Sally Brown,RN,BSN,MGA,OCN®,CCRP,FranklinSquareHospitalCenter,Bal-timore,MD.

Conflictofinterestisinherentinclinicalresearch.Theconcepthascomeunderincreasedscrutinyinrecentyearsasclinicalresearchhasexpandedfromacademiccenterstocommunityhospitalsandprivatephysicians’offices.Themostvisualformofconflictofinterestisfi-nancialasthemajorityofoncologyresearchreceivesexternalfinancialsupport.Cooperativetrialsgroupsandpharmaceuticalanddevicecom-paniesprovidefinancialsupportforenteringpatientsintoclinicaltrials.Cooperative trialsgroupsare increasing theircollaborationwithandfundingfromindustrysources.Thisescalatesthepotentialforconflictofinterestincooperativegroupstudies.Physiciansmayhaveafinancialstakeinthesuccessoftheinvolvedpharmaceuticalordevicecompanybyholdingstockorfunctioningasaprivatecontractorwithacompanybyparticipatinginaspeakers’bureauoronanadvisoryboard.

Conflictofinterestdoesnotnecessarilymeanthereisinappropri-ateconduct,butitcouldbeviewedaspotentiallyinappropriate.

Non-financialconflictofinterestislessvisualinvolvingcoordina-torsaswellasinvestigators.

Coordinatorshaveapotentialconflictofinterestifaccrualandde-linquencyratesarelinkedtoevaluationsandpromotions.Theneedordesiretopublishparadigm-changingresultscanbeperceivedasconflictofinterestintheconductofresearch.Anotherformofcon-flict of interest is physician-investigator confusion. If the treatingphysicianisalsotheresearchinvestigator,thepatientwhohasconfi-denceinhis/herphysician,hasthepotentialtoagreetoparticipateinresearchinordertomaintainthatrelationshipwiththephysician.

Severalauthoritieshaveaddressedaspectsoffinancialdisclosure.There remains a need to determine the degree of disclosure thatshouldbepresentedtopotentialparticipants.Explorationofthecon-sequencesofnon-financialconflictofinterestandthedevelopmentofmethodstoreduceanyimpactareneeded.

1994INTRASPINAL ANALGESICS IN THE MANAGEMENT OF CANCERPAIN.EllenDebondt,RN,BSN,OCN®,SeattleCancerCareAlliance,Seattle,WA.

Painmanagementcanbeachallengeincertainpatientswithcan-cerbecauseofinadequateanalgesiaandintolerablesideeffectsfrom

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systemic analgesic medications. In intraspinal analgesic therapy,opioidsandotheranalgesicagentsare introduceddirectly into thecentralnervoussystembyinfusion(epiduralorintrathecal)andcanbehighlyeffectiveforthemanagementofcancerpain.Theroleofnursinginpatientsreceivingintraspinalanalgesicsiscrucialtosuc-cessfulmanagementofthesepatients.

Thepurposeofthisistoprovideeducationtooncologynursesontheuse,appropriatenessandnursingcareofpatientsreceivingintra-spinalanalgesicsinthemanagementofcancerpain.

InthisposterIwillprovideanoverviewoftheintraspinalroutes,the differences and nursing care of implanted versus externalizedintrathecalcatheters,themedicationsusedandthepotentialcompli-cationsandsideeffects.Iwillalsodiscussappropriatepatientselec-tion,titration,andhomecaremanagement.Acasestudywillbepre-sentedoutliningpainmanagementoptionsusedpriortointraspinalanalgesicsandthetrial,titrationandrotationofvariousintraspinalanalgesicsusedtocomeupwithasuccessfulpainregimen.

OncologyNurses functioningascarecoordinators,patientadvo-catesandpatienteducatorsneedtobeknowledgeableontheavail-abilityanduseofintraspinalanalgesicsasanoptionformanagementofcancerpain.

Althoughmostpatientswithcancerpain,estimatedatgreaterthan90%canbeeffectivelymanagedwiththeuseofsystemicopioids,in-traspinalanalgesicsshouldbeconsideredinpatientswithintractablepainorexperiencingintolerablesideeffectswithsystemicanalgesicmedications.Theuseofintraspinalanalgesicscanprovideprofoundanalgesia with minimal side effects. Nursing care and assessmentisacrucialpartofeffectiveandon-goingmanagementofpatientsreceivingintraspinalanalgesics.

1995STRESS,COMPASSIONFATIGUE,ANDBURNOUT:EFFECTIVESELF-CARETECHNIQUESFORONCOLOGYNURSES.JohnLuquette,MA,LPC,LCDC,CGP,UniversityofTexasM.D.AndersonCancerCenter,Houston,TX.

Implicitinpatientcareisthenurse’sinterpersonalandempatheticconnection with patients and their families. Continual negotiationbetweenprofessionalstandards,personalegointegrity,andpatientneedswithinthetherapeuticrelationshipleavethenursevulnerabletostress,compassionfatigue,andburnout.Effectiveuseofself-caretechniquesbyoncologynursescontributetoimprovedpatientcareandincreasedjobsatisfaction.

Researchlinksstresstophysiologicalconditionslikecardiovasculardistress, immunosuppression, and gastro-intestinal problems. Stressadverselyimpactsattention,concentration,criticalthinking,andothercognitivefunctions.Familyandsocialrelationshipssuffer.Stresslevelscontribute toreducedpatientsatisfaction, increasedemployeehealthcosts,increasedspendingforrecruiting,andunnecessaryturnover.

Meta-analyses of stress research support the effectiveness of in-terventions. Research suggests that combinations of interventionsappear to be more effective than any single intervention. Nursesusuallylearnself-carestrategiesthroughpersonalexperienceortheadviceofcolleagues.

Thispresentationidentifiesanddescribeseffectiveself-caretech-niquesemployedbyoncologynurses.

Researchsupportstheeffectivenessofcognitive-behavioralinter-ventions.Thisbroadclassofinterventionsincludessuchdetachmenttechniquesasdistancinganddebriefing,guidedimagery,assertive-ness or other skills training, and establishing professional or per-sonalboundaries.

Relaxation training includes such techniques as diaphragmaticbreathing,meditation,progressivemusclerelaxation,andguidedim-

agery.Oncemastered,sometechniquesmaybeusedunobtrusivelywhileworking.

Grouptechniquesrelyonmemberssharingandacceptinginforma-tion,assistance,andsupportwitheachother.Theseincludeformaldebriefing, grief support, and Critical Incident Stress Debriefinggroupsaswellasunstructuredactsofcaringandassistance.Exis-tentialtechniquestrytofindmeaninginlifeandsuffering.Prayer,personalreflection,meditation,andrestoringalifebalancerepresentthesestrategies.

Providingoncologynurseswithmultipleself-caretechniquesmin-imizetheconsequencesofstress,promotesbetterpatientcare,andincreasestheirjobsatisfaction.

Futureresearchmightfocusonmatchingspecificstrategiestoindi-vidualnursesorspecificcircumstances.

1996PALLIATIVECAREFROMTHEINSIDEOUT:DRAWINGUPONEXIST-INGRESOURCESTODELIVEREFFECTIVESERVICES.APILOTPROJ-ECTOFAPALLIATIVEANDSUPPORTIVECARESERVICE(PSCS)ONTHEONCOLOGYUNITSATTHEUNIVERSITYOFARIZONAMEDICALCENTER(UMC).VirginiaLeBaron,RN,ACNP,AOCN®,UniversityofArizonaCollegeofNursing,Tucson,AZ;andSusanBohnenkamp,MS,APRN-BC,CNS,CCM,andAnaMariaLopez,MD,MPH,FACP,Univer-sityMedicalCenter,Tucson,AZ.

Palliativemedicineisnowrecognizedasanessentialcomponentofcomprehensivecancercare,andthe literaturedemonstrates thatpatientsandoncologynursesbenefitfromaccesstoeffectivepallia-tivecareteams.UMCisaleadingreferralsiteforoncologyservicesintheStateofArizona,butpriortoinitiationofthisprojecthadnoorganizedpalliativecareservices.Thevisionofthehospitalpallia-tivecarecommitteeservedasafoundation tobeginapilotpallia-tivecareserviceandeducationprojecttoenhancequalityoflifeforpatientsandcaregiverswhileimprovingpatient,caregiver,andstaffsatisfaction.• To implement a palliative care pilot project with the inpatient

medicaloncologyteam.• Todeliverapalliativecarenursingcurriculumthatwillestablish

a corps of “Palliative Care Resource Nurses” within UMC, theArizonaCancerCenter,andinthestate.

• Created an interdisciplinary PSCS team from preexisting clini-cianswithinUMC.

•Conduct bi-weeklyPSCSmeetings to discuss patient needs androunddailywiththeoncologyteam.

• Develop and implement formalized PSCS assessment and out-comemeasurementtools.

• RefinereferralcriteriaandmethodstomarketthePSCS.• Self-selectedRNsparticipateinmonthlyEndofLifeNursingCon-

sortium(ELNEC)educationalprograms,whichwillbebroadcastusingtelemedicinetechnologytonursesthroughoutArizona.

• Ongoingpalliativecareeducationisplanned.

• PrimaryendpointistoassessfeasibilityandacceptabilityofthePSCS.

• Referred patients/families and referring staff will assess theirexperienceandcommentonperceivedbenefitsandareasforim-provement.

• Staffparticipatinginpalliativecareeducationwillevaluateeachsessionandpreandposttestingwilloccur.

The implementation of a pilot PSCS, along with the concurrenttrainingofacadreofPalliativeCareResourceNurses,willenhancethedeliveryofpalliativecareandimprovetheoncologynurse’sabil-itytoidentifyandmanagethecomplex,holisticneedsofseriously

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illpatients.ItishopedthatresultsfromthispilotworkwillserveasafoundationforexpandingpalliativecarewithinUMC,andmayalsoserveasaguideforotherhospitalswithlimitedresourceswhodesiretodeveloppalliativecareservices.

2004SUCCESSFULLY INTEGRATING THE NURSE PRACTITIONER ROLEINTO AN ONCOLOGY PRACTICE. Nancy Leahy, RN, MSN, CRNP,AOCN®,AlbertEinsteinMedicalCenter,Philadelphia,PA.

Inthechangingoncologyenvironmentit isevenmoreimportanttoestablishacollaborativepracticebetweenallthemembersoftheoncologypractice.Morenursepractitionersarebeingemployedbyoncologisttoprovidequality,cost-effectivecarewithhighlevelsofpatientsatisfaction.

Theprocessandrequirementsofsuccessfulintegrationofthenursepractitioner role into an oncology practice will be discussed.Thesuccess of the integrationof thenursepractitioner role requires aclear,articulatedjobdescription,mentoring,supportandwillingnesstodelegate.Thefactorsthatinhibitsuccessfulintegrationalsomustbe recognized and addressed to facilitate the success of thenursepractitionerinoncologypractice.Thetruesuccessoftheintegrationintopracticeisthewillingnessofthephysiciantoutilizethenursepractitioner,understandthenursepractitionerscopeofpracticeandtounderstandthevalueoftheroleofthenursepractitioner.

Thepracticewillexperienceincreasedrevenue,efficiency,patientsatisfaction and collegial input. The self-evaluation of the perfor-manceappraisalwilldemonstratetheNP’ssatisfactionwiththeroleintegration.

The nurse practitioner in oncology is becoming an efficient ad-ditiontothepracticeinprovidingcost-effectivecaretothepatientwhileprovidingthepracticewithexpertiseandrevenue.Thesuccessoftheintegrationoftheroleintopracticewillbenefitalloftheprac-ticeandespeciallythepatients.

2005ADVOCATING FOR ONCOLOGY NURSE PRACTITIONER SCHEDULEIINARCOTICPRESCRIPTIVEAUTHORITYINPENNSYLVANIA.NancyLeahy,RN,MSN,CRNP,AOCN®,AlbertEinsteinMedicalCenter,Phila-delphia,PA.

Asacertified registerednursepractitioner (CRNP)practicing inthe state of Pennsylvania, the current prescriptive authority limitsprescribingScheduleIInarcoticstoa72-hoursupply.ThisincludesanyScheduleIImedicationregardlessofthepatientandtheirpainregimen. Working under a collaborative practice agreement, thenursepractitioner(NP)canprescribechemotherapy, treatandpre-scribeformostsymptomsandsideeffectstheoncologypatientmayencounter,butnottreatpainwithScheduleIInarcotics.

Thepurposeofthisprojectistodevelopamethodtoassistnursepractitionersinadvocatingforachangeintheirprescriptiveauthor-ityinPennsylvania.

CRNPs of Pennsylvania must network with peers and organiza-tionssuchasNursePractitionergroups,AdvancedPracticeNursesgroupsandONS.ItisimperativefortheNPtodiscussthismatterwith theircollaboratingphysicians togain their support ingettingheard.OncemoreNPsbecomeawareofthisseriousproblem,theymustcontacttheirlocalofficialsandthegovernortoseektheirsup-portinbringingthistotheStateBoard.

The success of the interventionwill bedeterminedby thenum-berofNPswriting,emailing,networkingetctotelltheStateBoardsomethingneedstochange.Aswemoveforward,GovernorRendellwill learnof theneedofhis support for this specificmatterashecontinuestosupporttheNProleinPennsylvania.

Thespecialtynursepractitionerneedstobeabletotreatthepatientpopulationintotal,notonlypartly.Thisisimperativewhenpainisthesymptomnotbeingabletobetreatedefficientlyandeffectivelyduetothecurrentprescriptiveauthority.Medicaloncologistsareem-ployingmorenursepractitionerstoprovideefficient,cost-effectivecaretotheirpatientsworkingautonomouslyunderthecollaborativepractice agreement. The current limitation of 72-hour supply forSchedule IIdrugs impedes thisautonomyanddiminishes theeffi-ciencyofthepatientencounter.

2006“SUNSAFESAFARI”:AUNIQUEMETHODOFEDUCATINGSCHOOLAGECHILDRENABOUTSUNSAFETY.VictoriaChambers,RN,OCN®,HelenRoorda,RN,BSN,OCN®,andPatriciaWang,RN,OCN®,FloridaHospitalCancerInstitute,Orlando,FL.

In2006,therewereapproximately63,000newcasesofmelanomaandoveramillionnewcasesofbasalandsquamouscellskincancer.AmericanCancerSocietyrecommendsthefollowingguidelinesforprevention:Limitoravoidsunexposure,wearahatandsunglassestoprotecttheface,neckandears,wearalong-sleevedshirt,andusesunscreenwithaSPFof15orhigher.According to theAmericanCancerSociety, severesunburns inchildhoodcangreatly increaseriskofmelanomainlaterlife.Knowledge,passionforteachingandsenseof commitmentputOncologynurses in thebest position toreachouttothecommunity,especiallyyoungchildren,andprovideeducationregardingsunsafety.

Giventheshortattentionspanofyoungchildren,theinformationneedstobepresentedinashort,fun,entertainingformat.SunSafeSafari was created with the goal of reaching 100 children everymonth.

Thisisaccomplishedbycontactingelementaryschoolsandafterschoolprograms.TheSunSafeSafari teamconsistsof4actors,1musicianandadirector.There isapretestandapost test that thechildrentakehomeandcompletewiththeirparents.Bothtestsarecollectedandreturnedtothedirectorforgrading.Theprogramlasts20minutesandrevolvesaroundagrapenamedAlex,araisinnamedRandi and a storyteller named Moondoggy. Randi the raisin triestoconvinceAlex thegrape thathewill turn intoaraisin too ifhedoesn’tusesunsafety.“Sliponashirt,sloponsomesunscreenandslaponahat”.Brightcolorfulcostumes,musicandgamesencouragethechildrentoparticipate.Thechildrenalsoreceiveapacketwhichincludesasafarihat,sunscreen,lipbalm,abottleofwaterandanactivitybooklet.Todate,thescoresofthepretestandpost-testhaveshownanimprovementof75%insunsafeknowledge.

Currently in development is collaboration with the Girl ScoutCounciltocreateaSunSafeSafaripatch.Withalittlecreativity,tal-entandmotivation,thisconceptcouldeasilyberecreatedandusedinanycommunitysetting.

2007ONCOLOGYNURSINGANDCOMPASSIONFATIGUE:CARINGUNTILITHURTS.WHOISCARINGFORTHECAREGIVER?LoriMcMullen,BSN,RN,OCN®,UniversityMedicalCenteratPrinceton,Princeton,NJ.

Thefeelingofempathywhichisakeycomponenttoatherapeuticrelationshipwithaclientandfamilycanbecomeoverwhelminginafieldthatdemandsstrengthandresiliency.Workingwithcancerpa-tientschallengestheoncologynursewithavarietyofdifficultissues,fromethicalconcernsandpalliativecare,tointenseinteractionswithpatientsandfamiliestointricatetreatmentsandendoflifedecisions.Theconsequenceofthisconstantexpenditureofempathyiscalledcompassion fatigue, literally caring until it hurts. Compassion fa-

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tigue,astressresponsethatissuddenandacutehasbeendefinedasaphysical,emotionalandspiritualfatigueorexhaustionthattakesoverapersonandcausesadeclineinhis/herabilitytoexperiencejoyorcareforothers.

If not recognized and treated, compassion fatigue can interferewiththeabilitytogivequalitynursingcarethatissafeandeffective,cancausephysicalandemotionalexhaustion,andresultindeperson-alizationandultimatelyburnout.

Thepurposeof thisstudyis toexaminetheabilityof theoncol-ogynursetorecognizecompassionfatigueandtoexaminetheorga-nizationalsupportsystemsavailabletotheinpatientandoutpatientoncologynurse.

This study is supportedby thehumanistic theoryofPaterson&ZderadandBaston’ssocialpsychologytheory,theempathyaltruismhypothesis.Therelationshipofcompassionfatigueandstressissup-portedbytheworkofLazarusandFolkman.

Adescriptiveandcorrelationalsurveywillbeusedbydistributingaself-completedsurvey to~30oncologynursesata localchaptermeetingofONS.Inpatientandoutpatientoncologynursesatacom-munitybasedhospitalwillbeaskedtoparticipateinthestudy.Themeasurewillbe theProfessionalQualityofLifeScale(ProQOL):Compassion Satisfaction, Burnout and Compassion Fatigue/Sec-ondaryTrauma Scale by Stamm (1997-2005). Demographics willbecollectedtoestablishfieldofpracticeandavailabilityoforgani-zationalsupportsystem.

Preliminaryimplicationssuggestthatoncologynursesareignorantofthetermandassociatedsymptomsofcompassionfatigue.Whilepreventionisclearlythemosteffectivemeansofcopingwithcom-passionfatigue,itseemsthathealthorganizationsarenotsupportingthepsychologicalwellbeingofstaff.

2008RECOGNIZING ONCOLOGY CRISES IN THE EMERGENCY DEPART-MENT:ASTAFF-DRIVENIMPROVEMENTPROCESS.LisaF.Cull,BS,RN,OCN®,MiddlesexHospitalCancerCenter,Middletown,CT;Mary-Beth Nolan, MSN, RN, CEN, Middlesex Hospital, Middletown, CT;AnneCampbell-Maxwell,MBA,BSN,RN,MiddlesexHospitalCancerCenter,Middletown,CT; and JacquelynG.Calamari,MS,BSN,RN,CEN,KathyPalaski,RN,andCyndyMarotta,RN,MiddlesexHospital,Middletown,CT.

Increasingly,oncologypatientspresentintheEmergencyDepart-ment seeking care during their disease continuum. Knowledge ofnewtreatmentmodalitiesaswellasastuteassessmentskillstorec-ognize a related host of symptoms and side effects are now criti-calcompetenciesforsafeemergencymanagementofthesepatients.Specializedcareforcancer-relatedemergencieshasevolvedasahy-bridofoncologyandemergencymedicine.

Thepurposeofthisclinicalprojectwastouseanevidence-based,interdisciplinaryapproachtoimprovethequalityofemergencyon-cologycarethroughcollaboration,education,resourcesupportandcreationofbestpracticeprotocols.

Aninterdepartmentalprojectteamcomprisedofnursingstaff,man-agersandnurseeducatorsfromtheEmergencyDepartmentandtheCancer Center examined current care practices, patient outcomes,availableeducationandresourcestodeterminethequalityofemer-gency oncology care. Based on the data, communication betweenstaffandareviewofthecurrentliteratureinoncologyemergencies,anumberofareaswereidentifiedtoimprovepatientmanagement.The improvement initiatives included: design and implementationofa“VitalOncologyFacts”guideforthetriagereferencemanualswith pocket versions provided to staff; standardization of the on-cologytriageprocess;developmentandpresentationof“Oncology

Emergencies”asaneducationalserieswithanalysisofcasestudies;andenhancementoftheEmergencyDepartment’sreferencelibrarieswiththeadditionoftwonewoncologyemergencyresources.

This collaborative initiative achieved outcomes in the followingdomains:enhancednursingstaffcompetencyandconfidenceinon-cologyemergencycare;improvedtimetotreatmentwiththeoncol-ogypatientidentifiedasatriageEmergencySeverityIndexscoreof“2”; and expandednetworkof oncology care collaboration acrossoutpatient, inpatient,andemergencycaresettingsinordertostan-dardizebestcarepractices.Thishasresultedinthedevelopmentofacontinuum-basedoncologyneutropenicpathway.

Theinterdisciplinarycooperationbetweenemergencyandoncolo-gyspecialtiescultivatesprofessionaldevelopment,qualityimprove-ment initiatives and opportunities for oncology-emergency educa-tiontoenhancepatientoutcomes.

2009ONCOLOGYNURSEASACOLONSCREENINGNURSENAVIGATOR.CharleneMarinelli,RN,BSN,OCN®,NoraKaturakes,RN,MSN,OCN®,and Sandra Donnelly, RN, OCN®, Helen F. Graham Cancer Center,ChristianaCareHealthServices,Newark,DE.

ColorectalcancerdeathsinDelawarearethethirdhighest.Mortal-ity ishigheramongAfricanAmericans thenCaucasians.Colonos-copy isa reliablescreening test.FewDelawareans takeadvantageofthislifesavingtest.BehavioralRiskFactorSurveillanceSurvey(BRFSS)1999data reported,45%Caucasiansand39.6%AfricanAmerican Delawareans ever having a sigmoidoscopy or colonos-copyscreening.

In2002,theDelawareCancerConsortiuminitiatedacomprehen-sivestatewidecommunity-focusedcolorectalcancerscreeningpro-gram.AfulltimeColorectalScreeningNurseNavigator(CRCNN)was housed in each major health system. Christiana Care HealthSystem(CCHS)hired2part-timeOncologyCertifiedNursesspe-cializing in community outreach to provide culturally sensitiveoutreachandrecruitment,ensurescreeningaccessandscheduling,monitor screeningcompliance, andensurepromptclinical evalua-tionandfollow-uptopositivetesting.

The CCHS CRCNN shared their oncology nursing expertise tocreateprogrammaterialsandrecruitindividuals50yearsandolder,mostlyAfricanAmericans,uninsuredlivingingeographicareasde-terminedtobehighrisk.Assistancewasprovidedtoovercomebar-rierstoscreeninge.g.,ifuninsured,enrollinthestatefundedcolonscreeningprogram.Partnershipswerefosteredwithcommunityor-ganizationsandthemedicalcommunitytoassistwithreferrals.TheCCHSCRCNNparticipatedinthedevelopmentandimplementationofaweb-baseddatasystemdesignedtoassistincasemanagementandtrackingthroughintake,planning,screeningandfollowup.

BRFSS data 2004 reported a statistically significant increase inCaucasiansandAfricanAmericans(62.3%and58.4%respectively)everhavingasigmoidoscopyorcolonoscopy.CCHSCRCNNcasemanaged690individuals.Aportion(230)werefoundtohaveun-surmountablebarriers(comorbidconditionsandunabletocontact)couldnotcompletescreening.Colonoscopywascompletedby274(40%)individuals,85wereenrolledinthestatefundedprogram,and86wereAfricanAmerican.Usingtheweb-baseddatasystem,166individualscontinuetobecasemanagedwithnewenrolleesaddeddaily.

Oncologynursescontributekeyattributesandexperiences to in-crease public awareness and educate about colon cancer. Further,theyassistwithaccess to insuranceandnavigatedifficultorcom-plex families from diverse populations to increase screening ratesinDelaware.

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2010A NURSE CAN SAFELY DELIVER RITUXIMAB OVER 90 MINUTES.PeggyCorey,RN,BSN,OCN®,RonaldGo,MD,andAnaSchaper,RN,PhD,GundersenLutheranHealthSystem,LaCrosse,WI.

Implementation of evidence-based practice protocols for cancertreatmentcanbenefitpatients’qualityoflifeandmaximizeutiliza-tionof available resources.Recently, three studies fromacademiccenterssuggestthatrapidrituximabinfusion(RRI),whichreducesinfusiontimefrom4hoursto90minutesinthetreatmentofnon-Hodgkins lymphoma (NHL), is well tolerated and safe. However,cohortsinthesestudiesweresmallandmaynotbereflectiveofthepatientpopulationtreatedinthecommunitysetting.Nurses,aspa-tientadvocates,needtobecautiousofchangesintreatmentregimes,whenbasedonlimitedevidence.

Forthisproject,theoncologynursingstaffpartneredwithaphysi-ciantoinvestigatethefeasibilityofRRIatacommunity-basedcan-cercenter.

Patients,withNHL,wereenrolledinthismodifiedtreatmentpro-gramiftheyhadreceivedrituximabaccordingtoproductmonographwithinthelast4months,nopriorgrade3or4infusionrelatedtoxici-ties,nocontra-indicationtofluidinfusionof200ml/hr,andanabso-lutelymphocytecountof<10,000.Patientswerepre-medicatedwithacetaminophenanddiphenhydramine.Rituximabwasinfusedin90minutes (20% dose first 30 minutes; 80% dose next 60 minutes).Nursesmonitoredpatientsduringandafterinfusionfortoxicityasdefinedincommonterminologyforadverseevents.

Thirty-threepatientsweretreatedfortotalof88infusions(median3).Clinical profile includes:median ageof69years (range32 to88),70%male,67%stageIII/IVdisease.Chemotherapyregimensincluded:33%CHOP(cyclophosphamide,vincristine,doxorubicin,prednisone),21%CVP(cyclophosphamide,vincristine,prednisone),3%CF(cyclophosphamide,fludarabine),6%CEP(cyclophospha-mide,etoposide,prednisone),and36%rituximabalone.Noadverseeventswereobservedforthe90-minuterituximabinfusions.

Rituximab infused over 90-minute was safe in the treatment ofNHLandwell toleratedinthiscommunitycohort.Bothrituximabandchemotherapywereinfusedwithin4hours.Thereducedinfu-siontimeallowedpatientsmorecontrolandflexibilityintreatmentscheduling,andmoretimeawayfromthefacility.Inaddition,short-erinfusiontimesimprovedaccessinthechemotherapysuite.2014REDUCINGBARRIERSTOPAIN&FATIGUEMANAGEMENTFORCAN-CERPATIENTS.TamiBorneman,RN,MSN,CNS,BettyFerrell,PhD,FAAN,VirginiaSun,RN,MSN,andMariannaKoczywas,MD,CityofHopeNationalMedicalCenter,Duarte,CA;BarbaraPiper,DNSc,RN,FAAN,AOCN®,UniversityofArizona,Scottsdale,AZ;andGwenUman,RN,PhD,VitalResearch,LLC,LosAngeles,CA.

Painandfatigueimpactalldimensionsofthepatient’slifeinclud-ingphysical,psychological,social,andspiritualwellbeing.

TheoverallpurposeofthisprospectivelongitudinalstudyfundedbyNCIistotestaninnovativemodelofreducingbarrierstomanag-ingpainandfatigueincancerpatientsusingevidenced-basedguide-linesfromtheNationalComprehensiveCancerNetwork.

Themodel,“PassporttoComfort”addressespatient,professionalandsystembarrierstothereliefofpainandfatigue,andisbasedonevidencebasedguidelinesdevelopedby theNationalComprehen-siveCancerNetwork.

Thestudy,conductedinacomprehensivecancercenterisdesignedinthreephases.InPhaseI:Usualcare,wedescribedthecurrentsta-tusofpainandfatiguemanagementin83patientswithbreast,lung,colonorprostatecancer.Methodsofdatacollectionincluded7ques-

tionnairesconductedatAccrual,1-month,and3-month,andachartauditat1-month.

AninterdisciplinaryAdvisoryBoardprovidesinputanddirectionregardingpatientcareandeducation.ThisteamincludesPsycholo-gy,Chaplaincy,SW,Nutrition,Rehab,MedicalOncology,andPhar-macy.PhaseIIincludesintensivepatientandprofessionaleducationalongwithpeerauditandfeedbacktoaddresseachcategoryofbarri-ers.InPhaseIII,investigatorswillcontinuetomovetheinterventiontoamorerealisticmodelofcaretobemaintainedandreplicatedinotherclinicalsettings.

PhaseI:Ofthe83patients,64%werediseasestageIIIorIV,meanage was 61, and 81% were currently on treatment. Overall meanscore for quality of life was 5.4 (0=negative to 10-positive). 85%reportedfearofaddiction,45%werereluctanttoreportpainforfearofbeingseenasa“badpatient.”Overallscoreforpatientknowledgepaintoolwas75%correct.Chartauditsrevealedalackofdocument-ingpresenceofpain.Regardingfatigue,80%reported>4severityand84%reported>fatigueasemotionallydistressing.Overallscoreforpatientknowledgefatiguetoolwas82%.Chartauditsrevealedlackofdocumentationofthepresenceoffatigue.

Thisclinical interventionhas identifiedkeybarriers to symptomreliefandshouldcreateareplicablemodelforotheroncologyset-tings.

Thesefindingsrepresenttheneedtoprovidefurthereducationandinterventionstopatientsandprofessionalstobetteraddressexistingbarrierstopainandfatiguemanagementandresultingpsychosocialissues.

2015POPULATION-BASEDNURSE-INITIATEDCANCERSYMPTOMMAN-AGEMENT:DESCRIPTIONOFANONGOINGPROGRAM.CarolKamhi,MSN,APRN,BC,OxfordHealthPlans,aUnitedHealthcareCompany,Trumbull,CT;RichardWeininger,MD(boardcertification:heme,onc),OncoMetrix,Inc.,Claverack,NY;RamonaHays,RN,BSN,Oxford,aUnitedHealthcareCompany,Trumbull,CT;andElizabethMicholovich,BS,MPA,SecureHorizons,aUnitedHealthcareCompany,Trumbull,CT.

AmajorNortheasthealthinsurancecompanyrecognizedanoppor-tunitytoreducecomplicationprevalenceandrelatedhospitalizationsinpatientsundergoingcancertreatmentsusinganinnovativenursecasemanagementmodel.

Thisprogram’spurposeistoreduceadmissionsrelatedtoprevent-abletreatmentanddiseasecomplications.Thistelephoniccareman-agement(TCM)modelwasdesignedforpatientsundergoingactivechemotherapy or radiation cancer treatments focusing on those athighestriskofpreventablehospitalization.

Selectioncriteriaweredevelopedandtestedtoidentifythosepa-tientsathighestrisk.Thesecriteriawereusedtocreatea“riskindex”based on: diagnosis (excluding childhood malignancies and acuteleukemias);diseasestage;particulartreatments(e.g.:platinumbasedtherapy);caregiversupport;andhospitaladmissionhistory.TheriskindexwasusedtostratifytheTCMintervention’sintensityprovidedtothepatient.

PreventablehospitalizationcriteriaweredevelopedbasedonICD-9codestocreateamatrixfromwhichhospitalclaimscouldbeusedto identifypreventablehospitalizations fornausea,vomiting,diar-rhea,dehydration,infection,hematologicabnormalities,respiratoryproblems,andothers.

Telephonicnursingassessmenttoolswerecreatedtoevaluatesignsandsymptomsof treatmentcomplications to interveneproactivelywithpatientsandtheirhealthcareteamtohelpestablishcareintheappropriatesetting.

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Programresultswereassessedbytheabilitytodemonstrateare-ducedlevelofpreventablehospitaladmissions.Admissionswereas-sessedforICD-9codesfittingthesecriteriaovertimeandcomparedtoanunmanagedpopulation.Initial,early,resultshaveshownapos-itiveeffectoncomplicationmeasures:prevalence,admitsper1,000,admits,andaveragelengthofstayformanagedpatientsversusthosepatientswhodidnotreceivecasemanagement.Theseoutcomepa-rametersrepresentcoregoalsforoncologynurses.

Byinterveningproactivelywithpatientsandtheirhealthcareteamandhelpingsupporttimelycareintheappropriatesetting,preventablehospitalizationsarereduced.Theapproachanddevelopedtoolsout-linedherecanbeadaptedforusebyoncologynursesinotherclinicalsettingstoreducemorbidityofcancerandrelatedtreatments.Addi-tionalanalysiswillbeconductedonthismodel’simpactonenhancingthehealth care team’s care coordinationas it relates topreventablehospitalizations,treatmentoutcomes,andpatients’qualityoflife.

2016THECLINICALSCHOLAR: FORMALRECOGNITIONOFNURSECLI-NICIANS’COLLABORATIVEACTIVITIES.MarshaFonteyn,RN,PhD,OCN®,MarthaHealey,RN,MSN,FNP,NaoeSuzuki,MFA,andSusanBauer-Wu,RN,DNSc,Dana-FarberCancerInstitute,Boston,MA.

Thenursescientistsandotherstaffinournursingresearchcenter,locatedinaNCI-designatedCancerCenter,arecontinuouslyseek-ingwaystoencouragethenursecliniciansatourinstitutiontobe-come more involved in the research, evidence-based practice andscholarlyactivitiesoftheresearchcenter.Suchcollaborationisnotonlymutuallybeneficial,butalsoprovidesamechanismformorerapidtranslationofnewknowledgeintoclinicalpractice.

Toencourageandpromotegreaterinvolvementofnurseclinicianswithournursingresearchcenteractivities,wehavedeveloped theClinicalScholarsProgram.GuidedbyprinciplesofTransformation-alLeadershiptheory,weuserolemodelingandceremonytobuildandsustainanursingculturecommittedtoinquiryandscholarship.

TheClinicalScholarwasoriginallyconceived(fouryearsago)asamentored researchexperience thatwould linkaclinicianwithanursescientistbyprovidingamechanismfortheScholartoreceivereleasetimeandfundingtocarryoutasmallresearchproject.Thisexpensiveandlabor-intensiveapproachmeantthatwehadtolimitthenumberofClinicalScholarstooneayear,thusslowingprogresstowards our goal of creating a culture of inquiry and scholarshipinnursingpracticeatourCancerCenter.Now,threeyearssinceitsinception, we have expanded the Clinical Scholar Program to en-compassmoreofournursingstaff.

In thespringof2007,wewill formally recognizeover30nursecliniciansasClinicalScholarsfortheircollaborativeworkwiththenurses from our research center. Correspondingly, the number ofcollaborativeprojects (evidence-basedpractice and research), pre-sentationsandpublicationshasremarkablyincreasedandfeedbackfromthoseinvolvedhasbeenverypositive.

Establishingamechanismtoencourageandrewardcollaborationbe-tweennursesfromclinicalpracticeandanursingresearchcentercanbetransformationalincreatingacultureofinquiryandscholarshipinnursingpractice.Ourrecognitionprogramcouldbeeasilyadaptedtoavarietyofsettingsasaneffectivestrategyforincreasingtheinvolvementofclinicaloncologynursesinresearchandotherscholarlyactivities.

2019REVITALIZING YOURSELF: MAKING TIME 4U. Susan Politsky, RN,MSN,CNA,BC,FoxChaseCancerCenter,Philadelphia,PA.

Oncologynurses,particularlythosewhoworkincriticalcareset-tings are at risk for developing moral distress which can be from

medical futility and bad deaths, burnout and compassion fatigue,whichcanleadtopoornursesatisfaction.

Allowingstafftheopportunitytoverbalizeanddiscusstheirfeel-ingsofworkrelatedstressinaforum,validatedtheirfeelingsandallowedthemanopportunitytosharesimilarexperienceswithoneanother.

ThepurposeofthisprogramwastoprovidetheICUstaffanop-portunitytorelaxtheirmindsandparticipateinactivitiesthatinclud-ed: song, yoga,mediation, affirmations and therapeuticmassages.Themodelbehindthistheorywasadaptedfromanoncologyarticlewhichsupportedaretreatdaytoallowstafftodecompensateduetostressfulworkencounters.

My program was designed as a corroboration of staff issues re-gardingsomeethicalissuesthatrecentlyoccurredintheunit.Thisprogramofferedthemasafeplace,amongtheircolleaguestodiscusstheir recent feelingsandde-stresswithsomeactivitieswhichpro-motehealthyworkenvironments.Participantswhoprovidedservicesincludedconvenientemployeeswhohavebeentrainedintheirfieldsofexpertisesuchasinyoga,meditationandtherapeuticmassage.

SomeoftheactivitiesincludedhavingstaffcompleteaCompas-sionFatigueSurvey,utilizationoftheAmericanAssociationofCrit-ical Care Nurses:The 4A’s to RiseAbove Moral Distress, GoodDeathversusBadDeaths,ReviewingtheANACodeofEthics,Re-viewingFoxChaseCancerCenterpoliciesonethicaldilemmas.Allstaffweretreateda45minutetherapeuticmassage.

ThisprogramisdesignedtobeofferedeveryothermonthuntilalloftheICUstaffattend.Staffarerequiredtobeofffromworkthedaybeforetheprograminpreparationforthiseducationaloffering.

Implications for nursingpractice include employers to be awareofissuessuchasmoraldistressthatcanbeaffectingtheirstaffandallowaninterdisciplinaryteamtobegintomanagetheseissuewhichaffect the work environment.As an employer, being aware of thecultureoftheworkenvironmentisinvaluabletoproducehighqual-ityhealthcareproviders.

2025EDUCATION:THEKEYTOSAFELYIMPLEMENTACLINICALTRIAL.AnnaVardeleon,RN,OCN®,andDonnaGerber,RN,MN,PhD,AOCN®,M.D.AndersonCancerCenter,Houston,TX.

Newscientificdiscoverieshaveledtothediscoveryofpathwaysthatcanbetargetedinthebattleagainstcancer.Newtargetedtherapyclinicaltrialsaremorecomplexandrequireplanningandeducationtosafelyexecute.

Ensuringpatientsafelyduringtheirparticipationinaclinicaltrialrequirescarefulplanninganddevelopmentofmaterials toeducatethestaffnurses,patientandfamilymemberswhatmeasuresarere-quiredforparticipationandtheirroleinthesuccessfulcompletionofthetrial.Also,patientswhotraveltoacomprehensivecarecentertoparticipateinaclinicaltrialmaypresenttothelocalemergencyroomafterreturningtotheirhomeareaandinformationisneededbythelocalphysicianregardingthemedicationsthatthepatientisreceiving.

Theresearchnurseneedstoreviewtheclinicaltrialrequirementsand receive input from the principal investigator as needed.Theneducationalmaterialneedstobedevelopedforthepatientandfam-ily to ensure safeparticipation.Thesematerialswill alsoassist inthesuccessof theclinical trial.Thesematerials includedrug-drug(includingherbalsupplements)interactions,food-druginteractions,clinicappointments,specimencollection,instructionsonwhattodoforanticipatedsideeffectsoftreatment,properhandlingandstorageofmedicationandcontactinformation.Apatientcangiveacopyofthismaterial to theirhomeareaphysician so that theycanunder-

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standwhatthepatientisreceivinganddoappropriateinterventionsifrequired.

Evaluationisseenintheexecutionofclinicaltrialswithfewerde-viationsandviolations.Safety isenhancedas those involvedwiththecareofthepatienthaveaccesstotheseeducationalmaterials.

Thus,researchnursesmustbeinnovativeincreatingeducationalmaterialthatpatientscanusesothatclinicaltrialscanbeexecutedsafelyforeveryoneinvolved.2028WHO,WHAT,WHEN,WHEREANDWHY: IMPLEMENTATIONOFANEVIDENCEBASEDPRACTICEMODELINAMBULATORYCARE.Mau-reenMajorCampos,RN,MS,EthelLaw,RN,MA,MelanieCarrow,RN,OCN®,ACRN,andRoriSalvaggio,RN,MS,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Topromotenursing scienceandbestpractice at thisNCI-desig-nated Comprehensive Cancer Center, an Evidence Based Practice(EBP) initiativewas implementedby theDirectorofNursingRe-search andPractice,with support of theChiefNursingOfficer.ADepartmentalPracticeCommitteewasestablishedwithrepresenta-tionfromallpatientcareareas,anditsmissionistofosterandguideEBPthroughouttheinstitution.

TheAmbulatoryPracticeCouncilwasdesignatedtodevelopandoverseeEBPinitiativesintheoutpatientsetting.Membershipcon-sistedofstaffnurseswithvaryinglevelsofprofessionalexperience.AChairandCo-ChairwereselectedtofacilitategroupprocessesandreportactivitiestotheDepartmentalPracticeCommittee.

Ourgoalwas toeducatenurseson the theoryandapplicationofEBPmethodologysothatourinstitutionalguidelinesandstandardsofpracticereflectedthelatestscientificevidence.

Educational methods included didactic lectures and individualguidance throughoutprojectdevelopment.Fourpracticequestionswere identified as models for application of learning. The nurseswereeducatedonframingthepracticequestion,searchingandana-lyzingtheevidence,applyingtheevidencetopracticeandevaluat-ing outcomes. Internal and external consultation with experts anddevelopmentofpartnershipswithotherdisciplineswasencouraged.Thecreationofavirtualofficeandutilizationofcentralizedtoolsforreportingandpresentationeasedcommunicationamongthenurses.Mentors,includingalibrarianandresearchassistantwereavailable.

AnevaluativemeasureofsuccesswasthecompletionoffourEBPprojects,demonstratingmembers’learningandcompetency.Nursesfromeachprojectwereabletopresenttheirclinicalquestiontovari-ous audiences. Project members indicated that the success of thisEBPmodelwasdependentonnursingleadershipsupportanddesig-nated“protectedtime”forEBPactivities.Asurveyofknowledgeac-quisitionandsatisfactionwasperformedandwillbereported.Futureeducationalinitiativeswillbebasedonsurveyanalysis.

ExpansionofEBPmethodologyinthisoutpatientdepartmentwillrequirereorganizationofmembersthroughoutourcouncilstructuretoallowexperiencednurses tomentorotheroutpatientstaff in theEBPprocess.Thispresentationcanprovideademonstrationforoth-eroncologynursesonsuccessfulimplementationofanEBPmodelofcareatthebedside.

2030HITTING THE JACKPOT: ENHANCING APN KNOWLEDGE FOR THEONCOLOGY ACUTE CARE SETTING. Janet Sirilla, RN, MSN, OCN®,and Phyllis Kaldor, RN, MS, OCN®, OSU James Cancer Hospital &SoloveResearchInstitute,Columbus,OH.

As theACGME (American Council for Graduate Medical Edu-cation)Guidelines for resident and fellowhoursbecamemore re-

strictive,agapwascreatedinmanyacademicmedicalcenters.In-creasingly,atthisinstitutionthegapisfilledbyNursePractitioners.Currently,fewNursePractitionersaretrainedfortheacutecareset-tinganditisdifficulttorecruitacutecareNPstoanon-ICUsetting.Therefore,inadditiontoanextensiveorientationplan,administra-tionidentifiedtheneedtoprovideongoingeducationfortheNursePractitioners.

ANeedsAssessmentwasdevelopedthataskedtheNursePracti-tioners to evaluate the importance of specific competencies whenprovidingacuteoncologycareandthecurrentskilllevelthatthecur-rentmid-levelprovidersdemonstrate.First,theNursePractitionerswereaskedtoratetheimportanceofavarietyofcompetenciesusinga1-5Likertscalewith1=“NotImportant”and5=“ExtremelyIm-portant”.Thebroadtopicsforthecompetenciesincluded:symptommanagement, oncologic emergencies, infectious disease, hematol-ogy,cardiovascular,Respiratory/ENT,Endocrine,Neurology,Geni-tourinary, Diagnostic testing including laboratory testing, surgicalpathology,radiology,andothertesting,pharmacology,andspecificdiseases.Undereachbroadtopic,morespecificcompetencieswereidentified.

The Nurse Practitioners were then asked to rate the knowledgelevelthatthemajorityoftheNursePractitionersdemonstratedusingaLikertscalewith1=“LittleorNoKnowledge”and5=“ExpertKnowledge”.

Interestingly,therespondentsfoundmostcompetencies“VeryIm-portant”totheirpracticewithanaveragescoreof4.49withsymp-tommanagementofneutropeniaandanemiarankedthehighestat4.91.Ontheotherhand,theyratedthecurrentknowledgelevelofmostcompetenciesas“Adequate”withanaveragescoreof2.9.

Afteranalyzingtheresponses,itappearedthatthehighestlearningneeds are diagnostic testing including laboratory testing, radiologictesting,pulmonaryfunctiontests,andechocardiograms.Inaddition,stagingandresponsetotreatmentforspecificdiseaseswerealsoiden-tified as learning needs. Continuing educations programs with CEcredithavebeenplannedforthenextyearonthesetopicsusingad-vancedpracticenurses,physicians,andotherexpertsaspresenters.

2031STRATEGIESTOSUPPORTONCOLOGYNURSES’SCHOLARLYAC-TIVITIES. Marsha Fonteyn, RN, PhD, OCN®, and Susan Bauer-Wu,DNSc,RN,Dana-FarberCancerInstitute,Boston,MA.

Developingand implementing strategies topromoteand supportnurses’scholarlyactivitiesisanessentialcomponentofbestpracticethatresultsinthewiderdisseminationofexemplarsofbestpracticethrough presentations and publications, thus benefiting the entirenursingprofession.AsnursesatourNCI-designatedCancerCenterbecameincreasinglyinterestedinsubmittingabstractstoconferenc-esforposterandpodiumpresentationanddevelopingmanuscriptstosubmitforpublication,we,thenurses,scientistsandstaffinthenursingresearchcenter,recognizedtheneedtodevisecreativewaystoencourageandsupporttheseefforts.

Topromoteandfacilitatenurses’scholarlyactivitiesatourinstitu-tion,wedevelopedarepertoireofstrategiesthatwouldallowustoprovidesupport for theseactivitieswhilestillcarryingoutour re-searchstudiesandtheotherimportantworkofournursingresearchcenter.Weusedprinciplesof adult learning theory as theguidingframeworkfor thestrategies thatwedeveloped tosupportnursingscholarship.

Amongthestrategiesdevelopedandimplementedwere:• Scheduling drop-in work sessions for nurses to obtain help de-

velopingabstracts,PowerPointorposterpresentations,ormanu-scripts

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• Providingamentoredwritingprogramfornurseswhohadneverpreviouslypublished

• Offeringin-housepeerreviewofabstractspriortosubmissiontoanationalconference,andcritiqueandfeedbackofplannedpresen-tationsorresearchprojects

• EstablishinganannualExcellenceinWritingawardforpublishedwork

• InstitutingaClinicalScholarProgram to recognizenurses’ col-laborativeworkwithourresearchcenter

Sinceimplementingthesestrategies,feedbackfromcliniciansandnursemanagershasbeenpositive,nurses’interestinscholarshiphassteadilyincreased,andthenumberofconferencepresentationshasmore than tripled,while thenumberofmanuscripts submitted forpublicationhasgrownsubstantiality.

Manyof the strategieswedescribe in thispresentationcouldbeeasilyadaptedforusewithnursesinavarietyofsettings.Promot-ingandsupportingnurses’scholarlyactivitiesdirectlycontributestoevidence-basedpracticethroughdisseminationandthushasimpor-tantimplicationsforoncologynursingpractice.

2033STAFF NURSE IMPLEMENTATION OF AN EVIDENCE-BASED PRAC-TICE STANDARD: CARING FOR ONCOLOGY PATIENTS WITH AL-TERATIONINSKININTEGRITYRELATEDTOINCONTINENCE.SusanO’Donnell, RN, BSN, OCN®, Heather Robertson, RN, BSN, CynthiaHarrington,RN,BSN,LauraBrown,RN,BSN,OCN®,GinetteAudette,RN,BSN,andAuraVasquez,RN,BSN,MassachusettsGeneralHos-pital,Boston,MA.

Patientswithcancerareatan increased risk fordevelopingskinbreakdown. They are susceptible for perineal-rectal skin integrityimpairmentrelatedtomultiplefactorsincludingsideeffectsofche-motherapy/radiation, altered nutritional status, immobility/weak-ness, and immunosuppression. Incontinence of urine and or stoolcanfurthercomplicatethisproblem.Perinealskindamagesecond-arytoincontinenceispainful,preventable,andprevalent,occurringinapproximately33%ofhospitalizedadults(Lyder,1992).Nursesplayacrucialroleinassessing,treating,andpreventingperinealskinbreakdownrelatedtoincontinence.

Afterattendingatwo-dayworkshoponwoundcare,aworkgrouponahematology/oncologyunitwascreatedtoidentifycommonskincare problems in our patient population.Altered perineal skin in-tegrity related to incontinencewas thechosen issue.Anextensivereview of evidence-based literature was completed examining thecurrentprotocolsinuseforthemanagementofperineal-rectalskinalterations.Althoughthereisasignificantamountofliteraturefocus-ingonskinmaintenanceofthemedical-surgicalpatientpopulationthereremainsapaucityofresearchfocusingonskincareofinconti-nentoncologypatients.

Utilizingavailableinformation,askincareinitiativewasstartedtocreateaperinealskincareprotocolontheunit.Afocuswasplacedoncleaning,assessing,protecting,andtreatingtheaffectedskininbothpatientswithabreakdownorthosewefeltwereatriskforfu-turecomplications.Astaffsurveywasconductedtoevaluatecurrentstandards for skincareon theunitwhencaring forapatientwithincontinence.Thissurveycollectedinformationoncurrentpracticesofcleaning,assessing,protectingandtreatingtheskinofincontinentpatientsinanoncologysetting.

Thesurveyresultswillbeanalyzedandevidencebasedguidelineswillbedeveloped.Thisworkisongoing.Aseriesofstaffeducationprogramswillbeconductedandmembersoftheunitbasedwoundcareworkgroupwillserveasconsultants/resourcesinplanningcare.Thewoundcareworkgroupwillevaluatethisinitiativebyconduct-

ingasurvey,auditingpatientrecords,andobservingnursingprac-tice.

Thegoalofthewoundcareworkgroupistoimplementevidencebasedpracticesforoncologypatientswithskincarealterationsre-latedtoincontinence.

2034APILOTSTUDYTODETERMINENUTRITIONALNEEDSOFAMBU-LATORYCHEMOTHERAPYPATIENTS.LouiseGoldstein,RN,OCN®,CHPN,DukeUniversityHospital,Durham,NC.

Research has demonstrated a connection between nutrition andhealth.Peoplewithcancer,undergoingtreatment,experienceweightlossandpoornutritionalstatus,whichcanhaveadetrimentaleffectontheresponsetocancertreatmentandpatients’qualityoflife.Theoutpatientoncology infusionclinic currentlydoesnot receive anynutritionalsupportfromadietitian.TheRNistheonlyresourcefornutritionalguidance.

Thepurposeof thisprojectwastodeterminehowmanypatientsreceivingchemotherapyorcombinationtherapyneededtobeevalu-atedandsupportedbyadietitian.Thegoalwastodemonstratetheneedforapaidpositionforadietitian in thisoutpatient treatmentarea.

TheScoredPatient-GeneratedSubjectiveGlobalAssessment(PG-SGA)wasselectedasthepatientassessmenttool.Thistoolwascho-senbecause it hasmultiple levelsofnutritional triage recommen-dationsandestablishedreliabilityandvalidity.Ademographictoolwasusedtocollectdataontypeofcancer,ifreceivingsingleorcom-binationtherapies,whatagentswerebeingused,andthefrequencyof treatments. Nurses used the PG-SGA and demographic tool tocollectinformationonarandomsampleof90patients.

TheassessmenttoolswerecompletedandenteredintoanAccessdatabase.Ofthe90patientssurveyed,itwasdeterminedthat72%ofthosepatientreceivingchemotherapyaloneand93%ofpatientsreceiving combination therapy required dietitian evaluation andsupportbasedon the triageguidelines.Of thecancerdiseasesitesreviewed, breast, gastrointestinal, head & neck and gynecologicalcancerspredominantlyrequireddietitianintervention.

Basedontheaboveinformation,presentationshavebeenmadeatboththedepartmentandservicelinelevelstressingtheneedfornu-tritional support for this vulnerable population.The data has alsobeensharedwiththeDirectorofNutritionServicesforthehospital,who isbenchmarkingwithotherprograms.Theneedfor thisnewpositionhasbeenestablishedandaccepted.Thepositioniscurrentlybeingworkedintothenextfiscalbudget.Thisisanexampleofhownursescanuseclinicaldatatoadvocateforimprovedpatientcare.

2038ONEPRACTITIONER’SEXPERIENCEWITHCOUNSELINGANDTEST-ING WOMEN AT RISK FOR HEREDITARY BREAST AND OVARIANCANCER SYNDROME. Tracey Tatum, RN, MS, FNP, OCN®, ThomasJohnsCancerCenteratCJWMedicalCenter,Richmond,VA.

TheOncologyNursingSociety andAmericanSocietyofClinicalOncologyhaveidentifiedthatgenetictestingforHereditaryBreastandOvarianCancerSyndrome(HBOCS)isnotappropriateforscreeningofthegeneralpopulation,butisanimportanttoolforcancerpreven-tionandearlydetectioninspecificgroups.Importantcharacteristicsthathavebeenidentifiedinclude:breastcancer<50years,bilateralbreast cancer, male breast cancer, Ashkenazi Jewish ancestry, andovariancanceratanyage.Therefore,itisimportanttoobtainathor-oughmedicalandfamilyhistorytoidentifyappropriatecandidates.

Thepurposeof this reviewwas to evaluatemypractice and thepatientsthatproceededtogenetictestingforHBOCS.Thisreview

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included:mypatients’hereditarycharacteristics,riskfactorsofpa-tients tested, testing results,medicalmanagementadvisedandpa-tient’smedicaltreatmentdecisions.

Aretrospectivechartreviewwasconductedtoassesspatientsre-ferredforgeneticsservices,whoreceivedpreandpost-testcounsel-ingandBRACAAnalysistestingforHBOCS.Also,outcomesdataon patients testing positive for a deleterious BRCA mutation wasobtained.

Outoftheseventy-ninepatientsevaluated,15%testedpositiveforadeleteriousmutation.TwoormoreriskfactorsforHBOCSwereidentifiedin65%ofthesepatients.Additionally,eighty-fourpercentof patients had breast cancer before the age of fifty diagnosed inthemselvesand/orafamilymember.

Theoverwhelmingmajorityofpatients referred tomehad adi-agnosisofeitherbreastorovariancancerandwerereferredbyon-cologyproviders.Thesetestresultswereutilizedtomakemedicaldecisions to reduce the riskof recurrenceor topreventnewdiag-nosesinpatientsandtheirfamilymembers.Optimally,toimproveprevention and early detection of hereditary cancer, primary careprovidersandgynecologistsneedtobetargeted.AstheU.S.SurgeonGeneralhasadvised,areviewofallpatients’familyhistoriesshouldbeobtained.Thus,indicatorsofriskforHBOCScouldbeidentified.Then,changestomedicalplanstoreducerisksofHBOCSassoci-ateddiseasescouldoccurbeforecancerisdiagnosed.

2039QUESTIONOFTHEDAY:ANEDUCATIONALINTERVENTIONTOAS-SIST IN IMPROVING SPECIALTY KNOWLEDGE ASSIMILATION BYNOVICENURSES.DeWayneGallenberg,RN,MS,OCN®,MayoClinic,Rochester,MN.

Thecomplexityofcareonanacutecareinpatientunitatatertiaryreferral teaching hospital is frequently intimidating to the novicenurse.Competingtimepressuresofprovidingcarewhiletryingtocontinuetoexpandtheirknowledgebasehasbeencitedbynovicenursesasafactorfrequentlyassociatedwithdissatisfactionanddeci-sionstoleavethebedside.Thisisfurthercomplicatedbytherapidpaceofchangeinoncologycareasnewmedicationsandtreatmentregimenarediscoveredorevolve.

Thisprojectinvolvesa“justintime”educationalinterventiononadailybasistoassisttheunitteaminlearningnewinformationorreinforcingpreviouslydiscussedconceptsonahematologyunitatalargemidwesternteachinghospital.

AMasters-preparedRNonadailybasisreceivesreportonallpa-tients in thearea,andconstructsanddeliversaonetofiveminuteinservicetotheteampresentatthatreport.Thequestionsaddressedarecompiled,andonaweeklybasisdistributedviaanemaildistri-bution list to interestednurseswithin theorganization at largeona voluntary basis. Current research topics are able to be includedbecausetheprojectcoordinatorisamemberofthemedicalspecialtyresearchcommittee.

Overhalfoftheinpatienthematology/oncology/BMTnursingstaffat the organization across multiple nursing units have voluntarilysubscribedtotheelectronicdistributionlist.

With the increasingpaceofchange in thescientificbasisofon-cologynursingpracticeandtheimprovedavailabilityofelectroniccommunicationsplatforms,novelmethodsofinformationdistribu-tionmayassistinkeepingoncologynursesinformedaboutcuttingedgetopics.

2041ASSESSINGTHESEXUALHEALTHNEEDSOFRECIPIENTSOFBLOODCELLORBONEMARROWTRANSPLANTATION.ReanneBooker,RN,

BSCN,TomBakerCancerCenter/AlbertaCancerBoard,Calgary,Can-ada.

Sexualityisabroadtermandiscomprisedofphysical,psychologi-cal,socialandfunctionalcomponents.Itisanintegralpartofone’squalityoflifeandissignificantlyinfluencedbyacancerdiagnosisandsubsequenttreatment.Severalauthorshaveidentifiedthatsexualdysfunction inpostbonemarrow transplantpatientsoccurs inap-proximately50%ofpatients.Further,closeto70%offemaletrans-plantsurvivorsand20%ofmalesurvivorsreportedongoingsexualdifficultiesthreeyearsfollowingtreatment.

Patientsareoftenhesitanttodiscusssexualhealthconcernswiththeir health care provider for a variety of reasons. Often, patientswillwaitforthehealthcareprofessionaltoinitiatediscussioninthearea.

Reviewoftheliteraturerevealedalackofstandardizedinstrumentsavailableforassessingsexualhealthinoncologypatients.Veryfewexistingtoolsweredevelopedsystematicallywithsubsequentpau-cityofpsychometricdataavailable.Additionally,fewofthetoolsarecomprehensive.Mostassesssexualfunction/dysfunctionandnotthebroaderconceptofsexuality.Objectives:1.tofieldtestanovelsexualhealthassessmentguideinpatientswho

haveundergonebloodcell/bonemarrowtransplant2.toidentifypatients’concernsaboutsexualityfollowingbloodcell/

bonemarrowtransplant(autologousandallogeneic)3.toidentifyareasofpatientconcernrequiringfurtherassessment

andinterventionFollowing reviewof the literatureandexistingassessment tools,

theSexualHealthAssessmentGuidewasdeveloped.Thistoolusesthesexualresponsecycleasaconceptualframework.ThetoolwascreatedwithinputfromBMTpsychologists.Thetoolincorporatesphysical, psychological and social/relational domains. A 6-pointLikertscaleassessespatients’sexualhealthconcernsandtherelateddistressthattheseconcernsimpose.

This pilot study will employ a descriptive exploratory design toexamine the sexual health needs of patients who have undergonehematopoieticstemcelltransplantation.

In addition,psychometricpropertiesof the sexualhealth assess-mentguidewillbeassessedaspartofthispilot.

Nofindingsavailableatthistime.

2042WEARING FACE MASKS FOR THE NEUTROPENIC POPULATION:WHATISTHEEVIDENCE?ElizabethSorensen,MSN,APRN,BC,UTM.D.AndersonCancerCenter,Houston,TX.

Communityrespiratoryvirusesareapotentialcauseofpneumoniaanddeathamonghematopoieticstemcelltransplantationrecipientsandpatientswithhematologicmalignancies.Oncologynursescom-monlywearmaskswhile in thepresenceof severeandprolongedneutropenic patients to protect the patient from any potential air-borneinfections.Currently,therearenoevidencebasedguidelinestosupport thispractice.Furthermore, therearemanypossibledis-advantagestothispracticeincluding:socialisolationofthepatient,delayedresponsetimebynurses, lessfrequentvisitsbythenurse,increasedequipmentrequirementsandcost,andfinally,maskscanimpaircommunicationfromthenursetothepatientresultinginlesseffectiveinteractionsandteachingopportunities.

Currently,variabilityexitsinmasktypeused,lengthoftimeused,andfrequencyofmaskchangingbythehealthcareprovider(HCP).Thiscurrentpracticeisimplementedinmanyhealthcarefacilitiesandlittleevidenceexiststosupportorguidethepractice.Thepur-poseofthisprojectistoidentifyandevaluatetheevidencesupport-

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ing thepracticeofmaskwearingby thehealthcareproviderwithpatientswhohavesevereandprolongedneutropeniaandtooutlineguidelinesregardingrecommendedpopulations,masks,weartimes,andpotentialdisadvantagesofthepractice.

AnextensivesearchoftheonlinedatabasesCINAHLandPubMedwasperformedusingthefollowingsearchterms:masks,respiratoryinfections, nosocomial, and immunosuppressed. Institutional poli-ciesandprocedures,theOncologyNursingSocietyguidelines,andCDCguidelineswerereviewed.

Anevidence summary tablewasdeveloped thatdescribespopu-lations studied, research designs, outcomes and relevant findingsthatmaybeappliedtopractice.Acriticalappraisaloftheliteraturerevealedthatlimiteddatawereavailableonthetopicduetooldre-search,lackofresearchregardingthetargetpopulation,andfewran-domizedcontroltrials.

Theresultsfromthisevidencebasedpracticeprojectwillbepre-sentedwithsuggestionsforfurtherfollow-upandinvestigationintothepracticeusingrandomizedcontroltrialsinordertosetpracticeguidelines.

2045CONTINUOUSBLADDERIRRIGATIONFORONCOLOGYPATIENTS:APROPOSEDPROTOCOL.KristenJohnson,RN,BSN,KristenThomas,RN,BSN,andTracyDouglas,RN,BSN,MSN,JohnsHopkinsHospital,Baltimore,MD.

Hemorrhagiccystitis, inflammationof thebladderwithhematu-ria, is awell recognized complicationofbonemarrow transplantresultingfrominfectionorchemicalinsulttothebladder.Approxi-mately10%ofhematologicstemcell transplantpatientsdevelophemorrhagic cystitis. Nurses in the oncology center have treatedhemorrhagic cystitis with continuous bladder irrigation (CBI) for20years.Theurologyserviceprovidesconsultationonthesecases,butnursingexpertiseismostutilizedwithoutastandardofcareforCBI.

AstandardCBIprotocolwouldclarifynursingpractice,increasenurse autonomy, clarify patient outcomes, and alleviate obstacleswheneducatingnewnursesonthemanagementofCBI.

Basedonpaststandardofcareatourinstitutionandotherhemato-logicstemcelltransplantcenters,literaturereviewsandexpertmedi-calandnursingopinionsfromoncologyandurology,wedevelopedaprotocolformedicaloncologypatientshavingintermittent,partial,orcompleteurinaryobstructions,relatedtobloodclotsintheblad-der; or requiring the administration of intravesicular medication.Parametersfornursingassessmentsareoutlinedandinclude;colorofurine,presenceofclots,patencyofflow,leakingaroundcatheter,bladderdistention,intakeandoutputcomparison,flowrateneededtomaintaindesiredoutflowcolorandpatencyofdrainagesystem,vitalsigns,pain,dailyweight,dateoflaststool,andinterpretationoflaboratorytests(hematocrit,plateletcount,bacteria,whitebloodcells,JCvirus,adenovirus,andBKvirus).Nursesdeterminethefre-quencyofassessmentsbasedonoutputcolorandsystempatency.Nurseshaveguidelinesoninterventions,whichinclude,regulatinginfusionrate,flushingandirrigatingthecatheter,andholdingthein-fusion.Detailedinstructionsforinitiating,maintaining,andirrigat-ingthesystemareincludedintheappendices.Theprotocolresidesin the oncology center’s online interdisciplinary clinical practiceprotocolmanual.

ThisprotocolwillbereviewedbiannuallythroughtheStandardsofCareCommitteeandevaluationofnewnurses’managementofCBI.TheStandardsofCareCommitteeapprovedtheprotocol.

Theprotocolwillstandardizepractice,improvepatientoutcomes,increasenurseautonomy,andimprovetheeducationofnewnurses.

2047APPLICATION OF LEAN PRINCIPLES POSITIVELY IMPACTS CLINI-CALEFFICIENCYINANAMBULATORYCHEMOTHERAPYINFUSIONSUITE.AmiGaarde,RN,BSN,OCN®, JaneUtech,RN,BSN,OCN®,TinaDevery,andSarabdeepSingh,UniversityofIowaHospitalsandClinics,IowaCity,IA.

Thevolumeofpatients treatedintheambulatoryinfusioncenterat a largeMidwesternNCIdesignatedCancerCenterhas steadilyincreasedoverthepastseveralyears.Thereasonsforthisinclude:morecomplicatedchemotherapyregimens,anincreaseinthosebe-ingdoneintheoutpatientsetting,andearlierpatientdischargesfromthehospitalneedingcontinuedsupportivecare.

Amultidisciplinary teamat thisacademichospitaldetermined itwouldbebeneficialtoapplyLeanprinciplestothedailyoperationsoftheinfusionsuiteinordertoimproveefficiencyandpatientandstaffsatisfaction.Leanprinciples includeevaluatingworkflowandreplacingweaknesseswithvalue-addedserviceswhilemaximizingefficiency.Goalswereto:reducepatientwaittimes,reduceoveralllengthofstay,andincreasestaffefficiency.

Theclinicworkflowwasstudiedduringthe5-dayeventbydirectlyobservingsystemsofoperation.MembersoftheteamusedtheValueStreamMappingtool.Thistooloutlineseverysteptakenbythenurs-ingstaff. Itempowers the teamtoquestion thevalueofeachstepin theworkprocess.The team improvedefficiencyby incorporat-ingideasfromstaffdirectlyinvolvedinpatientcarepractices.Manysimplepertinentactionsweretakentoreorganizeandoptimizethehealthcaredeliveryprocess.Examplesinclude:creatingapodsys-temtokeepnursesconsistentlyinoneareaofthesuite,makingbothmedicationandpatientsuppliesmoreeasilyaccessibletoallnurs-ingstaff,frontloadingofpatientappointments,reformattingoftheschedulingsystem,andestablishinganautomatedpagingsystemtoalertstaffwhenmedicationisavailable.

Theeventsignificantlyenhancedclinicalefficiencyandsatisfac-tionofpatientsandstaff. It eliminatednon-valueaddedstepsandreducedunessentialhand-offs.Thishelpedreducepatientwaittimeby69percent,anddistancetraveledbystaffbyover80percent.

TheapplicationoftheLeanprinciplesmaximizedefficiencywith-outsacrificingoptimalpatientcare.Byimplementingthesebusinessprinciplesintothehealthcaresystem,oncologynurseshaveadirectimpactontheclinicalefficiencyoftheinfusionsuite.

2048RELATIONSHIPBETWEENSPIRITUALHEALTHANDDEPRESSIONOF PATIENTS WITH HEMATOLOGICAL MALIGNANCIES. Sang OkChong,RN,MN,APN,SaintMary’sHospitalCatholicUniversityofKorea, Seoul, Korea; and Won-Hee Lee, Yonsei University, Seoul,Korea.

ThespiritualhealthnegativelyrelatesthedepressionofHemato-logicalMalignanciespatients.SpiritualcareforspiritualhealthwillberequiredtoconsiderablydeclinethedepressionwhichwaswelldetectedonHematologicalMalignanciespatients.OncologynurseshouldmanagethespiritualhealthsoastoimprovethelifeofHema-tologicalMalignanciespatientsandthequalityofthenursing.

Thisstudywasdesignedtoidentifytherelationshipbetweenspiri-tualhealthanddepressionof theHematologicalMalignanciespa-tients in an isolated room.The results will be applied to developthespiritualhealthcare,tomitigatethedepression,andtosuggestimportanceofprevention,whichexactlymeet the requirementsofHematologicalMalignanciespatients.

Under conceptual model suggested by Stallwood and Stoll, thisstudyassumedthatspiritualhealthissignificantlyrelatedwithde-pressionofHematologicalMalignanciespatients.

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TheinstrumentofspiritualhealthisaSpiritualHealthInventoryScale(SHI)developedbyHighfieldandthenmodifiedbyLee.Thedepression was measured by SCL-90-R originated in DerogatiswhichwastranslatedintoKoreanbyKim.T-testandANOVAwerecalculatedtoexaminethedifferenceofthespiritualhealthandthedepression for characters of demographic data, primary caregiver,faithandheathtreatment1.ThemeanscoreforspiritualhealthoftheHematologicalMalig-

nancies patients in the isolated room was 111.62 within rangefrom31to155.Thescoreindicatedthatthepatientsperceivedthestateofspiritualhealthovermoderate.Themeanscoreofdepres-sionwas29.78from13to65.Itindicatedthattheyperceivedthelowlevelofdepressionbelowmoderate.

2.ANOVAandt-testwereperformedto test thesignificantdiffer-enceforthespiritualhealthanddepressionaccordingtothechar-acteristicsofdemographicdata,primarycaregiver,faithandheathtreatment.Inspiritualhealth,itwasthelargestsignificantdiffer-encesinthefieldoffaith(F=19.65,p=0.000)amongotherfields.Indepression,thereweretheconsiderablysignificantdifferencesinthefieldofyear(F=4.561,p=0.002)andspiritualstate(F=4.843,p=0.004)amongotherfields.

3.Negativecorrelationbetweenspiritualhealthanddepressionwasperceivedwiththemoderatelevel(r=-.681,p=.000).

2053FIGHTINGTHEFLU:AVACCINATIONPROGRAMFORHEALTHCAREWORKERS.AnitaReedy,RN,MSN,OCN®,JohnsHopkinsHospital,Baltimore,MD.

Healthcareworkerscantransmit influenzatopatientsevenwhenthey are asymptomatic. The CDC recommends vaccination ofhealthcareworkersasastandardofcare.Healthcareworkerswhoreceivefluvaccinationarereportedatonly35%–45%.Thisnumberisnotadequatetopreventtransmissionofflu.

Barrierstofluvaccinationincludeconcernthatthevaccinewillbeineffective,fearofdevelopingflufromthevaccineandfearofneedles. This NCI-designated Comprehensive Cancer Center pi-lotedaprogramwhere100%of the staffoneachunitwouldei-thergetthevaccineoractivelydeclineit.Itwasbelievedthatbyactivelyapproachingeachindividual,vaccinationswouldincreaseby greater than 45%. By increasing the numbers vaccinated, theriskofspreadinginfluenzatoimmunocompromisedpatientswoulddecrease.

TheNurseManageroneachunitidentifieda“champion”,anursewhowouldpromoteinfluenzavaccination.ThenameofeachstaffmemberwasenteredontoanExcelspreadsheetandpostedon theunit.Eachstaffmemberwasapproachedbythechampion,ClinicalNurseSpecialistorNurseManagertoassuretheyeitherreceivedthevaccineoractivelydeclinedit,givingtheirreasonsfordeclination.Thisassuredthatnostaffmember“fellthroughthecracks”andwasmissedbypassivenonparticipation.Datawascollatedandpresentedtostaff,thecancercenter’sadministrationandHospital’sEpidemiol-ogyandInfectionControlCommittee(HEIC).

100%ofthenursingstaffoneachunitwascontactedtoeitherre-ceiveordeclinethevaccine.Ratesforeachofthe4inpatientunitswere73%,84%,72%,and85%and60%fortheoutpatientunit.RNsweremorelikelytobevaccinatedthansupportstaff.106otherstaff,includingdoctors, respiratory andphysical/occupational therapistsandsocialworkerswasalsovaccinated.Thesevaccinationnumbersaresignificantlyhigherthanthosereportedintheliterature.

Influenzavaccinationratescanbeaffectedbyprogramswhereeachstaffmemberisapproachedforvaccinationordeclination.Reasonsfordeclinationcanbeusedtoeducatestaffwiththegoalofincreas-

ingfuturevaccinationrates.Thiscanresultinthedecreaseoftrans-missionofinfluenzatopatientsfrominfectedhealthcareworkers.

2056UNDERSTANDING MUCOSA-ASSOCIATED LYMPHOID TISSUE(MALT)LYMPHOMA:HELICOBACTERPYLORI INFECTIONANDBE-YOND.YazhenZhong,RN,ANP,AOCNP,M.D.AndersonCancerCen-ter,Houston,TX.

Mucosa-associated lymphoid tissue (MALT) lymphoma isadis-tinct subtype of extranodal marginal zone B-cell non-Hodgkinslymphoma.TheuniquenessofMALTlymphomaisthatitsgrowthisstimulatedbychronicinflammatoryprocess.Helicobacterpylori(Hp) infection isawell-knownrisk factor forgastricMALT lym-phoma.MorethanhalfofthepatientsachievelymphomaregressionwitheradicationofHpand thatmade this tumorapopularmodelof antigen-driven lymphomagenesis. Several infectious agents arereportedtoberelatedtonon-gastricMALTlymphoma,andtargetednew treatments have been studied. It is important that nurses areknowledgeableaboutthediseaseprocessandtreatmentssotheycanbettereducatepatientsandfamiliesaboutthemalignancy.

Thepurposeofthispresentationistoprovideanoverviewofpri-marygastricandnon-gastricMALTlymphoma.

Theoverviewwillincludeepidemiology,pathogenesis,diagnosisandstaging,standardandnoveltreatments,andnursingroleinman-agement.MALTlymphomaarisesatavarietyoforgans;however,the stomach is the most common involved organ. It accounts formorethan50%ofstomachlymphomaand90%ofthepatientsareHppositive.TheclinicalmanifestationsofgastricMALTlymphomamaybenonspecificwithdyspepsiaandepigastricpain.ThepatientwithearlystagediseaseusuallyhasbetterresponsetoH.pylorierad-ication treatment.The treatmentfornon-gastricMALTlymphomaistailoredtothediseasesite,stage,andcharacteristics.Thechoicesareinvolved-fieldradiationforlocalizeddisease.Rituximabisasef-fectiveaschemotherapybutlesstoxicfordisseminateddisease.Thepatientsdorelapseregardlessthediseasestage.Frequentfollow-upsareimperativetomonitorthediseasestatus.

Oncology nurses who view this presentation will gain a basicunderstanding of etiology and pathogenesis of MALT lymphoma;recognizeearlyclinicalpresentations;discusstheuniquetreatmentsandtherationaleoffrequentfollow-ups.

Since treatment forMALT lymphoma ismostly outpatient or athome,oncologynursesare inavitalposition ineducatingpatientofthisuniquemalignancy,reinforcingtheimportanceoftreatmentcompliance and long-term follow-ups, and monitoring treatmentsideeffects.

2059PRECAUTIONS, IMPLICATIONSANDCONTRAINDICATIONS:USINGEVIDENCETOESTABLISHANURSINGPROTOCOLFORARECOM-BINANT POXVIRUS (VACCINIA/FOWLPOX) BASED VACCINE PRO-GRAM.RobinGreen,RN,BSN,MSN,OCN®,NYUCancer Institute,NewYork,NY;JessieCondon,RN,BSN,OCN®,YaleUniversitySchoolofNursing,NewHaven,CT;andKathleenMcCaffrey,RN,MSN,OCN®,andZenonaLesko,RN,BSN,NYUCancerInstitute,NewYork,NY.

Vaccinetherapyhypothesizeswhenacancerpatientisvaccinatedwithaprimaryvectorandatumor-specificantigen,theantigenswillstimulate thepatient’s immunesystemtorecognizeandattack thecancercells,sparinghealthycells.Toinducethisimmuneresponse,thepoxvirusesareamongthemostcommonlystudiedvectors.Vac-ciniaisconsideredtheprototypicalpoxvirus.VacciniavaccineisalivevirusandclassifiedasaBiosafetyLevel2AgentbytheCenterforDiseaseControl.These agents are associatedwithhumandis-

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easeandpresentapotentialhazardtopeopleandtheenvironment.Government(CDCandNCI)mandatedregulations,aswellasinsti-tutionalconcerns,challengedtheoncologynursesinourfacilitytodeliveroptimalpatientcarewhileensuringthe“safety”ofpersonnel,immunocompromisedpatient’sandtheenvironment.Thispaperwilldescribethedevelopmentandimplementationofanevidence-basedprotocolintegratingbiosafetyregulationswithnursingexpertise

Todevelopanevidence-basednursingprotocolthatwoulddefinesafepracticeforpersonnelinvolvedinthemanagementofpatientsreceivingrecombinantpoxvirusvaccines.

AmultidisciplinarytaskforcewasformedandincludedNursing,Oncology, Infectious Disease, Environmental Services, EmployeeHealth, and Pharmacy.A literature review, including Medline da-tabasesandNCI/CDCwebsiteswasconducted.Anevidence-basedprotocol was synthesized from a critique of the literature, recom-mendationsfromthetaskforceandtheECOGprotocol.Apatienteducationtoolwaswritten.Educationwasprovidedforallperson-nelinvolvedincaringforprotocolpatients.Toensurecomplianceacompetencybasedchecklistwasdevelopedforthenursingstaff.

We opened the vaccinia trial the fall of 2006. The total accrualwillbe10patients.Currently,2patientsarebeingscreenedand3patientsareenrolled.Allenrolledpatientsreceivedthevacciniain-jectionwithoutincident.Thecoordinatedeffortsofalldepartmentsprovidedforstreamlinedtreatmentdays.

Thisclinicaltrialwithitsmyriadofbiosafetyprecautions,patientcare implications and protocol contraindications could intimidatethemostexperiencedresearcher.Oncologynursesplayapivotalrolein transforming “cutting-edge” science into clinical practice. Fol-lowingtheevidencewasaninvaluablestrategyinimplementingournursingprotocol.

2060COACHINGFORSUCCESS:AMULTIDISCIPLINARYAPPROACHTOPREPARING A PATIENT FOR HEAD AND NECK SURGERY. LindaSchiech,RN,MSN,AOCN®, FoxChaseCancerCenter,Philadelphia,PA.

Learning thatyouhaveacancerdiagnosiscanbedevastating toanyperson.Headandneck(H&N)cancerhastheuniquesituationofexistingontheareaofthebodythatisimmediatelyvisuallyseenbyothers.AmajorityofH&Ncancersaretreatedwithcurativeintentbysurgerythuscreatingphysicalandpsychosocialimpairments.

Aspeechtherapist,socialworker,dietitianandclinicalnursespe-cialist comprise a portion of the interdisciplinary team that meetswithapatientandsignificantothersbeforetheyundergoanysurgicalprocedureinordertofacilitatetheirpostoperativecourse.

Uponreceivingordersfromaphysicianontheteam,thissmallergroupmeetswiththepatientandsignificantotherstoreviewindetailwhatwilloccurduringthepatient’shospitalization.Expectationsofwhattoanticipatefromtheclinicalstaffincludingtheservicesthatwillbeprovidedbyeachmemberduringandafterthehospitaliza-tionareexplained.Picturesareoftenusedtoillustrateinformationandexpectedchangesinanatomy.Thepatientisprovidedapacketof informationregardinggeneraldietaryhintsforsoftermorepal-atablediets,generalmouthexercises theycouldstart to learnpre-operatively,abookletabouttheirspecifictypeofH&Ncancerandhowitmaybetreated,andinformationconcerningasupportgroupprovidedbytheinstitution.Finally,thepatientiseducatedregardingexpectationswehaveforthemthroughoutthehospitalizationsuchasambulationandfrequentmouthcare.Timeisprovidedforquestionstobeansweredandcontactinformationisgiventothepatient.

Thegoalofthiseffortistohavethepatientmeetandfeelcom-fortablewithothermembersoftheteamwhowillbehelpingthem

intheirrecovery.Wealsohopethatbymakingthepatientawareoftheirhospitalizationcourse,what’sexpectedofthem,andedu-cation about the changes in anatomy, function and rehabilitationneedsthattheymayencounterfollowingtheirprocedurewillspeedrecovery.

Greaterknowledgeforpatientsprior toacomplicatedprocedurewhichcancausevisualandpossiblefunctionalchangestotheirbodycanassistinincreasingtheircomfortlevelindealingwiththeseal-terations.

2062THEDEVELOPMENTANDIMPLEMENTATIONOFACOMPREHENSIVEBREASTCANCERTREATMENTPROGRAMATACOMMUNITYBASEDCANCERCENTER.DanaInzeo,RN,APRN,AOCN®,SandyBalentine,RN,OCN®,andNancyLibrera,RN,MA,ValleyHospital,Paramus,NJ;andThomasAhlborn,MD,privatepractice,GlenRock,NJ.

Facing a diagnosis of breast cancer can be overwhelming. It isestimated that212,920womenwerediagnosedwithbreastcancerin2006.Research supports efforts to identify, understandandad-dress theneedsofwomenwhoarenewlydiagnosedor havenewabnormalfindings inorder to facilitateadjustment to their illness.Womennewlydiagnosedwithbreast cancer suffer physically andpsychologically. This stress has been found to influence recoveryfromtreatment,qualityoflifeandlong-termsurvivaloutcomes.Itisan important role for theoncologynurse toassess theneedsofthesewomensoonafterdiagnosisandreferthemtotheappropriateresourcestopositivelyimpacttheiroverallwell-being.

ThepurposeoftheComprehensiveBreastCancerTreatmentPro-gramis(a)tointegrateservicescurrentlyavailableforbothwomenwithnewlydiagnosedbreastcanceroranewabnormalfinding,(b)toutilizeamultidisciplinaryteamtomakestandardizedtreatmentdeci-sions,(c)toprovideapatientnavigatortostreamlinethetreatmentprocessforwomenwithbreastcancer.

Theprogramwasdevelopedbyamultidisciplinaryteamofbreastcancerspecialistswhodevelopedguidelinesbasedonnationalstan-dardsfortheinitialdiagnosisandwork-upforbreastcancer.Atcom-munitybased centers, physicianspractice inprivateofficeswhichpresentsachallengeindeliveringmultidisciplinarycare.Thispro-gramisavirtualcentercoordinatedbyanoncologynursepractitio-nerwhoisresponsibleforbeingtheconnectionamongthemultidis-ciplineteammembers.Womenidentifiedtobeathighriskornewlydiagnosedare referreddirectly to thecoordinatorwhoservesasaresourceandpatientnavigatorprovidingeducation,referralstoap-propriateservices,support,andfollow-upthroughoutthetreatmentprocess.

Thegoalofthisprogramistoprovideacomprehensive,multidis-ciplinaryapproachtotreatmentplanningwithinacommunitybasedcenter for women with breast cancer. The nurse coordinator willevaluatepatientsatisfactionandtimelinessofinitialtreatmentonaregularbasisforqualityassuranceandimprovement.

The nurse coordinator’s experience and expertise guides the pa-tient and the team toward efficient andeffective care, resulting inpositiveoutcomesoverall.

2063THEETHICALCONSIDERATIONSOFMANDATORYINFLUENZAVAC-CINATIONFORONCOLOGYHEALTHCAREWORKERS.SuzanneCow-perthwaite,RN,BSN,SidneyKimmelComprehensiveCancerCenteratJohnsHopkins,Baltimore,MD.

Influenza causes 40,000 deaths in the United States each year.Immunocompromised patients with cancer are at significant risk.Health Care Workers (HCWs) may be exposed to influenza and

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spread the disease to patients. The Healthcare Infection ControlPracticeCommitteeandtheAdvisoryCommitteeonImmunizationPracticerecommendthatallhealthcarepersonnelbevaccinatedan-nuallyagainstinfluenza.However,influenzavaccinationofHCWsintheUnitedStatesremainslow(36%in2002and40.1%in2003).

HealthCareOrganizations(HCOs)haveattemptedtoincreasevac-cination ratesofHCWsthroughpromotion,marketingandeduca-tion,provisionoffreevaccine,useofmobilevaccinationcarts,giftincentives, and peer advocacy. Resulting vaccination rates rangedbetween40and80%.Mandatoryvaccinationshouldbeconsideredonlyaftercarefulexaminationfromanethicalperspective.

Ethical principles such as liberty, self-determination, autonomy,duty,justice,beneficence,andnon-maleficiencepresentcompellingarguments for, and against, mandatory vaccination of HCWs, andare carefully explored as part of this presentation. TheAmericanNursesAssociation’sCodeofEthicsandtheAmericanMedicalAs-sociation’sPrincipleofMedicalEthicsarealsoconsidered,aswellastheresponsibilitiesofHCOsimplementingmandatoryinfluenzavaccinationpolicies.

MandatoryinfluenzavaccinationforOncologyHCWsisethicallydefensible.HCWshavea right to self-determination,but ahighermoralobligationtopatients.Thepatientisinavulnerableposition,unabletoinfluencethevaccinationratesoftheHCWstheydependonforcare.Societyhasaresponsibilitytoprotectitsmostvulnerablecitizens,andHCWsacceptgreaterresponsibilitybyvirtueoftheirchoiceofprofession.

Although ethical reasoning supports mandatory vaccination,HCWsshouldnotbeterminatedfornon-compliance.CurrentHCWscanbeprovidedencouragementandastrongeducationalcampaignpromoting vaccination. Those refusing vaccination should be re-quiredtogiveactivedeclination,ensuringthattheirdecisionisnotoneofconvenience,apathy,oroversight.NewlyhiredHCWscanbeadvisedthatyearlyinfluenzavaccinationismandatory.HCOsmustallowdeclinationforemployeeswithreligiousobjectionsormedicalcontraindications.HCOsrequiringmandatoryinfluenzavaccinationhaveadutytoinformandeducateHCWs,andtoprovidefree,read-ilyavailablevaccine.

2064STAFFRETREAT:AJOURNEYTOTEAMBUILDING.NancyLambert,RN,MSN,OCN®,andNancySteward,MSN,RN,OCN®,CRNI,Chris-tianaCareHealthSystem,Newark,DE.

Teamworkandleadershipareimportantcomponentsofaneffec-tivedepartment.TheCancerCareManagementDepartmentat theHelenF.GrahamCancerCenteriscomprisedofstaffhousedindif-ferentlocations.Asthedepartmenthasgrown,itissometimesdif-ficultforstafftogettoknoweachother.Asaresult,cohesivenessisachallenge.TwoCareCoordinators investigated thepossibilityofhavinganoffsiteretreattoworkonteambuildingandpresentedittomanagement.

Inthepast,numerousattemptshavebeenmadetoimproveworkeffectiveness and cohesionwithout success.The retreatwas tobeusedtostrengthen,re-energizeourteam,clarifyrolesandexpecta-tions and identify the unique contributions of each staff member.KantersStructuralTheoryofOrganizationalBehaviorwasusedasamodelasabasesforthestafftomeetthedepartmentgoalsthroughaccessofinformationwhileenhancingtheirownabilitytogrowintheirrole.

OurfirstoffsiteretreatwasheldatWapitiinNortheast,Maryland.Thestaffwastreatedtodinnerandaneveningoffunandlaughter.Roomandtableassignmentsweremadetopairstaffthatnormallydoesnothaveanyinteraction.Afulldaywasspentonteambuilding

providedbyanexpertinstaffrelations.Topicssuchasunderstand-ingteamdynamics,understandingyourpersonalbehaviorstyleandhowitaffectsyourabilitytocommunicatewithothersandlearninghowtocreatedsafeenvironmentwherecandidcommunicationsareusedandaccepted.

Surveys post retreat showed that participants found this retreatbeneficial inhelpingdevelop teamworkand leadership skills.Thecomparisonofthe2004and2006Gallupsurveydemonstratedthatthestaffhadanoverall25%increaseinsatisfactionwiththeir jobrole,departmentanddepartmentdirector.

Asourdepartmentcontinuestoundergochanges,itisimportanttogatherourstaffinasafeenvironmenttoencouragecommunication.Ournursingstaffdependsonthesupportstafftohelpouroncologypatientsthroughthecontinuumoftheircare.Withoutcommunica-tionwearenotabletoworkeffectivelyorefficiently.

2066FANCONI’SANEMIAINPATIENTSWITHHEADANDNECKSQUAMOUSCELLCARCINOMA:CHALLENGESFORPATIENTS,CHALLENGESFORTREATMENT.MarianRichardson,RN,MSN,AOCN®,andAndreaCox,RN,BSN,JohnsHopkinsHospital,Baltimore,MD.

Fanconi’sAnemia(FA),arareautosomalrecessivegeneticdisor-der,isassociatedwithchromosomalinstabilityandabnormalDNArepair.Thispredisposespatients tocongenital abnormalities,bonemarrow failure, human papillomavirus, and development of solidtumors, especially squamouscell carcinomaof theheadandneck(HNSCC),esophagus,anus,andvulva.TheriskofHNSCCinFApatientsisapproximately500foldhigherthanthegeneralpopula-tion. Because of flawed cellular repair, standard cancer therapiesneed modification. Treatment considerations include the use oftargetedtherapiesversuschemotherapyandconventionalradiationtreatment versus Intensity Modulated Radiation Therapy (IMRT).NursesarecrucialinidentifyingpatientswithFAandaggressivelymanagingtheirtreatmentrelatedtoxicities.

ThispresentationprovidesanoverviewofFanconi’sAnemiaanda description of two case studies demonstrating the challenges ofmanagingthesecomplexpatients.

Case Study I:A 31 year old woman with known FA presentedstatuspostmultiplesurgicalproceduresfororopharyngealcancersand status post surgical excision of left retropharyngeal space forretropharyngealrecurrence.Conventionalradiationtreatmentto63Gytotheleftneckandsupraclavicularareawasadministeredwith2plannedtreatmentbreaks.Nursinginterventionsincludedmultidis-ciplinarycoordination,dailyassessment,managementoftreatmenttoxicitiesandpsychologicalsupport.

CaseII:A30yearoldmalepresentedwithSCCofthetonsil.Histreatmentplanconsistedofconcurrentchemotherapy(Platinumandtargeted therapy on protocol) and an IMRT based radiation plan.Earlytreatmenttoxicitiesincludingoralmucositis,neutropenia,andsepsisraisedsuspicionofaDNAfragilitysyndrome.Testingprovedpositive forFA.Treatmentplanwas amended to single agentCe-tuximabandconventionalradiationtreatment.Nursinginterventionsincluded aggressive management of odynophagia, mucositis, skinreaction,cachexiaandinterdisciplinarycoordination.

AreviewofFAcasestudiesinitiatedanursinginserviceontreat-mentconsiderationsinthispatientpopulation.

OncologynursesmustbeawareoftreatmentimplicationsforFApatients. Patients who develop early severe toxicities to treatmentshould be tested for DNA fragility syndromes. Treatment plansshouldbeamended,treatmentbreaksconsidered,andprolongedre-coverytimeanticipated.FApatientsshouldhaveearlyandregularscreeningforHNSCC.

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2067FORMBUILDER: A TOOL FOR PROMOTING DATA SHARING ANDREUSEWITHINTHECANCERCOMMUNITY.StephanieWhitley,RN,BSN,TerpSys,Rockville,MD;andDianneM.Reeves,RN,MSN,Na-tionalCancerInstitute,Rockville,MD.

Data collection in clinical trials management systems relies ontheuseofCaseReportForms(CRFs)tocaptureprotocoldataandsponsorrequirements.ThetimeinvolvedincreatingnewCRFsforastudyisquitelaborintensive,astheyaretypicallyrecreatedeverytimeanewstudy isbuilt.Theresult is thatdatastandardsarenotbeingconsistentlyused,andquestionreuseisnotenforced.Thiscanleadtosemanticdiscord,orthecollectionofdatathatisslightlydif-ferentacrossprotocols.Asaresult,dataisnotabletobeaggregatedacrossstudies.

TheNationalCancerInstituteCenterforBioinformatics(NCICB)CancerDataStandardsRepository(caDSR)FormBuildertoolwasdesignedtosupportdatasharingandreusewithinthecancercom-munityanditscollaborators.ThecaDSRhousesstudymetadata,orquestions,whichareusedbasedontheneedsofaparticularcommu-nityororganization.Thesestandardquestions,orsetsofmetadata,areimportanttoanyapplicationsupportingelectronicdatasharingsincetheyprovidestructuretothedatabeingcollected.

FormBuilderallowsfortheextractionofCommonDataElements(CDEs),or thequestionsbeingaskedonaCRF,andallows themtobedisplayedandstoredinameaningfulandreusableformat.ACDEisasinglevariableuniquelydefinedusingvocabularythatiswelldefinedandstatic;itwillremainstableovertime.Themetadata,or‘dataaboutdata,’ thatcomposeCDEsexplicitlydetailsasinglevariable and its attributes that are capturedelectronically to allowexchangeddatatobeinterpretedcorrectly.TheprotocoldatathatisbeingcollectedaretheanswerstotheCDEsontheCRFs.

FormbuilderallowsforthecreationandmaintenanceofformsandtemplatesthatusetheCDEsmaintainedinthecaDSR.Dataelementsdescribing clinical information can be collected, customized, andsharedamong theusercommunity.FormBuilderwasbuiltwith thespecificpurposeofenablingsharingandreuseofcaDSRcontent.

The CDE Browser and FormBuilder tools are open source andpubliclyavailableat:http://cdebrowser.nci.nih.gov.

2069NURSES AS INSTRUMENTS FOR CHANGE: INCORPORATING THEELDERLY IN CLINICAL TRIALS SAFETY. Donna Gerber, PhD, RN,AOCN®,M.D.AndersonCancerCenter,Houston,TX.

Theelderly(those75andolder)sufferagreatburdenfromcancer.Thebaby-boomergenerationhasenjoyedmanynewdevelopmentsinmedicalscienceandtheirexpectationswillcontinuetoincreaseand become more apparent as their need for medical interventionincreases.It isknownthatasapersonagesthebody’ssystemsdonotfunctionasefficiently.Newtargeted-therapiesandcombinationtherapiesarebeinginvestigateddailyinclinicaltrials.

Aconcernidentifiedbynurseswasthatoftentherewasanagelimitforolderadultsortheywereexcludedsecondarytoco-morbiditiesfrommanyPhase I/II trials.Onlywhen approvedby theFDAdothese new drugs or combinations become available to the elderly.When oncologists prescribe these new treatments, they have littledataonhowtheelderlywillmetabolizeandtoleratethesetreatmentswith their decreasing bodily functions. Nurses identified this as asafetyconcernforfuturepatientsonceFDAapprovaloccurred.Also,researchnurseswerefrustratedinexcludingtheelderlywithgoodperformancestatusfromclinicaltrials.

Withinourinstitutionsomenursesstartedaskingtheprinciplein-vestigators(PIs)foranoverridetoincludeolderpatients.Also,nurse

reviewersfornewprotocolsstartedtoquestionupperagelimitsandthisissuerequiredasatisfactoryresponsebythePIbeforethepro-tocol preceded to the Institutional Review Board (IRB).The IRBmembersstartedtonoticethesecommentsinthereviewsandalsostartedquestioningagelimits.Slowlyovertimechangeshavebeenseeninnewclinicaltrials.

ThemostdramaticchangeseeninnewclinicaltrialspresentedtotheIRBoverthelastyearisthatmostdonothaveanupperagelimit.Also,elderlyorpatientsabove75yearsofagearedoneinaseparatecohort(group)insomePhaseI/IItrialsusingthesamedosebutonlyafteratleast3patientsunder75havesafelycompletedthatdosingcohort.Aspharmokineticsand/orpharmodynamicsareusually involved this isbeneficialenablingcomparisonoftoxicitiesbetweenpopulations.

Thisdemonstratesthatnursingcanbeaninstrumentforachangeinphilosophyandsafelyincorporateelderlyinclinicaltrials.

2070A PILOT STUDY TO ASSESS PATIENTS’ COMFORT LEVEL WHILEUNDERGOINGINTRAPERITONEALCHEMOTHERAPYWITHTHEUSEOFWARMINGINTERVENTIONS.DarleneWhyte,RN,BN,TomBakerCancerCenter,Calgary,Canada.

Ovarian epithelial carcinomacausesmoredeaths than anyothercancer of the female reproductive system.Women with advancedovariancancerwhoareoptimallydebulkedhavetheopportunitytosignificantlyincreasesurvivaliftheirchemotherapyisadministeredviatheintraperitoneal(IP)routeascomparedtotheintravenous(IV)routeafterdebulkingsurgery.Anextensive literature searchcouldnotprovideevidencetosuggestthatspecificwarminginterventionsimprovethepatientscomfortwhileundergoingintraperitonealche-motherapy.Patientcomfortlevelscouldadverselyaffectthenumberof chemotherapy cycle that the patient can tolerate and therefore,couldaffectpatientoutcomes.

Theobjectiveofthisstudyistoexplorewarminginterventionsdur-ingintraperitonealchemotherapyandexaminetheimpactonpatientcomfort.Oncologynurseshaveanobligationtoprovidehighqual-ity, safe, compassionatecare inaccordancewithbestpractice/evi-dence-basedguidelines.Thisobligationincludesoptimizingqualityoflifeandpromotingthebestpossiblepatientexperience.Oncologynurseshavetheopportunitytopositivelyinfluencepatients’experi-encesandmitigatethepotentialadversesideeffects/experiencesthatpatientsmayencounter.ProvidingthemostcomfortablemethodofIPtreatmentmayinfluencethenumberofcyclesofchemotherapythepatientchoosestocomplete.Exploringtheuseofselectnursinginterventionswhilepatientsareundergoingintraperitonealchemo-therapywillprovideinsightastothepatientexperienceaswellasassesstheefficacyoftheaforementionedwarminginterventions.

Patientsareselectedforoneof3arms.InArm1thepatientreceivesintraperitonealchemotherapywarmedtobodytemperature.InArm2 the patient receives intraperitoneal chemotherapy at room tem-peraturebutwillapplyaheatingpadtotheabdomen.InArm3thepatientreceivesintraperitonealchemotherapyatroomtemperature.The patient completes baseline European Organization for Treat-mentofCancerQualityofLifeC30(EORTCQLQ-C30)andOV28(EORTCQLQOV28)formspriortotreatmentandfollowingeachIP chemotherapy infusion. Descriptive statistics will be computedfor all variables (including mean, standard deviation, median andrange).T-testswillbeusedtoassessdifferencesbetweengroups.

Researchisinprogress,nopreliminaryfindingsavailable.

2071ARESUBJECTSSATISFIEDWITHTHEEDUCATIONPROVIDEDDUR-INGTHEINFORMEDCONSENTPROCESS?ASURVEYOFRESEARCHD

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PARTICIPANTS.VickiTolbert,RN,BSN,OCN®,CCRP,ThomasJohnsCancerCenter,CJWMedicalCenter,Richmond,VA.

Informedconsentforparticipantsofclinicaltrialsisethicallyandlegally required.However, standardizedmethods forassessing theadequacyofinformedconsentforresearchislacking.Studiesshowthatpatientstendtodeclineparticipationinclinicaltrialswhentheydonotunderstandtheinformationprovidedtothem.Therefore,weneedtoensurethatweareprovidinginformationtoourpatientsatalevelthattheycaneasilyunderstand.

Thepurposeofthisprojectwastomeasureourpatients’satisfac-tionwiththeeducationprovidedtothemduringtheclinicaltrialen-rollmentprocess.Positivesatisfactionscoresofthoseenrolledwererecognizedasmeasuresofsuccess.

Aquestionnairewasdevelopedaddressingpatienteducationissuesrelated to enrollingon a clinical trial. In addition, questionswereaskedabouttheeducationprovidedbyspecificresearchstaffmem-bersand thecourtesyof the researchstaff.Thequestionnairewassent toallpatientswhosignedan informedconsentoveraperiodofoneyear.

Fiftypercentofallquestionnaireswerereturnedwith46%oftheparticipantsrespondingwithaperfectscore.Areasofstrengthiden-tifiedweresatisfactionwiththeexplanationoftheclinicaltrialpro-cess (treatments, schedules, tests).Areas for improvement includ-ing providing more information about potential side effects, risksandbenefits.Thebestproviderofinformationontheresearchteam(physicians, research,chemotherapyRNs)was the researchnurse.Thetopfactorinfluencingstudyparticipationwashowthephysicianpresentedtheinformationasatreatmentoption.

The survey identified the need to improve the understandabilityofthemedicalterminologyutilizedineducatingtheparticipants.Alistoftermsandwordsusedininformedconsentswerereevaluatedfordefinitionsatasixthgradereadinglevel.Also,inorderforthepatienttohavetimetomakeaneducateddecision,theyaregiventheconsenttotakehome.Afollowupphonecallismadepriortotheirreturntoansweranyquestionsorconcerns.Weplantoreassessourprogressafterimplementationofourrecommendations.

2072ALONGITUDINALSTUDYOFSOCIALSUPPORT,PSYCHOLOGICALANDPHYSICALSTATESAMONGJAPANESEWOMENWITHBREASTCANCER.ReikoMakabe,RN,PhD,FukushimaMedicalUniversity,Fu-kushima Japan; and Tadashi Nomizu, MD, Hoshi General Hospital,Koriyama,Japan.

Few studies have conducted to investigate the relationships ofsocial support and health outcomes among Japanese women withbreastcancer.

Thepurposeofthisstudywastoexploretherelationshipofsocialsupport,psychologicalandphysicalstatesamongJapanesewomenwithbreastcancer,andtocomparethesevariablesbeforeandafterbreastsurgery.

House’ssocialsupportframeworkwasusedtodeterminetherela-tionshipsofsocialsupport,psychologicalandphysicalstates.

Aconveniencesampleof48Japanesewomenwithbreastcancerparticipated in this study.Three instruments with established reli-ability andvaliditywereused: the Japaneseversionsof the Inter-personalRelationshipInventorytomeasuresupport,reciprocity,andconflict,theGeneralHealthQuestionnairetomeasurepsychologicalstates,andthePhysicalStatesForm.Datawerecollectedfourtimes:before(TimeI),threemonths(TimeII),sixmonths(TimeIII),oneyear(TimeIV),and18monthsafterbreastsurgery(TimeV).Dataanalysis included Pearson’s correlations, and repeated-measuresANOVA.

Significantcorrelationswerefoundbetweensupportandpsycho-logicalstatesatTimeII,TimeIV,andTimeV.Also,thereweresig-nificant correlations between psychological and physical states atTimeI,TimeII,TimeIII,TimeIV,andTimeV.Repeated-measuresANOVAshowedsignificantdifferencesinsupport(F=5.70,p=0.01)betweenTimeI(M=3.95)andTimeIII(M=3.65),between]TimeIandTimeIV(M=3.67)andbetweenTimeIandTimeV(M=3.62),inreciprocity(F=3.83,p=0.003)betweenTimeI(M=3.65)andTimeIII(M=3.36)andbetweenTimeIandTimeV(M=3.41),inphysi-calstates(F=28.61,p<0.001)betweenTimeI(M=1.18)andTimeII(M=3.78),betweenTimeIandTimeIII(M=3.42),betweenTimeIandTimeIV(M=3.20),andTimeIandTimeV(M=3.29).However,nosignificantdifferenceswerefoundinthevariablesofconflictorpsychologicalstates.Theresearchstudywillbecontinuedtoinvesti-gatetherelationshipsofthevariablesuptotwoyears

Funding Source: Japan Society for the Promotion of Science: #14572287

2073BARRIERS TO USING THE NATIONAL COMPREHENSIVE CANCERNETWORK(NCCN)DISTRESSMANAGEMENTTOOL:DOESITCAUSEMORESTRESS?MaryAnnRobbins,RN,BSN,OCN®,DukeUniversityHealthSystem,Durham,NC.

TheNCCNDistressTooldefinesdistressasanunpleasantexperi-enceofemotional,psychological,socialorspiritualnaturethatin-terfereswiththeabilitytocopewithyourtreatment.Cancerpatientsexperiencesometypeofdistressduringtheircancerjourney.Physi-cal symptomsare easier todiagnosis andmanage formosthealthcareproviders.Therefore,psychosocialissuesoftengounaddressedandunresolved.TheNCCNDistressToolhasbeenshowntobeaneffective tool for identifying non-physical issues. Nurses who areuncomfortablewithaddressingnon-physicalissuesmaychoosenottousethetool,thereforeprovidinginconsistentcare.

ThepurposeofthisprojectistounderstandthebarrierstousingtheNCCNDistressToolduringweeks1and5ofradiationandtoreinforceuseoftheassessmenttoolduringradiationtherapy.

ApilotprojectwasconductedtoevaluatethefeasibilityofusingtheNCCN tool.Uponcompletionof thepilot, the toolwas tobeused,duringweeks1and5oftreatment.Chartauditsindicatedthatthetoolwasonlycompleted75%ofthetime.Aquestionnairewasdevelopedandgiventothenursingstafftocomplete.Feedbackre-gardinguseofthetoolsuggestedthatsomenursesfeltuncomfort-able with approaching patients and discussing their concerns andthatphysicianswerenotalwayssupportiveof the time thepatientneededtocompletethetool.Basedontheseidentifiedbarriers,theClinicalNurseSpecialistandtheDirectoroftheCancerPatientSup-portProgramconductededucationalsessionswiththestaff.

Ongoingchartauditscontinuetoshowimprovementincompletionratesofthetool.Thenursingstaffismorecomfortablewithusingthetool,discussingissueswiththepatientandmakingappropriatereferrals.Educational sessions addressingpsychosocial, emotionalandspiritualneedsmayneedtobeaddressedperiodicallysonursesarecomfortableaddressingtheseconcerns.

Thetoolprovidesopportunitiesforopencommunicationbetweennurses and patients to discuss concerns based upon the patient’sperception.Ongoingevaluationanddiscussionregardinguseofthetool,referralprocesses,andcomfortlevelarecriticaltothesuccessofthetool.

2075THEINFLUENCEOFORALFOODINTAKEONPATIENTSWITHORALMUCOSITIS FOLLOWING ALLOGENEIC HEMATOPOIETIC STEMD

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CELL TRANSPLANTATION. Rumi Watanabe, RN, Hiroe Yamashita,RN,KayoYamamoto,RN,AkikoWatanabe,RN,SaoriYokouchi,RN,andTeruhikoKozuka,MD,PhD,EhimePrefecturalCentralHospital,Matsuyama,Japan.

Oralmucositisisafrequentcomplicationofthehigh-dosechemo-therapyandtotalbodyirradiationcommonlyusedinhematopoieticstemcelltransplantation.Inpatientsundergoinghematopoieticstemcelltransplantation,oralmucositishasahighinfectionandmortalityrate.Therefore,itspreventionandassociatedtherapyareimportant.Managementfororalmucositisisintegraltotheroleoftheoncol-ogynurse.

Inapreviousstudyweshowedbacterialnumbersintheoralcav-itydecreasedafteramealorgargling.Wethushypothesizedthatareductionoforalmucositismaybeinducedbyoralintakeinpatientswhounderwentallogeneichematopoieticstemcelltransplantation.Thepurposeofthisstudywastoinvestigateretrospectivelytherela-tionshipbetweenoralintakeandoralmucositisfollowingallogeneichematopoieticstemcelltransplantation.

Aretrospectivecomparisonstudyisappropriateforthisresearch.DataforthisstudyweretakenfromthemedicalrecordsfromApril

2002toJanuary2006of78patients.Dataconcerningconditionsoforal intakeandoralmucositisduring theperiod frombeginningatransplantconditioningregimentoneutrophilengraftmentwerecol-lected.GradesoforalmucositiswereevaluatedusingNCICommonTerminologyCriteriaforAdverseEvents(CTCAE)v3.0.

Therelationshipsbetweenthenumberoftimesofamealwastakenandtheperiodwhenoralmucositiswasobserved,andbetweenthequantity of the meal and the period when oral mucositis was ob-served revealed significant weak inverse correlations, respectively(r=-0.298p=0.014,andr=-0.3360.0056).Therelationshipbetweenthenumberoftimesofamealwastakenandthehighestgradeoforalmucositis also revealeda significantweak inverse correlation(r=-0.238p=0.0397).Afternadir,thehighestgradeoforalmucositissignificantly rose (p=0.0422), and the period when patients couldhaveanoralintakewassignificantlyshortened(p<0.0001).

Thisstudysuggestedthatcontinuousoralintakeduringallogeneichematopoieticstemcelltransplantationmaypreventsevereoralmu-cositis.Garglingtopreventfreeradicalsuntilnadirwhensecondaryoralmucositisoccursalongwithcontinuousoral intakeduringallperiodsappearcrucialforpreventingsevereoralmucositis.

2076PROMOTINGFAMILYINVOLVEMENTTOIMPROVESAFETY:APRE-SCRIPTIONANDOVERTHECOUNTERMEDICATIONSAFETYINITIA-TIVEINANINTENSIVEAMBULATORYSETTING.WendyWarrell,BSN,RN,andGinaSzymanski,MS,RN,JohnsHopkinsHospital,Baltimore,MD;andOluwatoyinAbiodun,AS.

MedicationreconciliationisatoppriorityfortheJointCommis-siononAccreditationofHealthcareOrganizationsandinourinstitu-tion.Medicationdiscrepanciesbetweenwhatisprescribedandwhatpatient’s take are reported to be as high as 76%. Blood and mar-rowtransplant(BMT)andLeukemiaoutpatientmedicationregimesarecomplexandoftenrequirenumerousmodificationsleadingtoahigherriskformedicationdiscrepanciesanderrors.Overthecounter(OTC)medicationsareoftenoverlookedbyprovidersbutcanhaveasignificantimpactonpatientoutcomesinthesettingofpoly-phar-macyandintheagingcancerpatient.

Oncology nurses in our NCI designated comprehensive cancercenter’s intensive ambulatory clinic for leukemia and BMT pa-tientsidentifiedcorrectself-administrationofprescriptionandOTCmedicationmanagementasasafetyissue.Weanalyzedourpatientmedicationself-administrationpracticesandimplementedasimple

interventionthatresultedinanincreaseinthecollaborationanddia-loguebetweenthepatient,caregiversandthenurse,andultimatelyincreasedmedicationsafetyintheclinic.

Usingaconveniencesample,wegathereddatafrompatientsandtheir caregivers, regarding theirknowledgeandadherence to theirprescriptionandOTCmedicationregimes.Weexaminedtheaccu-racyofouroutpatientmedicationlistandquantifiedhowoftentheclinic nurse completed medication reconciliation with the patient/caregiver.Aftertheinitialdatacollection,patientsreceivedamedi-cationbagtofacilitatetransportofmedicationstoeachclinicvisitandactasavisualprompttoinitiateaccuratemedicationreconcili-ationandbeginadialoguewiththepatient/caregivertoimproveanymedicationknowledgedeficits.

A month after the intervention was instituted a second identicaldata collection was done to examine patient/caregiver knowledgeandcompliancewiththeirmedicationregime.

Thenurseandpatient/caregiverteamareinauniquecollaborativerelationshipin theoutpatientsettingandplayakeyrole inmedica-tionreconciliation.Thepatientandcaregivermakesignificantcontri-butions to thepatient’scurrenthistoryofmedicationadministrationpractices,medicationsideeffectsandresponsetotreatment.Formal-izedmedicationreconciliationprotocolsthatincludediscussionswithpatient and caregiver improve the systems and self-management ofmedications,achievingimprovedsafetyoutcomesforthepatient.

2077FACTORS CONTRIBUTING TO SUCCESSFUL TECHNOLOGY IMPLE-MENTATIONINTHECOMMUNITYONCOLOGYSETTING.CathyForten-baugh, RN, MSN, AOCN®, Pennsylvania Oncology Hematology As-sociates,Philadelphia,PA;JillFallon,RN,MSN,CRNI,OCN®,EasternConnecticutHematologyOncologyAssociates,Norwich,CT;andSusanNorth,MBA,SupportiveOncologyServices,Memphis,TN.

Implementingnew technology such as an electronicmedical re-cordoranelectronicpatientself-assessmenttool(thePatientCareMonitor)inthecommunityoncologyprivatepracticesettingcanbeachallenge.Pre-implementationassessmentandplanninginsixar-eas,leadership,processplanning,readinesstochange,staffcommit-ment,stafftrainingandcompliancewithchange,canhaveapositiveimpactonthesuccessofthetechnologyimplementation

Todeterminehowassessment andplanning fornew technology,specificallyacomputerizedpatientself-assessment tool,affects itsimplementationanduse.

43of79practices,locatedacrossthenationwhoareutilizingacom-puterizedpatientselfassessmenttooltomanagecancerrelatedsymp-toms,respondedtoasurveyaboutthefactorsinvolvedinthesuccessfulimplementationofthecomputertechnologyandtheinitiativeitself.

Resultsofthesurveywereevaluatedtoidentifyfactorssignificanttotheoutcomemetric,usageofthetechnologyasmeasuredbythenumberofPCMreportsgenerated.Preliminaryanalysisshowsthatthe strongest relationships were leadership, compliance with thechangeandprocessplanning,inthatorder.FurtheranalysisshowedthatusagewashigherwhenMedicalOncologistsreferencedthePa-tientCareMonitorReportandlowerwhenthepracticewasdistractedbyothermajorchangesgoingoninthepracticeatthesametime.

Practices/nursesplanningamajortechnologyimplementationneedtoassessandplanforstrongleadershipsupport,aprocessforimple-menting change, staff readiness to change, staff commitment, andstafftrainingpriortoinitiatingthechange.AdvancePracticeNursescanbeutilizedtohelpproactivelyfacilitatetheprocess.Mostimpor-tantly,ifthepracticeisinvolvedinotherchanges,suchasmovinglo-cation,theimplementationofnewtechnologyshouldbepostponed.Inaddition,themoresupportiveandinvolvedtopleadershipisinthe

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process,themorelikelythepracticewillbesuccessful.Finally,ourquestionnaireshowedthatthemorethedoctorsandnursesreferredtothetoolduringthepatientvisit,themorelikelythepatientsweretofilloutthePatientCareMonitorinthefuture.

2079ASSESSINGPATIENTFLOWINANAMBULATORYONCOLOGYSET-TING.ShannonPhillips,MS,RN,AOCNS, JamesP.WilmotCancerCenter,Rochester,NY.

The flow of patients through ambulatory areas is central to pa-tientandstaffsatisfaction,aswellasreimbursementissuesrelatedtoroom/chairturnaroundtime.Patientflowinvolvesamultidisci-plinarygroupapproach,withcooperationneededfromnurses,pro-viders,clinicaltechnicians,secretarialstaff,andpatients.

Thepurposeofthisprojectwastoevaluatepatientflowandquan-tifywaittimesinanoutpatientcancerclinicandtreatmentcenterinWesternNewYork.

Datawerecollectedon442patientvisitsduring35businessdays.Astudentunobtrusivelyrecordedthetimethepatientwastakenintothe clinic room or treatment center, time the provider entered theroom,andtimethepatientlefttheroom.Thesedatawerecomparedtotheappointmentandarrivaltimesrecordedbythesecretary.Dataondrugpreparationandbarrierstobeingtreatedontimewereob-tained frompharmacyandnursing staff forpatientswho receivedmedications.

Twenty-onepercentofpatientsarrivedlatetotheirappointments.Delayswereobservedwaitinginlinetoregisterandinphlebotomybecauseofno/unclearorders.Theaveragewaitingroomtimewas17.8minutes(range1-153)and19.6minutesintheexamroombe-foretheproviderentered(range1-127).Waittimeswerecalculatedfor individual providers (range 7 - 43.4; SD=8.1).Ten percent ofpatientshadbothclinicandtreatmentappointmentsonthesameday;72%ofthosepatientsarrivedlatetotheirsecondappointment.Themost common causes of treatment delay from a nursing perspec-tivewere:multipledemandsonnursingtime,IVaccessproblems,labvaluespending,andnoordersfortreatment.Themostcommonpharmacydelayswereforlackoforderorsignatureonorder.

Theresultsofthisprojecthaveimportantimplicationsforpracticechange.Recommendationsforimprovementinclude:installself-ser-vicekiosksforregistration;stressimportanceofarrivingontimeforappointments;andensuringallproviderordersareenteredpromptlyandsigned.Nursingassignmentsshouldallowforemergency/add-onpatients;adelay inpatientswith samedayvisits; andequalityinpatientvolume/complexity.Thelargestandarddeviationinwaittimes has implications for specific providers, including alteringschedulingtimeforvisits.

2082DEVELOPMENTANDIMPLEMENTATIONOFACANCERREHABILITA-TION/WELLNESS PROGRAM AT A COMMUNITY CANCER CENTER.Jean Ellsworth-Wolk, RN, MS, AOCN®, Fairview Hospital, Cleveland,OH;andSusanDunson,RN,BSN,OCN®,andDebraA.Pratt,MD,FACS,ClevelandClinicCancerCenteratFairviewHospital,Cleveland,OH.

Physicalfitness,supportivenutritionandwellnesspromotionareat the forefront of cancer prevention, treatment and survivorshipdue to recent patient outcomes research. In addition, a landmarkpublicationfromtheInstitutesofMedicineoncancersurvivorship(2005)andthe2006AmericanCancerSocietyrecommendationsforphysicalactivityandnutritionhaveprovideddatathatsupportstheimportanceoftheseissues.Inordertoprovidecomprehensiveoncol-ogycare,cancerprogramsmustbegintoincorporatetheseareasintotheirpatienteducation,interventionandcommunityoutreach.

To achieve this goal in aCommunityOncologyProgram that ispartof largehospitalsystem,amultidisciplinaryCancerRehabili-tation/WellnessProgramwasdevelopedand implementedwith anAdvanced Practice Nurse (Oncology Clinical Nurse Specialist) asthecoordinator.

Anevidencedbasedprogramwasdevelopedthatincorporatedandadaptedaspectsofcardiac rehabilitation,exercisephysiology,dietcontrolandcomplementarytreatmentsutilizingexistinghospitalre-sources.Thepurposeoftheprogramistoimprovethequalityofapatient’s life through promotion of wellness behaviors.The focusisonphysicalfunctionandfitness,nutritionandmentalhealthbutincludesallaspectsofwellness.Theprocessutilizesanindividual-izedapproachwiththeAPNastheinitiatorandcoordinatorofeachpatient’s unique wellness plan. Priority is given to improving thefitnesslevelanddietofeachindividualonalongtermbasis.Thispersonalplanisthenimplementedbyamultidisciplinarygroupofprofessionals including representatives from nursing, medicine,physical and occupational therapies, exercise physiology, socialworkanddietetics.

Keycreativeaspectsoftheprogram,beyondtheuniqueimplemen-tationprocess,includefunding,marketingandpromotion,creatingcommunitypartnershipsandoutcomesevaluation.Patientoutcomesarebeingmeasuredconcurrentlybydetaileddatacollectionandaresearch study focusingonwomenwithearly stagebreast cancer.Futuregoalsincludeincorporatingcomplementarytherapiesandex-pandingtoincludemorecancersurvivorshipissues.

DespitedifferencesinresourceseachCancerCentercanandmustfindawaytodevelopsystemstointegratethepromotionofphysicalfitnessnutritionandwellnessissuesintotheirexistingservicesforoncologypatients.

2083UNDERSTANDING RESPONSE EVALUATION CRITERIA IN SOLIDTUMORS(RECIST):ACLINICALTRIALNURSE’SPERSPECTIVE.An-thonyDelaCruz,RN,OCN®,andTracyCurley,RN,OCN®,MSKCC,NewYork,NY.

Determiningobjectivetumorresponsesassociatedwiththeadmin-istrationofnewanticanceragentsiscrucialinevaluatingtheefficacyofadrug.RECIST(responseevaluationcriteriainsolidtumors),isawidelyemployedmethod toassesschanges in tumor size in re-sponsetotreatment.Thisisofparticularinteresttotheclinicaltrialsnurseandforpatientsconsideringaclinical trial.Objective tumorresponses determine whether the agent/regimen demonstrates suf-ficientlyencouragingresultstowarrantfurthertesting.Itisessentialthat nursesunderstandRECIST so theymaycounsel patients andfamiliesandassistinthedecisionmakingprocess.

Theneedformoreuniformreportingofatherapeuticresponseinclinicaltrialsisessential.Understandingtheguidelines,definitions,assumptionsandpurposesoftumorresponsecriteriaisacriticalpartoftheroleofthenurseinvolvedinclinicaltrialsandapplicabletoalloncologynursingpractices.Standardizedresponsecriteriaarecriti-cal for directing individual patient care, evaluatingnew therapies,andcommunicatingriskstofamilyandpatients.RECISTallowsforinvestigators to speak the same language when they are reportingstudyresults.Itenablesthenursetoclearlyandobjectivelydiscussindividualresultswithapatient.

Thispresentationwillinformnursesoftheeligibility,methodsofmeasurements,andspecificresponsecriteria.Limitationstothecur-rent guidelineswhichhavebeen identified in recentyearswill bediscussed.Toolsthatmaybeusedwillbedemonstrated.

RECIST guidelines may lead to more uniform reporting of out-comesofclinical trialsandfacilitate thewaynursescommunicate

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treatmentresponses.Understandingtheseguidelineswillalsoallowthenursetorecognizeproblemswiththecurrentsystemgiventhattumor cells may react differently to new drugs and new imagingtechniquesallowmoreaccuratemeasurementsoftumordensity.

Thisknowledgewillempowernursestoobjectivelydiscusstreat-ment effects with their peers, investigators, family members andpatients.UnderstandingRECISTwillenablenursestousestandardterminology when reporting treatment responses and aid in theircommunicationwithpatients.

2084BRINGINGABEREAVEMENTPROGRAMBACKTOLIFE.GraceMar-shall,RN,OCN®,KarmanosCancerCenter,Detroit,MI.

Oncologynursesdealwithmultipledeaths,providingcareforpa-tients,aswellas families/caregivers.Afterapatientdeathanurseis expected to continue working. Ineffective coping mechanismsmaybeadoptedleadingtoburnoutandharmfulbehaviors.Assistingnursesindealingwithdeathandprocessingofgriefguardsagainstburnout,leadingtobetterpatientcare.Interventionsincludeattend-ing funerals, holding alternative rituals, calling families, postingphotographsand/orsendingcards.

OnourBMTunit,nursesdealwithbothadultandpediatricdeaths.Inthepast,astructuredbereavementprogramhadbeenvaluedandseveralnursesparticipatedinsendingsympathycardsinitially,at6monthsandatoneyear.Withtheturnoverofinvolvedstafftheproj-ectdissolved.Anoriginalmember,anRNwith23yearsofoncol-ogyexperiencereturnedtotheBMTunitaftera2-yearabsenceandnoticedthatstaffwerestrugglingwithgrief issues.AproposalforreinitiatingthecardswasbroughttotheunitNursePracticecommit-teeandunanimouslyaccepted.

The Unit CNS gave a presentation on Nurses Grief, expandingnurses’ knowledge about the concept and described bereavementprogramsasoneeffectiveintervention.Bereavementcards,includ-ingpediatric specificwerepurchased.The leadnurse initiated thesympathycardandnotifiedstaff,enablingalltopersonallysigntheirnamesandexpresscondolences.With thepastprogramonenursewas responsible for cards eachmonth,while currently theprojectleaderasksnursesclosesttothefamilytochooseandinitiateacard.In thepastpatientsweremissedif theydidn’texpireontheBMTunit,thereforeadatamanagerprovidestheRNwithamonthlypa-tientexpirationlist.Patientphotographsandcardsarepostedinthenurses’conferenceroomandthenplacedinaunitscrapbook.

Previous participants voice gratitude for re-initiation of the pro-gram,whilenursesnewtotheexperienceprovidepositivefeedback.Bereaved families convey verbal and written appreciation for thethoughtfulgesture.

Bereavementprogramsallowoncologynurseswaystoexpressandresolvetheirgriefandcanbetailoredtomeet individualstaff/unitneeds.

2085OUTCOMESOFACERVICALCANCERAWARENESSPROJECT.BarbHenry,RN,APRN,MSN,UniversityofCincinnatiCentralClinic&Psy-cho-OncologyConsultants,Cincinnati,OH.

TheNationalOncologyNursingSocietyhasidentifiedtheimpor-tance of collaboration between ONS and the Black NursesAsso-ciationinanefforttocreatecervicalcancerawareness,prevention,andeducationalprograms.Thepurposeofthisprojectwastohelpwomentakeanactiveroleintheirhealthcareandlearnaboutcervi-calcancerprevention.

ResourceswerecollectedfromtheGynecologicalCancerFounda-tion,Women’sCancerNetwork,theAmericanCancerSociety,and

localCervicalCancernursingprofessionals.Sevendifferentpresen-tationswerecompletedbyCTC-ONS&BGNACmembersinavari-etyofcommunitysettings.Ateachofthesepresentations,thenursesdeliveredtheeducationalmaterialsinafashionthatbestsuitedtheneedsofthewomeninvolved.

Asaresultofthesenursinginterventions,manywomenwhohadnothadpelvicexamsorpapsmearsinthepastyearpledgedtomakeappointments.Approximately1,000handoutsweredistributedatallthepresentations.Wordwasspreadbythesethousandormorewom-en tootherwomenpromotingannualcervicalcancer screening topreventcervicalcancer.Thenursesinvolvedintheprojectdescribedapositiveexperienceofeducatingwomenatriskandcollaboratingwithcolleaguesfromadiverseprofessionalorganization.

Oncologynursescouldreplicatethisorsimilarprojectstoprovidecancerpreventioneducation toat riskcommunities, andenjoydi-verseprofessionally-rewardingexperiences.

2088HELPINGCANCERPATIENTSANDTHEIRCAREGIVERSPREPAREFORRADIATIONTHERAPY:AMULTIDISCIPLINARYTEAMAPPROACHTOPATIENTEDUCATION.KathleenMacDonald,RN,BSN,OCN®,CynthiaBriola, RN, BS, OCN®, Carole Sweeney, RN, MSN, AOCN®, CarolynWeaver,RN,MSN,AOCN®,SusanHaney,LCSW,andAnjaliAlbanese,LSW,FoxChaseCancerCenter,Philadelphia,PA.

It is well documented that patients experience anxiety and fearrelated to radiation treatment and continually seek out informa-tionrelatedtotheirtreatment.Theradiationoncologynurseplaysan importantrole inpreparing thepatientandtheircaregiversforradiation therapy.Atour institution, staff, aswell aspatientsandcaregivers,recognizedtheneedtoexpandontheteachingprovidedduringtheinitialclinicvisit.Therefore,themultidisciplinaryteamdevelopedaclasstoeducatepatientsandcaregiversaboutradiationtherapy.

Thepurposesofthe“PreparingforRadiationTherapy”classaretostandardize theeducationprovidedandbetterpreparepatientsandtheircaregiversforradiationtherapy.Orem’sSelfCareModelprovided the framework for theclass,which focusesonpromot-ingselfcareactivitiesduringtreatmentinordertoachievebetteroutcomes.

Initiallyaneedsassessmentwascompletedbypatientsundergoingradiation therapy. The results provided useful information relatedtoessentialcontenttoinclude,aswellaslogisticssuchaswhentooffer the class.Contentwasultimately reviewedandapprovedbyradiationoncologists,radiationoncologynurses,socialworkers,andthepatienteducationcoordinator.Participantsaretaughtabouthowradiationworks,howto lessenandmanagepotentialphysicalandemotionaleffects,andhowtoaccessavailableresources.Theclassistaughtbyaradiationoncologynurseandasocialworkerandisofferedevery2weeksatvaryingdaysandtimes.

Attheendofeachclassevaluationformsaredistributedtoeachparticipantandcaregiver.Thusfarresponseshavebeenoverwhelm-inglypositiveasattendeeshavestronglyagreedoragreedthat theinformationwasvaluabletothemandbetterpreparedthemfortreat-ment.Theyallstatedthattheywouldrecommendthisclasstoothersabouttostarttreatment.Basedonsuggestionsandfrequentlyaskedquestionsduringtheclass,contentwillbeadded.

Radiation oncology nurses can better prepare patients and theircaregiversforradiationtreatmentthrougheducationalprogramssuchasthe“PreparingforRadiationTherapy”class.Educatingpatientsoutsideoftheinitialclinicvisitandpriortotreatmentcanimprovepatient outcomes by decreasing anxiety and hopefully improvingmanagementofsideeffects.

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2089FINDING COMMON GROUND: PROVIDING MULTI-DISCIPLINARYONCOLOGYEDUCATIONFORACOMPREHENSIVECANCERCENTERNETWORK.EileenMilakovic,RN,BSN,MA,OCN®,andBrendaHow-ard,RN,BSN,OCN®,UPMCCancerCenters,Pittsburgh,PA.

Oncologynursessharepatientcarewithmultipledisciplines.Toshare oncology knowledge, this NCI-designated ComprehensiveCancer Center, with a geographically and numerically large net-work,hasbeguntooffermulti-disciplinarycontinuingeducationinoncology topics.Manyof theeducators in these topicsareoncol-ogynurseswhocandifferentiatetheseissues.Inaneedsassessment,nursesalsovoicedahighinterestininformationbeingpresentedbyexpertsfromotherdisciplines.

Thepurposeofthesechangeswasindirectresponsetotheannualeducationalneedsassessment.ItwasidentifiedthatmanydisciplinesrequireCEcredittomaintainlicensure/certification.Theseincludedpharmacists,socialworkers,dietitians,radiationtherapists,dosime-trists,tumorregistrars,PAs,andphysicians.

349surveyswerereturnedandevaluated.Whenitwasidentifiedthat so many other disciplines had specific CE requirements, re-searchwas initiated todetermine the specific issuesaroundmeet-ing theirneeds. Itwasrecognizedthateachdisciplinehas itsownrequirements,procedures,andaccreditingorganizations.Therewerecostsassociatedwitheach.DisciplineswhoidentifiedaneedforCEwereasked todesignatearepresentativefor theprogramplanningcommittee.Thegroupwiththegreatestnumberofrespondentswhocame forward with a committee representative first was radiationtherapists.Weproceeded to apply to theASRTas an institutionalprovider (1 year, $300 for unlimited programs and employees).Topicswere identifiedbasedon theneedsassessmentandcontentexperts identified. Itwas also requested that nursingCEbe avail-ablefortopicsofmutualinterest.Inthisformat,wehaveprovided7 one-hour monthly programs presented at our main campus andvideoconferencedtoournetworksites.Itisopentoallhealthcareprofessionals.In2006,forthisprogram,wefacilitated410creditsthroughASRTand140nursingCEcredits.(Totaloncology-drivennursingcreditsfor2006–10,345)

Eachsessionhasanobjective-drivenevaluation.Thegreatestex-pensehasbeenvideoconferencing.Therewillbeanotherneedsas-sessmentinitiatedinearly2007.

Othergroupsthatrequiremorecomplexplanningandhavehigh-ercostsforaccreditationmaybeintegratedinthefutureandwillalsobeconsideredwhenplanninglargermulti-disciplinaryconfer-ences.

2090EXPRESSIVE WRITING IN NEWLY DIAGNOSED BREAST CANCERPATIENTS.MelissaCraft,RN,PhD,AOCN®,BreastImagingofOkla-homa,Edmond,OK.

Breastcancercanleadtophysical,cognitiveandaffectivedistress.Positivebenefitsofexpressivewritinghavebeenreportedinothergroups.Expressivewritinghasbeenstudiedtoalimiteddegreeinbreastcancerpatients;questions remainabout thespecificwritingtypethatismostbeneficialtothisgroup,andtheimpactexpressivewritinghasonphysicalandpsychologicaldistress.

Thepurposeofthisstudywas(a)todeterminewhetherreportedbenefitsofexpressivewriting(i.e., improvedpsychologicalwell-beingandphysicalhealthrelatedoutcomes)areseeninnewlydi-agnosedbreastcancerpatientsand(b)tocomparespecificwritingassignments.Itwasproposedthatwomenwhodoexpressivewrit-ingaboutbreastcanceroraboutcriticalevents in their liveswillhave less depression and anxiety and improved overall physical

health as reflected by improved scores on: (a) Beck DepressionInventory (BDI-II) (b) StateTraitAnxiety Inventory (STAI) and(c)FunctionalAssessmentofCancerTherapy-Breast cancerver-sion(FACT-B).

Reflection/reframing and caring consciousnessprovide the theo-retical framework to explore the events that occur when a personexperiencesalife-alteringexperienceandusesexpressivewriting.

Thisstudywasalongitudinalrandomizedcontrolledtrialusingapretest-posttestcontrolgroupdesign.Participantswererandomizedintofourgroups:threewritinggroupsandonecontrolgroup.Instru-mentswereadministeredatentry(T1),onemonthpost(T2),andsixmonthspost (T3).Onehundredseventeennewlydiagnosedbreastcancerwomenwererecruited,and68ofthesecompletedthewritingassignmentsandtests.MANCOVA,ANOVA,andt-testswereusedtoevaluatedifferencesamonggroups.

Writing about breast cancer as the traumatic event was statisti-cally significant for improvement in functional quality of life anddepression. Simply writing about exercise, diet, sleep, and medi-cationsrelatedtothebreastcancerexperiencewasalsobeneficial.The group that wrote about a self-selected worst traumatic eventwasonlysignificantforanxietyreduction.Allthreewritinggroupsreportedastatisticallysignificantdecreaseduseofantidepressants.Expressivewritingwasfoundtobeausefulmechanismtodealwithbreastcancerandhadaneffectonphysicalfunctioning,depressionandanxiety.

2091DELAWARE,THEFIRSTSTATEINSTATEWIDECANCERCARECOOR-DINATION(CCC)ANDNAVIGATION.CynthiaWaddington,RN,MSN,AOCN®,HelenF.GrahamCancerCenter,Newark,DE;TerriClifton,MS,NCC, Nanticoke Memorial Hospital, Seaford, DE; Eileen Curtin, RN,BSN,St.FrancisHospital,Wilmington,DE;LatonyaMann,RN,OCN®,ChristianaCareHealthSystem,Newark,DE;KathleenRussell,MPH,DelawareDivisionofPublicHealth,Georgetown,DE;andClareWil-son,RN,MS,BeebeMedicalCenter,Lewes,DE.

Cancer is Delaware’s second leading cause of death. Addition-ally, Delaware’s cancer incidence and death rates are higher thanthenationalaverage.GovernorRuthAnnMinnerandtheDelawareGeneralAssemblyformedtheDelawareAdvisoryCouncilonCan-cerIncidenceandMortality.WithamissiontoprovidethehighestqualitycareforeveryDelawareanwithcancer,theDelawareCancerConsortium(DCC)wasformed.NotingtheeffectivenessofthePa-tientNavigator/CareCoordinatorroleinnavigatingpatientsaroundbarrierstoqualitycare,theDCCimplementedastatewideCCCPro-gram.

Financialsupportandleadershipinprogramdevelopmentensued,providinganetworkofCCCstohelppatientsnavigatethroughthebarrierstoqualitycareandthecomplexandmultidisciplinaryissuesthatarisewithcancer.

TheprogramsupportsoneCCCateachhospital.FacilitydiversityandgeographicallocationsrequireCCCstofunctionuniquelyandindependentlytomeetpatientneeds.Teamunityandconsistencyarefacilitatedthroughmonthlymeetingswhichprovideacollaborativeforum for sharing resources, knowledge and support; identifyingbarriers; and developing policy, procedure and practice standards.CCCsacquireadditionalrolesupportthrougheducationonendoflifeissues,culturaldiversity,financialandinsuranceissuesandcare-giversupport.

Prior tothisprogramonlyoneDelawarehospitalutilizedCCCs.By end of FY06, each hospital had a CCC. In FY06, Delaware’sCCCsfollowed1,280patientsandprovided11,086totalsupportiveinterventions. CCCs provided counseling on nutrition, psychoso-

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cialissuesandtreatment-relatedmatterson1,558occasions.CCCsscheduled1,332appointments(specialistreferrals,diagnostics,andtreatment),andassistedin346transportationplansforcancer-relat-edappointments.CCCsprovided252financialsupportinterventionstoassistpatientsinobtainingmedicationsand344interventionstoassistpatients infindingfinancialsupport forco-pays.Ofparticu-larimportanceweretheCCCs’80referralstotheDelawareCancerTreatmentProgramwhichprovidestheuninsuredwithoneyearofcancertreatmentinsurance.

ThisprogramdemonstratestheimpactofindividualCCCsonas-sistingpatientstoobtainqualitycancercarestatewide.Italsoservesasamodelofstate-levellegislativecommitmentandaction.Adop-tionofthismodelforanypatientpopulationrequiringcomplexmul-tidisciplinarycoordinationispossible.

2093MEETINGBUDGETEDHOURSPERPATIENTDAY(HPPD)WITHOUTCOMPROMISINGPATIENTANDSTAFFSATISFACTIONONANINPA-TIENT ONCOLOGY UNIT. Susan Di Re, RN, Northwest CommunityHealthcare,ArlingtonHeights,IL.

Meeting thehoursperpatientday(HPPD)budget iseverynurs-ingmanager’sdilemma.Thisisespeciallytruefortheoncologyunitmanagerinthecommunityhospital,wherecensusfluctuates,FTE’sarelow,andthebudgetislimited.Nurse-patientratiosandpatientacuities are high.The budgeted HPPD for the inpatient oncologyunitatNorthwestCommunityHealthcare(NCH),challengedthedi-rectorwithimprovingpatientcareandsatisfaction,whilesimultane-ouslynotcompromisingstaffsatisfaction.

After reviewing nursing management and business literature, aproposalwasdevelopedfordisseminatingamajorityoftherespon-sibilitiesofthe“ChargeNurse”roletothestaffnursesthemselves.This approach holds the staff nurse accountable for direct patientcare and self-management as a stake-holder of the oncology unit.PatientcareoutcomeshaveimprovedandcorporateHPPDgoalsareclosetobeingmetwhileenhancingthenurse’sjobsatisfaction.

TheunitbasedsharedgovernancecouncilforCustomerSatisfactionwaskeyinimplementingthechanges.Theactionsincludedchangingthe“Charge”nurse role to a rotating“ShiftLeader” role.TheShiftLeaderassumescareofthreelesscomplexpatients,whilealsohavingresponsibilitytoassignbedsandoverseestaffingforthenextshift.AllstaffwereeducatedontheHPPDandbudgetprocess,aswellascom-munication,delegationanddecision-makingfortheShiftLeaderrole.

StaffRN’sselfassign3-4patients,takingintoconsiderationpatientacuityandcontinuity.Patientcaretechnician’s(PCT’s)weregivenmoreresponsibilityandchargedwithfallprevention,preventionofskin breakdown and quicker response to answering call lights.Anursingsatisfactionsurveywasconductedpriorto,atthreemonthsand6monthstomeasurestaffsatisfactionfollowingimplementationoftheplan.HPPDwasmonitoredmonthly.

These innovative approaches to the daily operations of our on-cologyunitempowered thestaffnurse tocritically-think,delegatefairly,andprovidesafe,cost-effectivequalitycaretotheironcologypatients.Anysmall,dedicatedoncologyunitcouldbenefitbycon-sideringthisplantomeetcorporate,unit,patientandstaffgoals.

2094CREATING A LEARNING ENVIRONMENT FOR NURSING SCHOOLFACULTYANDSTUDENTSINACOMPREHENSIVECANCERCENTERWHENALLTHEYWANT ISMED-SURG.ElizabethOwens,RN,MS,RoswellParkCancerInstitute,Buffalo,NY.

Inourcommunity,impendingchangeswillresultindownsizingofcommunityhospitalsandlossofclinicalsitesfornursingstudents.

ThisalongwithminimalexposuretooncologyinnursingcurricularequirescreativityanddevelopmentofrelationshipsbetweenschoolsofnursingandhospitalbasednursingeducationtoprovidestudentswithavaluableclinicalrotationataComprehensiveCancerCenter(CCC).

RoswellParkCancerInstitutehaslong-termrelationshipswithlocalschoolsofnursing,buthashadlimitedsuccessinattractingrotationsfromlocalBaccalaureate(BSN)programs.Facultyidentifythattheyonlywantmedicalsurgicalrotations,andfrequentlyshyawayfromamedicaloncologyexperience.Whetherthisisfromlackofknowledgeofthecomplexitiesofoncologycare,orfearofthesameisunknown.Clinical rotations lead to employment interest from students, butwehaveaworkforcethatisunder-representedbyBachelor’sdegreepreparedNursing staff.Advantages to attractingBSNprograms forclinicalrotationsaremany:introducingstudentstooncologynursing,providinganopportunitytoworkwithexperiencedoncologynurses,increasingtheknowledgebaseofnursingschoolfacultyasitrelatestooncologyandincreasingtherecruitmentpoolofBSNgraduatesinaperiodoftimewherethereisashortage.

Challenges were how to entice baccalaureate nursing faculty toexploreaclinicalrotationatacomprehensivecancercenter,howtosupportfacultywhosupervisestudentsinanewenvironment,pro-videavaluablelearningexperienceforthestudentsandanenviron-mentthatwillencouragethemtoapplyforpositions.

Thispresentationwillreviewanoncologyorientationfornursingfaculty, methods utilized to encourage faculty to consider clinicalplacementonan inpatientoncologyunitataCCC,preparationofnursingstaffwhopreceptstudentsontwohighlyacutemedicalon-cologyinpatientunitsandfeedbackfromthenursingstudentsandfacultywhoparticipateinclinicalrotationsatRPCI.

The nursing shortage and employment opportunities have RPCIcompetingfortherecruitmentofoncologynurses.Supportingbothnursing faculty andnursing students throughanoncologyclinicalrotationmayprovidearecruitmentopportunity,butwillprovidenewgraduateswithvaluable learningopportunities inanoncologyset-ting.

2096ROUNDING FOR OUTCOMES: CAPTURING NURSING EXCELLENCEONANINPATIENTONCOLOGYUNIT.LauraConnelly,MA,RN,CCRN,OCN®,EvelynMarinas,BSN,RN,andYvonneSmith,BSN,RN,M.D.AndersonCancerCenter,Houston,TX.

Oncology patients face extraordinary challenges in obtaining,maintainingandcompletingtheirtreatmentforcancer.Inthehospi-talsetting,patientscanfeeloverwhelmed,forgottenandfrightenedduringtheirtreatmentcourse.Nursesarethefrontlineleadersforthecoordinationandcommunicationofpatientcare.Thehealthofthenurse-patientrelationshipwillaffect thepatients’healing.Inordertoprovidethebestpossiblepatientcare,thepatient’sperceptionofexceptionalnursesmustbetakenintoconsideration.

Thepurposeofthisprojectistoevaluatethepatient’sperceptionofexcellenceinnursingcare.Manypatientsreceivequestionnairesathomeafter theyaredischarged.Thesesurveysare standardizedand provide useful global information; however, nurses providingexcellentcarecannotbeindividuallyrecognizedusingthestandard-izedsurveys.

While hospitalized on the Gynecological Oncology unit, nursemanagers and administrators rounded on the patients. EmployingthetechniquesdelineatedbyQuintStuderinhisbook,HardwiringExcellence,patientswereable togive timelyfeedbackabout theircare.Patientswerealsocontactedwithin24-72hoursofdischargeaswellusingthesamemethodology.

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Patientsatisfactionandsafetyimprovedwithtimelyrounding.Dur-ingthethirdquarterof2006,thepatientsatisfactionscoresimproveddramatically.Theunitmovedintothetopquartileforthehospital.TheNursingcarefortheunitwasrated9.7outof10.Theunitwastheonlyonetohave100%consistencyincheckingthepatient’sIDbandforsafety.TheLengthofStaywasreducedbyhalfadayforthemonthsofSeptemberandOctober.Additionally,patientsweregiventheopportunitytorecognizetrulyoutstandingnursesandassistants.

Interestingly,over50%ofthemostmentionednurseswerenurseswith less than two years experience. These nurses represent only15%ofthetotalnursingstaffontheunit.Allofthenewnurseswerebaccalaureateprepared.The impactofeducational leveland train-ingshouldalsobeevaluated.Nursesatisfactionshouldalsobemea-sured.

2097OBTAINING AND SUSTAINING A HEALTHY WORK ENVIRONMENT.LauraConnelly,MA,RN,CCRN,OCN®,M.D.AndersonCancerCenter,Houston,TX.

TheAmericanAssociation of Critical Care Nurses advanced aninitiativein2005thatupheldtheIOM’scontentionthathealthyworkenvironmentsprovidethesafestcareforpatientsandthestaff thatcareforthem.Poorcommunication,poorprofessionalrelationships,understaffingandpoormanagementsetthestageformedicalmis-takesandsubstandardcare.

SimilaritiesbetweenanoncologypatientandanICUpatientcanbefoundinmedicationregimens,isolationprotocols,anddiseasepro-cesses.Allstaffmembers,medicalandnursing,neededtobeawareoftheelementsofahealthyworkenvironmentaswellasitsimpactonpatientsafety.Educationwasprovidedtoin-patientnursingstaffonanoncologyunitaswellastothemedicalfacultyandfellows.

Nursingandmedicalstaffwereeducatedaboutthesixelementsofahealthyworkenvironment:skilledcommunication,truecollabora-tion,effectivedecisionmaking,meaningfulrecognition,appropriatestaffing and authentic leadership. Nurses communicated to physi-ciansinSBARformat.Nursesroundedwithfacultyinthepatient’sroomsaswellasofferednursepracticeguidance inweeklygrandrounds.Staffingratioswere reducedanda freechargenurseswasaddedaswellasadischargenurse.Nursingstaffwererecognizedif they were mentioned in “Rounding for Patient Outcomes” and“RoundingforStaffOutcomes”usingtheStudermodel.

Physiciansandnursesreportedbettercommunicationandmorale.TheLengthofStay reducedbyhalfaday for the thirdquarterof2006.Thepatientratingfornursingcaremovedfrom9.4to9.7inthe3rdquarter.Therewerenomedicationerrorsinthe3rdquarter.Therewere91daysbetweenpatientfallsinthe3rdquarter.Nursingturnoverwas0%andfivenewstaffnurseswereaddedinthisquarterduetoastaffingbudgetincrease.Therewerenounsuccessfulpatientrescuesontheunit.

Oncologynurses,physiciansandpatientsallbenefitfromahealthyworkenvironment. Incidenceofmedicationerrors,patient fallsandsuccessfulpatientrescuesshouldremainlowinanenvironmentthatsupports healthy team work, communication and decision making.Theseelementsarereportedmonthlyontheunit’squalityscorecard.

2098A STRUCTURE FOR EVIDENCE-BASED NURSING PRACTICE IN AHOSPITALENVIRONMENT.NancyKline,PhD,RN,CPNP,FAAN,andBridgetteThom,MS,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Despite an aggressive research agenda, the majority of findingsfrom research are never integrated into practice. Without current

bestevidence,practicebecomesrapidlyout-of-datetothedetrimentofpatients.Wedevelopedaformalizedprogramforevidence-basedpractice within the Department of Nursing, in which all existingpoliciesandpracticesarereviewed,andnewpoliciesaredevelopedusingastandardizedevidence-basedapproach.

ThepurposeofthispresentationistodescribethedevelopmentandmaintenanceofanorganizationalinfrastructuretosupporttheEBPprocesswithintheDepartmentofNursing.

InSeptember2005,fivepractice subcommitteeswerecreated torepresentnursingpracticethroughouttheinstitution:acutecare,pe-diatrics,proceduralareas(e.g.,OR,radiology,endoscopy),ambula-toryclinics,andcriticalcare (e.g., ICU,PACU).Themembershipconsists of nurses from each area, and each subcommittee meetsonedayeachmonth.Formaltrainingintheevidence-basedreviewprocesswasprovided for the subcommitteemembersprior to ini-tiationoftheDepartmentalprogram.Initially, theDirectorofEvi-dence-BasedPracticeandResearchandtheResearchAnalystfortheDepartmentmetwith the individual subcommittees as facilitators,and still continue to do so as needed. Ongoing training regardingadvancedliteraturesearchtechniquesandcritiquingtheresearchlit-eratureisoffered.Tasksofthesubcommitteesincludethefollowing:revisionofexistingpoliciesanddevelopmentofnewpoliciesusinganevidence-basedapproach,evaluationofcurrentevidencetomakerecommendations for practice changes, designing metrics to mea-surepatientoutcomes,andcommunicatingworkinprogresstotheDepartmentalPracticeCouncil.

Inthe15monthssincetheprogramstarted,10clinicalquestionshavebeenansweredusingtheevidence-basedapproach.Afirstan-nualevidence-basedpracticecontinuingeducationconferencewasheld in December 2006. The individual subcommittees presentedtheirevidence-basedreviewsandpracticechanges.

Anevidence-basedapproachtopracticeisnotadestination,butanongoingjourney.Developinganinfrastructuretosupportevidence-basedpracticeisnecessarytomakesurethatcurrentbestevidenceisusedwhenprovidingpatientcare.Thisprograminvolvesamajoror-ganizationalcommitmentandculturechange,alongwiththeabilitytoprovideeducationregardingtheprocessandongoingmentoringfromexperiencedresearchers.

2100SYMPTOMCONCERNSANDQOLINPATIENTSWITHOXALIPLATIN-INDUCEDPERIPHERALNEUROPATHY.VirginiaSun,RNMSN,BettyFerrell, RN, PhD, FAAN, Shirley Otis-Green, MSW, ACSW, LCSW,OSW-C,StephenShibata,MD, andGloria Juarez,RN,PhD,City ofHopeNationalMedicalCenter,Duarte,CA;andKyongChoi,MA,VitalResearch,LosAngeles,CA.

Standardchemotherapeuticregimensforcolorectalcancer(CRC)oftenutilizemultiple agentswith toxicities thatmay impactQOLboth acutely and chronically. Oxaliplatin-induced peripheral neu-ropathy,adose-limitingtoxicity, iscommoninCRCandmayim-pactQOL.

ThepurposeofthisstudywastodescribethesymptomconcernsofCRCpatientswithoxaliplatin-inducedperipheralneuropathyandexploretheimpactofsymptomsonpatient’sQOL.Thisstudyad-dressedtheprioritytopicofincreasingtheunderstandingandman-agementofunderstudiedsymptomssuchasperipheralneuropathy.

StudyframeworkisbasedupontheCOHQOLmodelandontheFACITmodel.TheframeworkdemonstratesthatsymptomconcernsmayimpactQOLacrossthedomainsofphysical,social,emotional,andfunctionalwell-being.

Thisprospective,longitudinalstudyincorporatedamixed-methodsdesigntogaininsightintoparticipant’sexperiencewithperipheral

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neuropathy.Sixty-threeCRCpatientstreatedwithoxaliplatinwereaccrued, and 20 semi-structured interviews were conducted. Par-ticipantswerefollowedfromtreatmentinitiationandat24hours,1week,1month,and2monthspost-initiation.Outcomemeasuresin-cludedtheFACT-C,FACT/GOG-Ntx,andNeuropathicPainScale.Toxicitygradingwasdocumentedusing theNCI-CTCandOxali-platinSpecificScale.Dataanalysiswasderivedthroughdescriptivedesignofquantitativesymptomreportsalongwithsimultaneousre-gressionmethodtodeterminevarianceinQOL.Qualitativedatawasinterpretedthroughcontentanalysismethods.

Meanageofsubjectswas60,andethnicityincluded61%Cauca-sian,14%Hispanic,11%Asian,and6%AfricanAmerican.Subjectsincluded22%Stage III and29%Stage IVdiseaseofwhich45%wereundergoingtreatmentfor initialdiagnosisand14%wereun-dergoing treatmentfor recurrentdisease.Allparticipantswereox-aliplatin-naïveatbaseline.Subjectsidentifiedsymptomconcernsinthephysical(30%),emotional(40%),andfunctional(30%)domainsof QOL. Grade I neuropathy was seen in 47%, Grade II in 13%,andGradeIIIin1.6%ofparticipants.Qualitativedataindicatedthatperipheralneuropathywastolerablebuthadsomeimpactonfunc-tionalstatusforparticipants.Theidentificationofspecificsymptomconcernsinoxaliplatin-inducedperipheralneuropathywillenhanceclinicalunderstandingofthesymptomandaidinthefuturedevelop-mentofnursinginterventionsforthispatientpopulation.2101DECREASING THE RISK OF CHEMOTHERAPY ERRORS THROUGHAFAILUREMODESANDEFFECTSANALYSIS(FMEA)ANDAFOCUSPDCA(PLAN,DO,CHECK,ACT)QUALITY IMPROVEMENTMODEL.KarenRoesser,RN,MS,AOCN®,ThomasJohnsCancerCenter,Rich-mond,VA.

Schulmeisterreportedthatsixty-threepercentofnursesrelatedthatchemotherapyerrorshaveoccurredintheirpractice.Theendresultmay be increased patient morbidity, mortality, and/or lawsuits re-latedtothenurse’sroleinchemotherapyadministration.Therefore,everyefforttoensureandimprovesafetymechanismsrelatedtoche-motherapyneeds tobeundertakentopreventchemotherapyerrorsfromeveroccurring.

Thepurposeofthisprojectwastosystematicallyevaluatethepro-cessesassociatedwithchemotherapyadministrationatour institu-tionandwherepotentialproblemareaswere.Thisincludedareviewoftheprocessinourinfusioncenter,medical,andsurgicaloncologyunits.

Ateamwasdevelopedwhichconsistedofstaffnurses,pharmacists,nursingmanagement,theoncologyclinicalnursespecialist,andthepatient safety officer. The team utilized the FMEA methodologyand identifiedpotentialproblemareas and their root causes.Eachproblemareawasratedandgivenariskpriorityscoreaccordingtohowlikelyitwastooccurandtheconsequencesofit.TheseFMEAresultswereincorporatedintopatientsafetyperformanceimprove-mentactivitiesusingtheFOCUSPDCAmethodology.Asaresultofthis,anewchemotherapyorderformwasdevelopedwithinputfromthisteam,ourphysicians,andourcancercommittee.

Theteamidentifiedthefollowingareastobeofhighestriskrelatedtothechemotherapyprocesswhichwasinplace:chemotherapyor-deringformincomplete,orderclarificationnotcommunicated,andAUCdosing formulanotknown.The evaluationofournewly re-visedchemotherapyorderingformhasbeenerrorfreetodate.

TheuseofaFMEArelated to thechemotherapyprocess ispar-ticularlybeneficialinevaluatingprocessesforpossiblefailuresandtopreventthembycorrectingtheprocessesproactivelyratherthanreactingtoadverseeventsafterfailureshaveoccurred.Usedincom-

binationwithothertoolssuchasthePDCA,anewchemotherapyor-derformwasdevelopedwhichwillcontinuetobeevaluatedthroughthePDCAmodel.

2102EMPOWERINGSTAFFNURSESTOIMPROVETHECHEMOTHERAPY/INFUSION PROCESS FOR PATIENTS, FAMILIES AND STAFF. MaryAnnLong,BSN,RN,OCN®,MichelleLorenz,RN,AASN,andSalemDenton,RN,BSN,RoswellParkCancerInstitute,Buffalo,NY.

Amainstayinthearsenaloftreatmentforcanceristheadministra-tionofchemotherapyasbothaprimaryandasecondarytherapy.Nu-merousfactorsincludingincompleteorders,inadequatelyscheduledappointments andchair lockplaya role indetermining the actuallengthoftimethatapatientspendsintheambulatoryChemothera-py/InfusionCenter,howtolerablethevisitisforthepatientandhowseamlesslythetherapyisadministered.

Becausethenursesthatadministerthechemotherapyandinfusionsinthecenterhaveanintimateknowledgeandunderstandingofhowtreatmentsarescheduledandadministered,itisimperativethatthesenursesbeinvolvedinthechangeprocesstoensurethatthechemo-therapyorinfusionexperienceisoptimizedforpatients.

Thenursingstaffidentifiedbothbarriersandpotentialsolutionsforimprovementincluding:a.analternateworkschedulewasproposedbythenursingstaffand

implementedwhichallowedforadditionaltimeawayfromtheirstressfuljobandallowedgreaterflexibilityinschedulingforpa-tient’stherapies.

b.patient’sscheduleswerealteredtoincreasetheavailablenursinghoursandsubsequentlyincreasetheavailablechairhours.

c.aprocessforobtainingandcheckingchemotherapyordersthedaybeforetherapywasinitiatedtoensureavailability,completenessandaccuracyoforders.

Includedinthispresentationwillbethepositiveimpactresultingfrom these interventions in the areas of recruitment and retentionofregisterednurses,utilizationofovertime,patientsatisfactionandmedicationvariancesandinterventions.

ImplementingasharedgovernancemodelintoourChemotherapy/InfusionCenterhasimprovedtheoperationofthecenter.Thispre-sentationwillbeof interest tooncologynurses inotherorganiza-tionalsettingschallengedbyincreasingdemandsontheirresources.

2105IMPLEMENTING A PROGRAM TO PROMOTE PATIENT SAFETY BYENHANCING COMMUNICATION BETWEEN INPATIENT MID-LEVELPROVIDERSANDTHEPATIENT’SFOLLOW-UPPHYSICIAN/NURSE.MichelleRohlfs,RN,DonnaGerber,RN,MN,PhD,AOCN®,CarolLac-ey,PA-C,JessicaRichard,RN,ANP,OCN®,andTinaDett,RN,FNP,UTM.D.AndersonCancerCenter,Houston,TX.

Manypatients travel to comprehensive cancer centers to receivecancertreatment.Theyreceivemedications,whetherinpatientorinan ambulatory treatment center, and return to their hometownbe-tweencoursesoftreatment.Treatmentcomplicationsmostoftenoc-curinthepatients’homeareas/settingswhileunderthecareoftheirlocal oncologists/family physicians. In some instances the cancercenter’sclinicteamappearstobeunawareofwhattranspiredduringtreatment.Withouttheknowledgeofwhatthepatientreceivedandwhattoexpectwhilethepatientisundertheircare,thephysiciansand/or clinic nurses may be lacking important information whenmaking decisions regarding appropriate interventions. This is notanissueduringthehospitalstayintheprimarytreatmentcenter,ascommunicationisdonewithnurse-to-nursehandoffandphysician-to-physicianhandoffperJCAHOrequirements.

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Aneedtohaveasystematicoutlineofhowtocommunicatewiththemedicalteamresponsibleforthefollow-upofpatientsreceivingtreatment with biochemotherapy or high-dose bolus interleukin-2wasidentified.AnactionplanwasinitiatedwithintheDepartmentofMelanomaMedicalOncologytoimplementaprogramtoenhancecommunicationbetweenthehomemedicalteamandtheoutpatientclinicalteamwithinourinstitution.

Aplanwasdevelopedtoimplementaconsistentcommunicationprocess within our own institution. When a patient is dischargedfromtheinpatientsetting,anemailissenttotheoutpatientclinicalnurse/mid-levelproviderregardingthepatient’scurrentstatus.Theemailmessageincludespertinentclinicalinformationandanynec-essaryfollow-upincludingpendingcultures.Thiscommunicationisdoneregardlessofdisposition/dischargelocation.Inaddition,thein-patientmid-levelproviderscommunicatewiththehomeareahealthcare teams.Communication includes laboratoryorders for interimtests,documentationoftreatmentincludinggrowthfactors,andanyotherpertinentinformation(usingHIPPAguidelines).

Toevaluatetheprocess,monthlymeetingsbetweentheinpatientandoutpatientpersonnel(includingmid-levelproviders)arecalledtoaddressanyissuesthatmayhavearose.

Thisposterwilldiscusstheprocessandimplementationofacom-municationplantoensurethesafetyofpatientsreceivinginpatienttreatmentandappropriatefollow-up/outpatientcare.

2107FAILURE MODE AND EFFECTS ANALYSIS (FMEA): INTRAVENOUSCHEMOTHERAPY ADMINISTRATION. Sandra Vannice, RN, MSN,OCN®,AOCN®,andPeggyWimmer,PharmD,DenverHealthMedicalCenter,Denver,CO.

Achemotherapymedicationerrorcanhaveacatastrophicoutcomeforapatientandfamily.Systemproblemssuchasunderstaffingandpoorcommunicationcancontributetotheoccurrenceofmedicationerrors.HealthcareFailureModesandEffectsAnalysis(FMEA)isaproactiveassessmentthatidentifiesandimprovesstepsinaprocessensuringasafeandclinicallydesirableoutcome.FMEAprovidestheframeworkforasystematicapproachtoidentifyandpreventprob-lemsbeforetheyoccur.Becauseofthehighriskrelatedtoadminis-trationofchemotherapyandtherelativelysmallvolumeofpatientstreatedatbothourinfusioncenterandhospitalwechosetoconductanFMEAtoensurethehighestlevelofsafetyforourcancerpatientsreceivingchemotherapy.

Thepurposeofthisprojectwastoevaluateourprocessesrelatedtochemotherapyadministrationfromthewrittenordertodrugdeliverytoensureahighqualityofpatientsafety

A multidisciplinary team consisting of pharmacy, in patient andoutpatient nursing staff, nursing administration, oncology physi-cians,clinicandhospitaladmissionsstaff,andriskmanagementmettodiscussprocessesandcompleteflowdiagramsofchemotherapyadministration to proactively determine where failures in the pro-cesscouldoccur.Ahazardanalysiswasconductedandinterventionsleadingtorevisedpolicyandproceduresweredesignedtopreventerrorsandimprovehazards.Indicatorswereidentifiedtofollowout-comesandtotestandanalyzetheredesignprocess.Astrategywasimplementedforsustainingimprovementsovertime.

Thenumberofreportablechemotherapyeventsdeclinedovertimeandthehazardscoreimproved.AsaresultofthisprojecttheFMEAwasextendedtoreviewtheorderingandadministrationprocessesofcytotoxicdrugsfornon-oncologicindicationsinallsettingsacrosstheinstitution.

ByreviewingthechemotherapyadministrationprocessesthroughanFMEA,oncologynursesareabletoidentifyhowandwherefail-

uremayoccurinasystemleadingtochemotherapymedicationer-rorsandundesiredoutcomes.Wehaveimprovedthechemotherapyadministrationpractices,decreasedreportableeventsandimprovedthesafetyofchemotherapyadministrationtopatientsatourinstitu-tionthroughtheFMEAprocess.

2108CHEMOTHERAPY INDUCED NEUTROPENIA AND RELATIVE DOSEINTENSITY:ANEVIDENCEBASEDPRACTICEPROJECT.SandraVan-nice,RN,MSN,OCN®,AOCN®, JeremyGarcia,RN,MarySweeney,RN,CatherineDingley,RN,FNP,MaryDerieg,RN,DNP,andTeresaTrabert,RN,DenverHealthMedicalCenter,Denver,CO.

Chemotherapyinducedneutropenia(CIN)canresultintreatmentdelaysand/ordose reductions.Recent studies focusedonRelativeDose Intensity (RDI) in patients with non-Hodgkins lymphomaandbreastcancerdemonstrate thatmaintainingdose intensityandpreventingdosedelays impactpatientoutcomesandsurvival.TheNationalComprehensiveCancerNetworkrecentlypublishedguide-linesfortheuseofmyeloidgrowthfactorsincancertreatment,in-cludingriskfactorsforchemotherapyinducedneutropeniatoguidepractitionersinearlyidentificationofpatientswhomaybenefitfromprophylacticgrowthfactortomaintainanoptimaltreatmentsched-ule.Nursingstaffinourinfusioncenterperceivedanincreaseinthenumberoftreatmentdelaysduetoneutropeniaandfeltthatourprac-ticepatternsappearedinconsistentwithcurrentrecommendations.

Determine the number of chemotherapy patients in our practicewhoaredosedelayedordosereducedduetoCINandcalculatetheRDIofthispatientpopulation.Determinewhatriskfactorsasdocu-mentedintheliteratureimpactourpatientpopulation.

Datawascollectedonchemotherapy treatmentdelaysdue to anAbsolute Neutrophil Count (ANC) less than 1500 mcg/dl in bothinpatientandoutpatientsettings.Individualriskfactorsforneutrope-niawereidentifiedusingtheChemotherapyRiskFactortoolcreatedbyWolf,Crawford,&Dale.

Thirtypatientswereidentified–16outpatientsand14inpatients.The average RDI of outpatients was 71% and 79% for inpatientswithapproximatelyhalfofthepatientswithRDIsbelowtherecom-mended 80%. Predominant risk factors among the patient sampleincluded:advancedcancer,lowhemoglobin,bonemarrowinvolve-ment,andcomorbiditiessuchasdiabetes.

Thisprojectinformedusastothenumberofpatientsinourprac-ticewhoexperiencedCINresulting indosedelaysordose reduc-tionsandcongruenceofriskfactorsthatimpactourpatientpopula-tionwith those in theoncology literature.Theproject focusedonapopulationthatistypicallyunderserved,thuscontributingtoourunderstandingoftheidentifiedriskfactorsinadiversepopulation.FuturedirectionsincludeinitiativestoimplementariskassessmenttoolandRDIcalculationinourpracticesetting.2109UTILIZATION OF VACUUM ASSISTED CLOSURE (V.A.C.) THERAPYIMPROVES QUALITY OF LIFE IN THE ONCOLOGY POPULATION.Elizabeth Grahn, RN, BSN, OCN®, Umme Ahmed Aleya, RN, BSN,HalinaBenenati,RN,BSN,TraceyLiucci,RN,BSN,OCN®,andLor-raine Solomon, RN, BSN, Memorial Sloan-Kettering Cancer Center,NewYork,NY.

Oncologypatientswithwoundsexperienceimpairedhealingduetochemotherapy, myelosuppression, immunosuppression, disease pro-cessesorradiation.UtilizationofV.A.C.therapysignificantlyimprovesqualityoflifeforoncologypatientswithimpairedwoundhealingabil-ity.Qualityof life improvements includedecreases inhealing time,bioburden, dressing change frequency and associated pain. V.A.C.

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therapyispalliativelyusedtocontaincopiousdrainage,decreasepainandincreasepatientindependence.Uniqueadvantagesintheoncologypopulationincludeimprovedcaregiverwoundmanagementability,fa-cilitationofwoundhealinginpreviouslyirradiatedareasandmanage-mentofdrainagefromwoundsencompassingdisease.

ThepurposeofV.A.C.therapyistofacilitatehealing,remove,di-vertandcontaindrainageandcontrolodor.Itisaclosedsystemthatusescomputercontrollednegativepressureandreplacestraditionalwettomoistdressingswithspecializedfoams,anocclusivedress-ingandacloseddrainagesystem.Itreducesbioburdenandhelpstodecreasecomplicationsintheimmunosuppressedoncologypatient.It can significantly decrease frequency of multiple daily dressingchanges and completely contain drainage allowing oncology pa-tientsgreatercomfortandmobility.

Once appropriateness ofV.A.C. therapy is determined and it isinitiated, nursing care includes removal, cleansing, and reapplica-tionofspecializedfoams,dressingsandapplianceseveryotherday.Increased reapplication frequency may be required with infectedwounds.Systemsmustbemonitored toensure the integrityof theocclusivedressingandapplicationoftheprescribedpressuresetting.Drainagemonitoringisalsonecessary.AtthisNCIdesignatedcom-prehensivecancercenter,woundcarenursesimplementV.A.C.ther-apyaccordingtoprescribedorders.Thesenursesassesseachwound,apply and manage systems. They educate nursing staff regardingmonitoringandmanagementofV.A.C.therapysystems.Theyactasclinicalresourcestocolleagues.

Wounds are assessed prior to therapy implementation and witheachremovalandreapplication.Woundsaremeasuredatinitiationoftherapyandatweeklyintervalsthereafteruntildiscontinuationtodeterminetreatmenteffectiveness.Patientcomfortandqualityoflifeissimilarlyassessedforsuccessoftherapy.

Inconclusion,V.A.C.therapyprovidesanopportunitytoimprovethecomfortandqualityoflifefortheoncologypatientandfacilitateshealingofwoundsuniquetothispopulation.

2110VALIDATIONOFRISKASSESSMENTINANUNDERSERVEDPATIENTPOPULATIONWITHCHEMOTHERAPYINDUCEDNEUTROPENICFE-VER.SandraVannice,RN,MSN,AOCN®,andJodiLuddington,RN,DenverHealthMedicalCenter,Denver,CO.

Researchhasshownthatdosedelaysanddosereductionsleadtoadecreasedrelativedoseintensity(RDI)effectingoverallsurvivalinsomecancerpopulations.Riskfactorsforneutropeniadocumentedintheoncologyliterature,andguidelinesforadministrationofhema-topoieticgrowthfactor,canguidepractitionersinearlyidentificationofpatientswhomayneedprophylacticgrowthfactortomaintainanoptimaltreatmentschedule.Inspiteofcurrentevidence,manyprac-titionersdonotutilizeriskassessmentidentificationtoguideclinicaldecisionsandpractice.

Todetermineifpatientsadmittedforhospitalmanagementofneu-tropenicfever(NF)hadriskfactorsthatcouldhavebeenidentifiedthroughtheuseoftheNeutropenicRiskAssessmenttool.

Thisprojectwascarriedoutinanurbanteachinghospitalserv-ingapredominantlyindigentpopulationthathasahighnumberofHispanicpatients.Througharetrospectivechartreview,25cancerpatientsadmittedforneutropenicfeverduring2004wereidentifiedbyamedicalrecordquery.Medicalrecordswereindividuallyre-viewedtoensureadiagnosisofcancer.DataontheadministrationofG-CSF, treatmentdelaysand/ordosereductions in thesamplewasgathered,andIndividualriskfactorsforCINwereidentifiedusing theNeutropeniaRiskAssessment tool developedbyWolf,Crawford,&Dale.

Findings reveal a relatively young population (mean = 48 yrs.),predominantlyHispanic(79%),whoutilizedprimarilyMedicaidorMedicareasapayersource.Themostfrequentlyoccurringriskfac-torsincluded:doseintensivetreatment,activetissueinfection,bonemarrowinvolvement,lowbaselinehemoglobin,andpreexistingneu-tropenia.TheaverageANConadmissionwas400mm3and43%ofthepatientsreceivedgrowthfactor.

Althoughthesmallsamplesizelimitsthegeneralizabilityofthesefindings, thisprojectdoes informusofourpatientpopulationandpracticepatterns.DeterminingwhichriskfactorsapplytoouruniquepatientpopulationwillenableustobettermanageourpatientswithCINandpotentiallyimpacttheiroutcomes.Thisprojectaffirmsthevalueof risk factor identificationandcollaborationwithprovidersontheuseofgrowthfactor.Additionally,itenforcestheneedtocon-tinueongoingresearchinanunderservedHispanicpopulationwithuniqueneeds.

2113ADMINISTRATIONOFCHEMOTHERAPYACROSSTHECONTINUUMOF CARE: BUILDING NURSING COMPETENCE IN A LONG TERMACUTE CARE FACILITY. Elaine Kelley, RN, OCN®, and Erika Rosa-to,RN,MHA,OCN®,YouvilleHospital,Cambridge,MA;andSusanFinn, MSN, RN, AOCNS, Joanne P. LaFrancesca, MN, RN, AOCN®,andDonnaPerry,RN,PhD,MassachusettsGeneralHospital,Boston,MA.

High acuity can make a plan for discharge home from an acutecare facility unrealistic for many oncology patients. Long TermAcuteCareHospitals(LTAC)providethepotentialforsymptomandmedicalmanagementwithafocusonrehabilitationandindividualidentificationofshortandlongtermgoals.Inordertomeetthecom-plexneedsoftheoncologypopulation,innovativemethodsmustbesoughtout toprovide for thecontinuumofcareof thesepatients.Transport of a patient by ambulance back to the acute setting forchemotherapy administration canbe an exhausting and at times apainful trip for the patient. It also incurs significantly higher costthanifthepatientisabletoreceivethischemotherapyadministrationduringtheirstayintheLTACsetting.

Buildingaprogramthat isabletoaccommodatetheseimportantpatient needs involves the development of an educational nursingprogramthatfacilitatessafepracticeforchemotherapyadministra-tion.Inordertoachievethis,aneducationalplanwasdevelopedinconjunctionwithanacutecarefacility.

NursesfromtheLTACsettingattendanONScertifiededucationalprogramforchemotherapyadministration.Oncethisportioniscom-pletedthesenursesarethentrainedonanout-patientchemotherapyinfusionunit.Conceptsandfollowthroughofsafehandling,admin-istrationandeducationarereviewedanddemonstratedwithapre-ceptorattheout-patientchemotherapyinfusionunit.

Eachnurse isevaluatedonthe infusionunit forcompetenceandthenreturnstotheLTACsetting.EvaluationandsafeadministrationofchemotherapyperhospitalpolicyisverifiedandongoingbytheNursePracticeLeaderand/orProgramDirector.

Administrationofchemotherapyandsubsequentmanagementofsymptomsisonlyoneaspectofbuildingacompetentprogram.Thedevelopmentofthisaspectnotonlyhelpsmeetthepatientneedsbutalsocreatesanenvironmentofongoingeducationandchallengefornurses.Theresultisstaffnurseretention,jobsatisfactionandpatientsatisfaction.

2114INFECTIONCONTROLANDPREVENTIONINTHEONCOLOGYPOPU-LATION:DEVELOPINGANINFECTIONCONTROLRESOURCENURSE

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PROGRAM.LisaRoman,MSN,RN,OCN®,andLauraMulderrig,BSN,RN,OCN®,FoxChaseCancerCenter,Philadelphia,PA.

Oncology patients become immune-compromised due to one ormoreflawsinbodilyintegrity.Someoftheseflawsincludedefectsinskinandmucousmembranescausedbymedicaltreatment(i.e.sur-gery,radiation,chemotherapy),trauma,smoking,invasivecatheters,and/orpoorhygiene.Defectsmayalsobecausedbyobstructivecon-ditions (tumors, calcifications), abnormalnumberofgranulocytes,abnormalcell-mediatedimmunity,andsedationorcentralnervoussystemdysfunction.Opportunisticinfectionsmayariseasaresult.Anumberofmeasuresshouldberoutinelyimplementedtopreventin-fections.Theoncologypatientcanstrengthendefensesbypracticinggood dental care, not smoking, following treatment recommenda-tions,performinghandhygiene,keepingimmunizationsup-to-date,maintaininggoodnutrition,engaginginphysicalconditioning,andreceiving psychosocial support. Oncology nurses can help protectthe immune-compromisedpatientbypracticingeffectivehandhy-giene,cleansingthepatient’sskinantisepticallywheneveritmustbebreached,strictlyfollowingtransmission-basedisolationguidelines,andrestrictingvisitorswithcommunicablediseases.

Based on assessment of a need to incorporate current infectioncontrol and prevention standards for use by the bedside practitio-ner,aninstructionalprogramtodevelopInfectionControlResourceNurse(ICRNs)leaderswasproposed,planned,andimplementedatthisNCI-designatedcancercenter.

Utilizing evidence-based guidelines from the Centers for Dis-ease Control and Prevention (CDC),Association of ProfessionalsinInfectionControl&Epidemiology(APIC),andtheInstituteforHealthcareImprovement(IHI),aneducationalcurriculumwasde-velopedbyan infectioncontrolpractitionerwho isalsoanoncol-ogy-certifiedregisterednurseforoncologynurseswithaninterestininfectioncontrolandprevention.

The curriculum objectives included describing the interaction be-tweenagent,host,andenvironment,aswellasmodesoftransmission,whichpromotethechainofinfection;reviewingstandardandtrans-mission-based precautions; reviewing types of opportunistic infec-tions;discussingantimicrobial therapyandemergingresistance;ex-ploringthepurposeandbenefitsofmicrobiologyculturesurveillance;promotingpatientsafetyinitiatives;andlistingpatient/familyeduca-tionstrategies.Nursesfromeveryinpatientandoutpatientareaofthecenterparticipatedin the inauguralcore trainingdaysessions.Withspecializedtrainingandcontinuingeducationalopportunities,ICRNswill improve identificationofpatientsat risk for infection, improvequalityofcare,andreduceorpreventtheincidenceofinfections.2116CARE DELIVERY ALGORITHM FOR ALTERED FAMILY DYNAMICS.Mary Lohmann, RN, and Mary Cline, MSN/MPH, APRN, BC-PCM,AOCN®,UniversityofTexasM.D.AndersonCancerCenter,Houston,TX.

Oncologynurses,intheacutesetting,careforveryillpatientsandtheirfamilymembersonadailybasis.Someofthesepatientsexperi-encelongandcomplicatedhospitalstays.Providingqualitycarecanbeextremelychallengingwhenfamilydynamicsareadisruptiontotheprovisionanddeliveryofcare.Familydynamicsinafamilywithahistoryofpoorcopingskillscanbeexacerbatedbyhospitalization;andwithinthiscomplexdynamicnursingmustbeabletodevelopaplantoprovideeffectivecare,decreaseanxietyandburn-outamongstaffmembers,increasepatientandfamilysatisfaction,andfacilitatepositivecommunicationbetweenthestaff,patient,andfamily.

Literatureondifficultfamilydynamicsandconflicthasidentifiedkeybehaviorsofsuchfamilies:demandsforfutilecareorunneces-

sarymedicalinterventions,tyrannicalabsenteefamilymember,in-creasingdemandsandphonecalls,splittingofstaff,verbalabuseofstaff,and increasedstaffanxiety.By identifying thesebehaviorsastaffingpatternutilizingcaredeliveryalgorithmwouldbedevelopedthatwould individualizepatient carewithin the contextof alteredfamilydynamics.

Thecaredeliveryalgorithmwouldbeinitiatedearlyinapatient’sadmission.Interventionswouldinclude,butnotbelimitedtothefollowing:patientassignments tobestructuredbasedon thepri-marycaredeliverymodeltoprovidecontinuityofcareandpreventthe splittingof staff by the family; alignmentof treatmentgoalsbetweennursingandthemedicalteam;increasedcommunicationamong the medical and interdisciplinary team, and nursing staffincoordinationofcare;andlimitsettingofthefamily’sdisruptivebehaviors.

Evolutionofthecaredeliveryalgorithmwouldbehighlyindividu-alizedduetothecomplexityofdifferentpatientsandfamilydynam-ics.Thenursingstaffwouldmeetweeklyforeducationanddiscus-sion regarding the case.The staffwould alsomeet post-dischargefordiscussionanddebriefingofthecasesoanyalterationscouldbemadetotheplantobettermanageidentifiedpatientsandfamiliesinthefuture.

2117THEONCOLOGYNURSE’SROLEINCARINGFORTHEPATIENTWITHHEREDITARYNONPOLYPOSISCOLORECTALCARCINOMA.DanielleDevita,RN,BSN,MA,MemorialSloan-KetteringCancerCenter,NewYork,NY.

HereditaryNonPolyposisColorectalCarcinoma(HNPCC) isanautosomaldominantinheriteddisorder,characterizedbyearlyonsetcoloncancerandisassociatedwithanincreasedlifetimeriskofen-dometrial,ovarian,andgastriccancers,tonameafew.Individualsandtheirkin,whoareidentifiedascarriersofthisgeneticmutation,havealifetimeriskofcoloncancerashighas82%.Thesecondmostcommon malignancy reported is endometrial cancer. Consideringthelargenumbersofpatientswhoareaffectedwithbothcolorectalcancerandendometrialcancereachyear,thereisthepotentialforasubstantialamountofpatientswhomayhaveageneticmutation.Asthefieldofgeneticsbecomesmoreestablished,theoncologynursehasanincreasedresponsibilitytounderstandgeneticsyndromessothattheycanidentifyatriskpatients,educateaccordinglyandantici-pateappropriateplansofcare.

ThispresentationwilldescribethecharacteristicsofHNPCCsyn-drome,theassociatedmolecularmutations,relatedcancerrisks,ap-propriatesurveillancealgorithmsandtheimplicationsforoncologynursingpractice.

Oncologynursesareinakeypositiontoidentifypatientswhopres-entwithasignificantfamilyorpersonalhistorythatmaysuggestanunderlyinggeneticsyndrome.Onceidentified,patientsarereferredtoageneticsexpertwhowilldeterminetheneedforgenetictesting.IfgenetictestingconfirmsHNPCC,thepatientisplacedonasur-veillanceprogram.Incollaborationwiththepatient’scareteam,theoncologynursecaneducatethepatientregardingtherationaleandpreparationforscreeningprocedures,facilitatereferralsandprovidepsychosocialsupport.

Earlyidentificationofpatientsandfamilymembersatriskisacru-cialfirststepinhelpingtoreducemorbidityandmortalityassociatedwithHNPCC.

Intoday’shealthcareenvironment,thefieldofgeneticsisprovid-ingnewopportunitiesforscreeningandearlydetection.Oncologynurses are at the forefront to educate and care for these patients,potentiallyresultinginmorepositivepatientoutcomes.

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2118HANYSMODELAPPLICATIONINRURALBREASTCANCERSCREEN-ING PROGRAMS. Adrianne Lane, BSN MSN, EDD, and MadeleineMartin,EdD,RN,C,UniversityofCincinnatiCollegeofNursing,Cin-cinnati,OH.

Maximizingthepercentageofwomenwhoovercomebreastcanceriscurrentlydependentonroutinebreastcancerscreening—anactiv-itywhichcanbeenhancedbyoncologynurses.Ruralwomenareparticularly at risk because they frequently do not take advantageofscreeningmethodsthatarereadilyavailabletotheirurbancoun-terparts.Economic factors, socioculturaldifferences, and isolationof living in more remote areas combine to impede screening andhealthpromotionforruralpopulations.EightypercentofuninsuredUS individuals are full-timeworkersordependents.Remote ruralresidentsarelesslikelytohavehealthbenefitsthanurbanworkersbecausetheyaremorelikelytoearnlowerwagesandtoworkforsmallbusinesseswith feweremployeesmakingcoveragecostsbyemployersprohibitive.

The purpose of this project was to provide breast health educa-tionandaccesstonocostbreastcancerscreeningtorural,lowin-come,medicallyunderservedwomen.TheHANYSModelprovidedaframeworkfordevelopinganEmployeeMammographyIn-Reachprogram.AnIn-ReachProgramcanofferacosteffectivemethodtoreachsubstantialnumbersofwomenforbreastcancerscreeninginrural areas. Literature does not support that rural employers havebeeninvolvedinbreastcancerscreeningprogramsorthattheHA-NYSModelhasbeenusedoutsidelargeurbaninstitutions.

Thegoalsoftheprojectwereto:1)providebreasthealtheducationandaccesstonocostmammographyscreeningtorurallowincomewomen,2)useanEmployeeIn-Reachmodeltoprovidethisprogramtofemaleemployeesinlocalbusinessesand3)providesustainabil-itybyeducatingabusiness-basedbreasthealthresource.ApplyingtheHANYSModel,nurses from theSoutheastern IndianaCancerHealthNetwork(SEICHN)collaboratedwiththreesmallbusinessesintworuralcommunitiestoprovidebreastcancereducationandfreescreeningtoemployees.

Resultsindicatedthatover4/5’sofallfemaleemployeespartici-pated.IneachbusinessabreasthealthcontactpersonwaseducatedforprovidingongoingbreasthealthsupportandensuringanongoinglinkwithSEICHN.

Basedonoverwhelminglypositiveprojectevaluationbyemploy-ers,employees,andnurses,theHANYSModelisrecommendedtooncologynursesforconsiderationinplanningcancerscreeningpro-grams.

2120THEIMPACTOFDIETARYRESTRICTIONSONTHERISKFORINFEC-TIONINTHENEUTROPENICONCOLOGYPATIENT.LindaMoeller,RN,BSN,LindaAbbott,MSN,AOCN®,CWON,DebBohlken,RN,OCN®,andLauraSuchanek,RN,MA,AOCN®,Universityof IowaHospitalsandClinics,IowaCity,IA.

Myelosuppresivechemotherapyisthegoldstandardintreatingon-cologypatients.Neutropenia is an anticipated consequenceof thetreatment. In an effort to protect patients from infection, “neutro-peniaprecautions”areoftenimplemented.Onecomponentofneu-tropeniaprecautionsistorestrictthepatient’sintakeoffreshfruits/vegetables.

Thepurposeofthisprojectwastodetermineifevidencesupportsrestricting patient’s intake of fresh fruits/vegetables to prevent in-fection.AliteraturesearchwasconductedintheSpring,2005andrevealedthatdietcannotbedirectlylinkedtotheincidenceofblood-streaminfections.Researchsuggeststhatsafefoodhandling/prepa-

rationismorelikelytoreducefoodborneinfectionthanrestrictionsoffreshfruits/vegetables.

TheIowaModelofEvidence-BasedPracticetoPromoteQualityCarewasutilized.Strategiesinclude:1.)Formingamultidisciplinaryteam2.)UseofanOpinionLeader3.)Educatingnursing,medical,anddietarystaff4.)Obtainingbuy-infromkeystakeholders5.)Pi-lotingthepracticechangeonaclinicalunitand6.)Modifyinghospi-talpolicies.Proposedpracticechangesinclude:1.)Implementationofaneducationprogramfornursing/medicalstaff;2.)Restrictionofonlyselectfoods;3.)Educationofpatientsaboutsafefoodhandling/preparation;and4.)Modificationofneutropeniaprecautionspolicy.

Bloodstreaminfectionratescomparedbeforethepracticechangeandforayearaftershowedtherewasnoincreaseininfectionratesfor patients.A patient education tool was piloted on the practicechangeunit.Patientinputwasincorporatedintothematerialmain-taininga6-8thgradereadinglevel.

ModificationofpolicyispendingandthepracticechangewillbeimplementedthroughoutCancerCenterandhospital.Bynotrestrict-ingfoodchoicesandallowingpatientsawiderrangeofsafefoodstochoosefromduringcancertreatment,patient’sQOL,performancestatus,andtreatmentoutcomeswillbepositivelyimpacted.

2121ENDOFLIFEEDUCATIONFORREGISTEREDNURSESINACOMPRE-HENSIVECANCERCENTER:ISITANECESSARYCOURSE?ElizabethOwens,RN,MS,andElizabethLenegan,PhD,RoswellParkCancerInstitute,Buffalo,NY.

PreviousNursingResearchhasdemonstrated that there is insuf-ficient education to prepare practicing nurses who provide end oflifecaretopatientswithaterminaldiagnosis.Resultsfrompreviousstudieshaveshownthatnursesdonotreceiveeducationalprepara-tiontoadequatelyassistthepatientandorfamily.

Nursescaringfortheterminallyillareoftennoviceswithlimitededucationalopportunitiesorpreparation.According tonursing lit-erature,thehelpnurses’provideinpreparingthepatientsandfami-liesfortheprocessofdyingisextremelyimportant.TheAmericanAssociationofCollegeNurses(AACN)administersanationaled-ucation initiative to improveend-of-life care in theUnitedStates.Thatproject providesundergraduate andgraduatenursing faculty,CEproviders,staffdevelopmenteducators,specialtynurses inpe-diatrics,oncology,criticalcareandgeriatrics,andothernurseswithtraininginend-of-lifecare.OnemightassumethatnursesworkinginaComprehensiveCancerCenterwillbecaringforterminallyillpatients and will not have received the educational preparation intheirnursingprogram.

AstudywasconductedataComprehensiveCancerCenter to1)evaluateexistingeducationalpreparationforregisterednursescar-ing forpatientsdiagnosedwitha terminal illness,2) toassess theknowledgeandattitudesaboutnurses’perceptionsoftheirownskillsatcaringforpatientsdiagnosedwithaterminalillnessand3)deter-minetheneedforincludingend-of-lifecareinnursingorientation.

Thisstudyutilizedadescriptivesurveydesign.Abstractedinforma-tionwill include lengthof licensureasaregisterednurse, lengthofemploymentatRPCI,highestlevelofeducationcompleted,aswellasdocumentationofindividualperceptionsrelatedtoendoflifecare.

Thispresentationwillprovidetheresultsofthissurveyandapre-sentationoftheeducationalinitiativesdesignedandimplementedtoaddressneedsidentifiedbythesurvey.2122THE MEDICAL-SURGICAL NURSES’ EXPERIENCE IN THE OPERAT-INGROOMIMPACTSPATIENTCAREANDMD-RNCOLLABORATION.D

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AllegraJackson,RN,BSN,MBA,CNOR,M.D.AndersonCancerCen-ter,Houston,TX.

Treatmentofsurgicaloncologypatients includesprocedures thatrequireextensivedebulkingofcomplextumors,lysisofadhesions,extensivereconstruction,andsubsequentbleedingbecauseofche-motherapy/radiationpriortosurgery.Asaresultsurgicaloncologypatientsarepredisposedtomultiplepostoperativecomplicationsre-quiringhighacuitycareandobservation.Perioperativeexperiencecan increase medical-surgical nurses’ understanding of requiredpostoperativeassessmentmaximizepatientoutcomes,andaddvaluetotheRN-MDrelationship.

Thepurposeoftheprojectwastoprovideanopportunityfornurseswho provide postoperative care to surgical gynecologic oncologypatientstoobservepatientcareinthesurgicalsetting.Thisbenefitsthepatient, nurse, andattendingphysicianby supportingRN-MDcollaboration and enhancing the nurses’ understanding of how tocareforthepatientpostoperatively.

Nurses were scheduled one day long rotation in the operatingroom. While there they interacted with members of the surgicalteamandassistedwithpatientcare.Physicianswalkedthemthroughproceduresandexplainedastheywentalong.Attheend,thenursefollowedthepatienttothepostanesthesiacareunit,andultimatelycaredforthepatientonthesurgicalunit.

A questionnaire was used to measure if learning concepts weremetandobtainnurses’ feedbackon theoverall experience.Open-endedquestionsprovidedopportunityfornursestoexpresshowtheexperiencebenefited theirpractice,andaffected their rapportwithmedicalstaff.

Nursesreportedbeingenlightenedabouthowinvolvedtheproce-duresare,andwhatthephysiciansgothroughintheoperatingroomtodeliverqualitycare.Manynursesreportedhowtheyappreciatetheimportanceofpaincontrolafterseeinghowpatientsaremanipulat-ed.Theyfeltmorecompetentincaringforandassessingwoundsanddrainssincetheywereabletoseewhereandhowtheywereplaced.Dialoguesthatbeganbetweenphysiciansandnursesintheoperat-ingroomcontinuedthroughoutthepostoperativephase.Nursesfeltasthoughthephysiciansweregenuinelyinterestedincollaboratingwiththemandregardedthemascompetentprofessionals.Anoperat-ing roomexperience increases themedical-surgicalnurses’under-standing of postoperative care and encourages a positive RN-MDrelationship.Allofwhichmaximizespatientoutcomes.

2126THYROIDECTOMY:THEAMBULATORYNURSE’SROLEINPREVENT-ING LONG-TERM SEQUELAE. Jill Solan, RN, MS, ANP, OCN®, andJanetMcKiernan,RN,BSN,OCN®,MemorialSloan-KetteringCancerCenter,NewYork,NY.

In2006therewillbeover30,000newcasesofthyroidcancer.Themostcommontypesarepapillaryandfollicular.Smallencapsulatedcancerscarryanexcellentprognosis,withthyroidectomythemain-stay of treatment. Consequences of treatment include short-termhypoparathyroidism,whichcancausehypocalcemia,andlong-termlossof thyroid function.Calciumandhormone replacement ises-sential tomaintainmetabolic stability.Ambulatorynursesplay anintegralroleinmonitoringlabsandeducatingpatientshowtoadjusttheirdoses topreventhypo/hypercalcemiaandhypo/hyperthyroid-ism.

Thisabstractwillreviewtheendocrinefunctionsoftheparathyroidand thyroid glands and discuss the nurse’s role in collaborativelymanagingcalciumandhormonereplacement.

Serumcalciumlevelsareobtainedtheeveningandfirstmorningafterthyroidectomy.Intravenousororalcalciumtabletsareadmin-

istereddependingontheseverityofhypocalcemia.Labsaremoni-toredregularlyandpatientsareinstructedtoreportsignsandsymp-toms of hypo/hypercalcemia. Calcium doses are adjusted accord-ingly.Patientsarealsoinformedoftheneedforlifelongthyroxinereplacement.Thyroidfunctiontestsandthyroglobulinareobtained6 weeks after surgery. The nurse communicates the blood resultsto thesurgeonandendocrinologist todetermine theneedfordoseadjustment.ThyroxinedosewillbebasedontheleveloffreeT4andthyroidstimulatinghormone(TSH).Thedoseisadjustedtopreventhypo/hyperthyroidismand tosuppress thepituitary fromreleasingTSH which could stimulate the development of recurrent disease.Bloodworkisrepeatedin4to6weekseachtimethedosageofthy-roxinehasbeenadjusted.Patientsareinstructedtoreportsignsandsymptomsofhyper/hypothyroidism.Thyroglobulinlevelsastumormarkersarealsomonitoredregularly.

Ambulatorynursesplayakeyroleinthelong-termmanagementof patients post-thyroidectomybymonitoring labs and instructingpatientsaboutneededreplacementtherapies.

Thyroidectomyisaneffectivetreatmentforpapillaryandfollicu-lar thyroidcancer.However, it isnotwithoutrisk. It is imperativethatnurseshavesufficientknowledgetocollaboratewithmultidisci-plinestoensuresurvivorsresumetheirlifewithoutlong-termeffectsoftheirtreatment.

2128THE IMPACT OF PSYCHOSOCIAL SUPPORT ON REHABILITATIONOUTCOMES OF TWO PATIENTS AFTER EXTERNAL HEMIPELVEC-TOMY.BethYoung,RN,FNP,MN,OCN®,AOCN®,andConnieLeDay-Jacobs,MSW,M.D.AndersonCancerCenter,Houston,TX.

Despitemajoradvancesinchemotherapyandlimbsparingsurgery,externalhemipelvectomyremainstheoptimalsurgicalinterventionforhighgradeandmetastaticsarcomasoftheupperthighandbut-tock. Post-operatively, patients who undergo this procedure mostoftenrequireacomprehensiveinpatientrehabilitationcoursetoim-provestrength,preserverangeofmotion,optimizepainmanagement,andcontrollymphedema.Althoughmuchresearchhasbeenreportedonpost-operativecomplicationsandlong-termsurvivalratesofin-dividualsafterexternalhemipelvectomy,littlehavenotedtheimpactofpsychosocialsupportinpredictingfunctionaloutcomes.

In this case report, we present contrasting rehabilitation coursesoftwoexternalhemipelvectomyfemalepatientswithsimilardemo-graphics,butvaryingdegreesofpsychosocialsupportcontributingtodramaticallydifferentfunctionaloutcomes.

Bothpatients (AA,BB)underwent external hemipelvectomy sec-ondarytohigh-grademetastaticsarcomaofthepelvis.Postoperative-ly,AAandBBweremedicallystablewithmusclestrengthofthethreeremaining extremities intact. Four identified psychosocial variableswhichgreatlyinfluencedthefunctionaloutcomesofthese2patientsincluded:(1)extentofpatient’ssocialsupportsystem,(2)effectiveuseofeffectivecopingstrategies,(3)patient’soverallsenseofwell-being/qualityoflife,and(4)managementofphysiologicalsymptoms.

AAwhohadanexcellentsupportfromfamily,churchandfriends,as well as, a positive attitude regarding her rehabilitation and re-covery,madeexceptionalfunctionalgainsduringher14-dayreha-bilitationcourse.Atthetimeofdischarge,shewasabletoambulate200 feet with minimal assistance with a Functional IndependenceMeasure(FIM)gainof36.BBhadalimitedsupportsystemandex-periencedmultiplegrief/lossissuesrelatedtoherhemipelvectomy.Throughouther rehabilitationprogram,BBwasunmotivatedwithlittle participation in physical and occupational therapy.After her14-dayrehabilitationcourse,shestillrequiredtotalassistancewithambulationandhadaFIMscoregainof18.

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These 2 cases indicate the important influence of psychosocialfactorsonfunctionaloutcomes.Oncologynursesshouldincludeanassessmentofpatient’spsychologicalandsocialsupportinformulat-ingtheirplanofcare.

2130CONTENT VALIDITY OF THE PAIN AND NURSING CARE QUALITY(PANCQ)SURVEY.SusanBeck,APRN,PhD,AOCN®,FAAN,andPa-triciaBerry,PhD,APRN,BC-PCM,UniversityofUtahCollegeofNurs-ing,SaltLakeCity,UT;JeannineBrant,RN,MS,AOCN®,St.VincentHealthcare,Billings,MT;EllenSmith,MS,APRN-BC,AOCN®,NorrisCottonCancerCenter/DartmouthHitchcockMedicalCenter,Lebanon,NH;andGailTowsley,MS,UniversityofUtahCollegeofNursing,SaltLakeCity,UT.

Research todocument the impactofoncologynursesonpatientoutcomes,suchaspain,isanONSpriority.Asignificantbarriertosuch research is the inability toeffectivelymeasure thequalityofnursingcare.Themostcommonapproach,measuresofpatientsatis-faction,tendtobeglobal,e.g.overallsatisfactionwithnursingcareandareusuallytemporallyframedwithintheentirehospitalstay.

ThepurposeofthisstudywastoestablishthecontentvalidityofthePaNCQsurvey.Theultimategoalistodevelopasimplemeasureofthequalityofnursingcarerelatedtopainmanagementattheendof a nursing care shift in the acute care setting.This report sum-marizesdevelopmentalandjudgmentalphasesofexaminingcontentvalidityofthePaNCQ.

In thedevelopmentalphase,qualitativeanalysisofdata from34patientinterviewsyieldedanitempool(n=102)reflectingconceptsidentifiedbycancerpatientsasimportanttopainmanagementqual-ityofcare:beingtreatedright,safetynet,efficacyofpainmanage-ment,andpartnershipwiththeinterdisciplinaryteam.

Membersoftheresearchteamindividuallyratedtherelevanceofeachitemandcollectivelyagreedtodelete19items.PaNCQVersion3,consistingof88items,wasthenreviewedbyninenationalpainmanagementandnursingcarequalityexperts.Weuseda4-optionratingscale(rangingfromnotrelevanttorelevantandsuccinct).

Applyingpublishedandacceptedcriteria,weestablishedcontentvaliditybeyondthe.05levelofsignificanceifatleast8of9expertsagreed the itemwasrelevantbutneededminoralterationor if theitem was very relevant and succinct.We took a liberal approach,meaningfewer itemswouldbedeleted.Basedontheexpertpanelsurvey itemsweredeleted, reworded,andadded;75 items remainwhichwillnowbetestedsystematicallyusingcognitiveinterview-ingandtheninalargemulti-sitesample.

2131DEVELOPMENT OF A NURSE COORDINATED EVIDENCE-BASEDSMOKING CESSATION PROGRAM IN A COMPREHENSIVE CANCERCENTER.MaureenO’Brien,RN,MS,CTTS-M,andSheilaKeaveney,RN,MA,NP-C,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Tobacco products cause more cancer deaths than any other car-cinogen,with155,000newcasesof tobacco-relatedcancersdiag-nosedyearly.Sincetherearenoreliablescreeningandearlydetec-tionmethodsformostofthesecancers,smokingcessationiscriticalto reducingcancermortality.Mostof thesepatientsaremotivatedtoquitatthetimeofdiagnosis,offeringthenursea“teachablemo-ment”tointervene.Theefficacyofnurse-ledcessationinterventionshasbeendocumented.

This abstract describes the development of a nurse-coordinatedsmokingcessationprograminacomprehensivecancercenter.

AnOncologyClinicalNurseSpecialistwaschosenbytheprogramdirector(psychologist)tocoordinatetheprogram.TheCNSwascer-

tifiedasaTobaccoTreatmentSpecialistaftergainingproficiencyinbriefmotivationalinterviewingandtreatingtobaccodependence&withdrawal.TheCNSmovedtostandardizetobaccousequestionsinallnursingassessmentformsinordertoprovideaneffectivepromptforreferralstotheprogram.Multiplechannelswereestablishedformakingreferrals,i.e.,email,in-person,andelectronicordersystem.Electronic initial assessment and treatment forms were created aspartofthepatient’smedicalrecord.Tofacilitateproperuseofsmok-ing cessation pharmacotherapies, guidelines were developed anddistributedtoprovidersandintegratedintotheelectronicmedicationordering system. The program staff created educational materialstailoredtotobacco-dependentcancerpatientsandtheirfamiliesandplacedtheminallclinics.

Each year, referrals to the Smoking Cessation Program havesteadilyincreased,with875referralsmadein2005.ThemajorityofreferralshavecomefromtheThoracic(30%),Head&Neck(14%),and Breast (10%) services.As the program needs grew, a NursePractitionerjoinedtheteamtoassistwithpharmacotherapyandre-ferrals.TheoncologyCNSandNPplaykeyrolesonthefrontlinesinproviding treatment tocancerpatientsand their familiesand inprovidingin-servicetrainingandgrandroundspresentations.

Currentlyunderwayareeffortstodocumenttheefficacyofthepro-gram,examinetheefficiencyofthereferralprocess,identifypatientcharacteristicsinfluencingcessationsuccess,andgenerateideasforprogramimprovement.

2134THECANCERSERVICELINE’SUSEOFSIXSIGMAINTHEHEALTHCARESETTING:CREATINGSTANDARDIZEDPROCESSESANDHELP-INGNURSESBECOMEMOREEFFICIENTWITHLESSWORKWHILEIMPROVING STAFF AND PATIENT SATISFACTION. Deborah Dydyk,BS,MA,BSN,RN,C,TheresaFranco,RN,MSN,andJasonLebsack,MA,NebraskaMedicalCenter,Omaha,NE.

Continuousqualityimprovementisacriticalcomponentinachiev-ingexcellenceinhealthcaredelivery.NursesfromourCancerSer-viceLinehadmaderepeatedattemptswithmixedresultstoaddresschallenges surrounding optimum patient flow, timely laboratoryspecimenhandlingandreporting,orderaccuracy,andcorrectbill-ing/reimbursementprocessesinalargeambulatorycancertreatmentcenter.Followingourinstitution’sapplicationofSixSigmaandLeanQualityImprovementmethods,nursingstaffbelievedithadthepo-tentialtofacilitatetheidentificationofchangesthatcouldbeimple-mentedandsustainedtoaccomplishourdesiredimprovements.

The purpose of Six Sigma measurement-based strategy focusesonprocessimprovementwithreductioninvariation.Thegoalistoprovidehighquality,costeffectivecarewhilemaintaininghighlev-elsofpatient/familyandstaffsatisfaction.TheSixSigmamodelofdefine,measure,analyze,improve,andcontrol(DMAIC)guidedtheimprovementprojectsforeachservicelinechallenge.

Aspectsof caredelivery thatwere examinedusing thisDMAICprocessincluded:schedulingpatientsinthetreatmentcenter,assur-ing the availability of accurate orders and lab data, standardizingdocumentationofcharges,andprocessinglabordersandspecimens.The goal of the projects was to standardize Cancer Service Linepracticeandmakethedeliveryofpatientcaremoreefficient,requir-inglessworkwithoutcompromisingqualityorpatientsatisfaction.

ClinicalprocessexpertsincludingRNs,techs,clerks,andmanagerswereselectedtoworkontheprojectteamstoassureinvolvementinallaspectsoftheDMAICprocess.TheSixSigmaprojectssuccess-fullydecreasedpatientwaitingtimeandimprovedflow,decreasedbillingreworkandimprovedreimbursement,andreducedlabspeci-men turnaround time and improved efficiency.The improvements

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helpednursesworkmoreefficientlywithoutcompromisingpatientcare.

OurinstitutionisanexampleofhowSixSigmacanbeusedwithinthehealthcare setting.ThispresentationcanhelponcologynurseslearnhowtousetheDMAICprocesstoimprovedeliveryofpatientcareintheirownclinicalsettings.Providingnursingstaffwiththenecessarytoolsandresourcestoimprovecareefficiencyandinvolv-ingthemdirectlywiththeidentificationandimplementationofsolu-tionshelpsimprovestaffandpatientsatisfaction.

2139IMPACT OF AN ONCOLOGY NURSING CRITICAL THINKING PROJ-ECT.SusanWestlake,PhD,RN,AOCNS,NancyDelzer,MBA,MSN,PattyO’Connell,BS,BSN, andPatriciaQuinn-Casper,MSN,MAPS,ColumbiaSt.Marys,Milwaukee,WI.

Theabilitytothinkcritically,andsensitively,isanessentialcom-ponentof competentoncologynursingpractice.The impactof aninnovativeprojectdesigned to fostersuch thinking isexamined intheone-yearevaluationdatafrom90nurses.Theenduringinfluenceofthecriticalthinkingexperienceishighlightedandimplicationsforoncologynursingpracticearediscussed.

Thepurposeoftheprojectwastoenhancecompetencyincriticalthinkingandfosterchangeinclinicalpractice.

Smalldiscussiongroupsofinpatientandoutpatientnurses,facili-tatedbyclinicaleducators,criticallyanalyzedavideotapecompiledfrominterviewswithsixoncologypatients.Thepatientshadbeenaskedtodescribetheirexperienceoflivingwithcancer.TheONS14high-incidenceproblemareasprovidedtheframeworkfororga-nizing the interview excerpts, and video collages were developedto support a 4-year clinical education plan. Brief biographies andtreatmenthistorieswereusedtoframeeachpatient’sexperience.Afacilitatorguidewasformulatedspecifictodiseasepathophysiology,diagnosticwork-up,staging,psychosocialadjustment,andtreatmentregimensandtheircomplications.Evidence-basednursingstrategieswere stressed. The nurses shared clinical anecdotes, insights, andlearningwithcolleaguesastheyreflectedontherichdimensionsofpatientandfamilyexperienceportrayed.The2-hourmodulecreatedauniqueopportunityfornursestotranslatepatientexperiencesintonewclinicalrealities.

Evaluationdatawereobtainedimmediatelyafterandatoneyearfollowingthesessions.Scaledself-reportresponsesindicatedthesessionspositivelyaffecteddailypracticethroughenhancedcom-municationskillsandoncologyknowledge,strengthenedrelation-shipswithcolleagues,andimprovedpatientandfamilyteaching.Themesofenhancedsensitivitytopatientandfamilyexperience,abroadenedoncologyknowledgebase,andaheightenedsenseofself-confidenceandesteemforcolleaguesemergedfromthequali-tativedata.

Theuseofadidacticmethod,groundedinpatientstories,providesanengagingandnon-threateningopportunity fornurses toexperi-encesharedlearning.Criticalthinkingisenhancedwhenitisbasedin clinical reality and directly applicable to each nurse’s practice.This innovativeapproachof thoughtful clinical inquiry is relevantforalldimensionsofoncologynursing.2140GROWINGOUROWNINONCOLOGYNURSING.CarolMcCann,RN,MSN,OCN®,TriplerArmyMedicalCenter,Honolulu,HI;andJoanneItano,RN,PhD,OCN®,UniversityofHawaii,Honolulu,HI.

ONSstatesthat“nursesmusthelpattractindividualsintocareersinnursing”.Thenursingshortageandthe“graying”ofnurseswillimpactthequalityofcomprehensivecancercare.Thereisalsokeen

competition among nursing specialties for the scarce resource ofnurses.Mentoringisaprovenstrategytoattractandretainnurses.Thepurposeistodevelopamentorshipprogramforseniorstudentnursestorecruitthemintooncologynursing.

Ten nursing students participated in the 9-month program; 70%were from ethnic minorities. Mentors were ONS volunteers from4 community agencies.The students were required to complete aminimumof10activitiesplannedwiththeirmentor.Advocacywasanimportanttheme;menteesjoinedONSSTATandparticipatedine-mailadvocacy.TheywerewarmlywelcomedintotheONSfamily,recognized at dinner meetings and the local ONS conference andpresented certificates at the completion of the program. Menteeswho completed all requirements are eligible for a grant to attendthe2007Congresswheretheprojectcoordinatorswillcontinuethementoring.

The project was supported by a national ONS Chapter SpecialProjectFundingandagrantfromHawaiiASCO.

90%ofthestudentscompletedtheprogram.Ananalysisoftheirlogsindicatedawiderangeofactivitiesandpositiveimpactonthementees(“TheONSmentorshipprogramhasmademeconfirmthatoncologynursingiswhereIwanttobe”).Asix-monthfollowupwillassessthefinalimpactofthismentorshipprogram.

Oncologynurseswereabletogivebacktotheprofessionandsharetheirpassionaboutbeinganoncologynurse(“Beingamentorisagreatwaytohelpcreatealegacyandgivebacktoaprofessionthathasgivenmesomuch.”).

Menteeswere able to networkwithpotential employers and thecommunityofoncologynursing.HawaiiASCOhaspartneredwithONStosubmitaproposaltocontinuethisprogrambasedonitssuc-cess.NewmemberstoboththelocalandnationalONSwererecruit-edandwebelieveattendingCongresswillprovideaninspirationalandprofessionalalteringeventformentees.

2143CANYOUHEARMEYET?THE IMPORTANCEOFEFFECTIVECOM-MUNICATIONINHEALTHCARE.MoniqueWillingham,RN,BSN,andTimothyEden,RN,BSN,JohnsHopkinsHospital,Baltimore,MD.

SBAR (situation, background, assessment, recommendation), isaformatforsystematiccommunicationmodeledafteraviationandmilitarycommunicationhand-offs.Current literature supports thatorganizedcommunicationinhealthcareisessentialhowever;nofor-maltrainingorastandardhasbeendocumented.TheJointCommis-siononAccreditationofHealthcareOrganizationshasdeterminedthatseventypercentofsentineleventsaredirectlyrelatedtoineffec-tiveandpoorcommunicationbetweenmulti-disciplinaryhealthcareproviders.Asystematicstandardofcommunicationbetweenhealthcareproviders isdesperatelyneededtoimprovepatientsafetyandensurequalitypatientoutcomes.Nursesare inauniqueandpow-erful position to promote accurate and non-judgmental situationalawarenessregardingapatient’sconditionusingastandardizedcom-municationmodel.

Thisposterwilleducatenursestoeffectivelyutilizeasystematicandstructuredcommunicationmodel.ASBAR“CompetencyTrain-ingProgram”wasdevelopedforaunitbasednursingstaff.Thepro-gram consists of a three phase didactic, return demonstration andrealtimeobservationmodel,designedandledbyaunitnursecham-pion.NursesareintroducedtoSBARthrougha1-hourgrouppre-sentationincludinghandoutsandcasestudies.Phasetwoincludesa1:1educationalsessionandrole-playscenariostoincreasethelevelofcomfortandtrustwithSBAR.ThefinallearningphaseisarealtimecritiqueofanobservedSBARexchangebetweenthenurseandanotherhealthcareprovider,aswellas,theSBARdocumentationof

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thatexchange.TheSBARmodelfacilitatesassertioninnewnurseswhoarelearningtheartofcriticalthinkingandcommunicationandpromotesefficiencyininformationexchangesforthemoreexperi-encedproviders.

Multidisciplinary SBAR satisfaction surveys, documentation au-dits of preformatted SBAR communication notes, and a focusedreview of all communication related hospital events will serve asnursingoutcomemeasuresofSBARpractice.

Theutilizationofastructuredcommunicationtechniquefornursesandotherhealthcareproviderspromotespatientsafetyandqualitypatientoutcomesbyensuringacommonmodel.Theresultisassertivecommu-nicationthatpromotessituationalawarenessandtimelyinterventionforpatients.Nursesareinauniquesituationtoleadtheeffortinmodeling,teachingandmeasuringthevalueoforganizedcommunication.

2146EVALUATINGTHECORRELATIONOFSTAFFPERCEPTIONSOFCOL-LABORATION AND PATIENT SATISFACTION ON TWO MEDICALSERVICES: MALIGNANT HEMATOLOGY AND ONCOLOGY PATIENTPOPULATION.ReginaMiles,BSN,RN,OCN®,IndianaUniversityHos-pital,Indianapolis,IN;GraceSchoonveld,RN,ClarianHealthPartners,Indianapolis,IN;LarryCripe,MD,IndianaUniversity,Indianapolis,IN;DebraBurns,PhD,MT-BC,IndianaUniversity,Indianapolis,IN;FuadHammoudeh,ClarianHealthPartners,Indianapolis,IN;andRichFran-kel,PhD,IndianaUniversity,Indianapolis,IN.

ClarianHealthPartners,Inc.(CHP)incollaborationwithIndianaUniversityCancerCenter(IUCC)andIndianaUniversitySchoolofMedicine (IUSOM) is creatingafirstof itskind for Indiana free-standingcancerhospitalonthecampusofIndianaUniversity-Pur-dueUniversityat Indianapolis.Thegoalof thecancerprogram istobecomeatop-tenNCIComprehensivedesignatedcancercenterintheUnitedStates.Theresearchersofnurse-physiciancollabora-tionpositthatthereisadirectcorrelationbetweencollaborationandpositivepatientoutcomes.

Thepurposeistoevaluatedifferencesincollaborationinhematol-ogyandoncologyservices.Theauthor’sprimaryhypothesisisthatthereisastatisticallysignificantdifferencebetweennurse-physiciancollaborationforthehematologypatientpopulationandtheoncol-ogypatientpopulation.

UtilizingtheCollaborationandSatisfactionaboutCareDecisions(CSACD)toolbyJudithBaggs,aconveniencesampleof30medi-cineresidentsoncomingtothehematologyandoncologyservicewillbecollectedandat3weeksintotherotation.Atthe3weekinterval,theattendingphysiciansandphysiciansintheirfellowshipwillalsobeaskedtocompletethesurvey.Ateach3weekintervalwithinthe5months, a convenience sampleof10 staffoncology/hematologyRNswill be collected followingobtaining informedconsent fromtheparticipantsutilizingtheCSACDtool.

The primary outcome measure for all analyses will be the totalscorefromtheCollaborationandSatisfactionaboutCareDecisions(CSACD)questionnaire.Thestudy ispoweredbasedon thecom-parisonofcombinedRNandphysicianCSACDscoresbetweenhe-matologyandoncologygroups.Althoughaclinicallyrelevantdiffer-enceintotalCSACDscorehasnotpreviouslybeendefined,itwasdecided thata5-pointdifferencebetweengroupswouldconstituteasignificantdifference.Assumingastandarddeviationinquestion-naire scores of 7 for each group, a total of 86 participants wouldprovide90%powertodetectadifferenceof5pointsinmeanques-tionnairescoresbetweengroupsusingaStudentt-testwithasignifi-cancelevelofa=0.05.

Resultsofthisstudywillprovideevidencetooncologynursesforadministration to propose developmental opportunities and team

interventions to improve nurse-physician collaboration within theinpatientcancerprograms.

2148MORETHANJUSTCANCER:PILOTINGASELF-MANAGEMENTPRO-GRAM AS AN INNOVATIVE, POTENTIAL PREVENTION STRATEGYFOR BREAST CANCER SURVIVORS. Elyse Caplan, MA, Living Be-yondBreastCancer,Ardmore,PA;JulieBecker,PhD,MPH,andAbbieSchlener,ThomasJeffersonUniversity,Philadelphia,PA;andAndreaCrivelliKovach,PhD,CHES,ArcadiaUniversity,Glenside,PA.

Withthechangingnatureofthedisease,breastcancerisbecomingacurablediseaseforsomeorachronicdiseaseforothers.Totalingmorethan2.2millionwomenandgrowing,survivorshipisagreaterconcern, since little is known about what long-term breast cancersurvivors(LTBCS)require tomaintain theirdisease-freestatus, tomakeinformedhealthdecisionsandtoreducepotentialco-morbidi-tiesofotherchronicdiseases.

Thepurposesofthispilotstudyareto(a)understandtheknowl-edgeandattitudesofLTBCSabouttheirhealthstatus,and(b)testifaself-managementprogramcanassistLTBCSinincreasingtheirhealthinformationseekingbehaviorsandinfluencehealthbehaviorsthatdecreasechancesforothercancersorhealthconditions.

UsingacombinationofBandura’ssociallearningandBeck’scog-nitivebehaviortheories,weconsideredtheconstructsofhealthandillnessandtheefficacyofaknowninterventionforLTBCS.

Weconductedanexploratorystudyutilizingqualitativeandquan-titativemethodswithacommunity-basedorganizationofbreastcan-cer survivors between the ages of 45-79, and are at least 5 yearsdisease-freefromcancerbutmayhaveotherchronicdiseases.

Withthequalitativeportionofthestudy,wehaveidentifiedthreekeythemesfromLTBCS:1)theuseoftheterm“cancersurvivor”anditsconnotations;2)theconceptualizationofhealthandillnessand;3)sourceswherewomengethealthinformation.Thesethemeswereusedtodeveloptailoredmessagesusedinaself-managementprogram. Twenty women completed the 6-week self-managementprogram,withpre,post, and4monthdata collection.Despite thesamplesize,fivescalesdemonstratedanimprovementinbehavior,withtwoshowingstatisticalsignificance(p<.05),includingimprovedcopingbehaviors.Theseresultssuggestthataself-managementpro-gramtailored to theneedsofLTBCScan increase theirhealth in-formationseekingbehaviorsandinfluencebehaviorsnecessaryforimprovinghealthoutcomes.Understandingtheconstructsidentifiedfromthequalitativeportionofthestudyandtheevaluationsfromtheself-managementprogrammayassistnursesincoordinatingeffortstoassistLTBCStopotentiallyreduceco-morbidconditions,includ-ingsecondarycancers.

FundingSources:Funded,inpart,withagrantfromthePennsyl-vaniaDepartmentofHealth.

2150ACLINICALEXEMPLAROFAPATIENTWITHSEVEREHEMORRHAG-ICMUCOSITISFOLLOWINGAHEMATOPOIETICSTEMCELLTRANS-PLANTANDUSEOFTHEENDOTRACHEALTUBEWITHSUBGLOTTICSUCTION.MaryMelvin,RN,TracyDouglas,MSN,RN,OCN®,LouAnnTasony,BSN,RN,JohnKornet,AA,RN,AllisonMurter,MSN,RN,andBrendaShelton,MS,RN,CCRN,AOCN®,SidneyKimmelComprehen-siveCancerCenteratJohnsHopkins,Baltimore,MD.

Mucositisoccursin80-100%ofpatientsundergoinghematopoeticstemcell transplant (HSCT).Mucositis rangesfrompainandery-thematohemorrhagiculcerationandedemasoseverethatpatientscannoteffectivelycleartheirsecretions.Patientsmayrequireintuba-tiontoprotecttheirairway.Thesepatientsareathighriskforaspira-

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tionandventilator-associatedpneumonia(VAP)duetoimmunosup-pression,damagedmucosa,excessivesecretions,andoralbleeding.StudiesdescribeVAPasacommonandfatalcomplicationofme-chanicalventilation.Evidence-basedguidelinessuggestcontinuoussubglotticsuctioniseffectiveinpreventingaspirationandVAP.

Applying evidence-based guidelines, continuous subglottic suc-tionviaspecializedendotrachealtubes(ET)wasimplementedontheHSCTunit.Onepatientusingthisdevicedemonstratedexemplaryresults.Thispatient’scareandnursingmanagementofthesubglotticETtubearepresented.

The multidisciplinary team began evaluation of ET tubes withsubglotticsuctioninJuly2006.Staffevaluatedeaseof insertion,clinicaleffectsonventilationandcuffpressures,andtheamountand typeofdrainagefromthesubglotticport.Thisexemplarpa-tienthadseveremucositisandexcessiveoralbleeding.Althoughthoroughmouthcareisessentialforpreventionofpneumonia,itisoftendifficulttoperformeffectivelyinapatientwithseveremuco-sitis.Over500mLofbloodydrainagewasremovedbythecontinu-ous suctionportover the19days thepatientwas intubated.Thepatientdidnotdeveloppneumoniaandwassuccessfullyweanedasthemucositisresolveddespitethepatientshighriskforaspirationofbloodandsecretions.

Thisprojectdemonstrates successful implementationofevidence-basedguidelinestoimproveoutcomesforhighriskcriticallyilloncol-ogypatients.SecretionsthatweresuctionedfromthesubglotticportcouldnothavebeenremovedbysuctionthroughstandardETtubesandoralcaremeasures.Previousexperiencewithsuchpatientsdem-onstratesahighincidenceofaspiration,oftenwithfataloutcomes.

StatisticsshowthatVAPcontinuestohaveahighmortalityrate.Asdirectcaregivers,nursescanmakeanimpactonpatientoutcomes.Oncologyprovidersinvolvedinthecareofmechanicallyventilatedpatentsshouldconsiderthistherapytopreventpneumoniaincriti-callyillpatentswithmucositisrequiringintubation.

2154THE ROLE OF NURSE EDUCATORS AS FACILITATORS FOR THEIMPLEMENTATION AND EVALUATION OF EVIDENCE BASED CLINI-CALGUIDELINES.DarleneWhyte,RN,AnitaSimon,PhD,andReanneBooker,RN,BScN,TomBakerCancerCenter,Calgary,Canada.

There has been increasing emphasis that health care decisionsshouldbebasedonthebestpossibleevidence,ensuringthathealthcareisbotheffectiveandefficientwhichleadstooptimalaswellasequitablepatientcare.However,thereareconcernsthatdissemina-tionofevidencetohealthcareprofessionalsdoesnotchangeclinicalpractice.

TheTomBakerCancerCenterdecidedtoaddressboththedevelop-mentandtheimplementationofevidencebasedpracticeclinicalguide-linestoensurethatdisseminationofevidencedidchangepractice.

Anorganizational frameworkwasdevelopedwhich includes theadditionofaKnowledgeManagementResourceTeam(KMRT)andaDecisionSupportUnit.Thesetwoteamsprovidethemethodsforevaluating and synthesizing evidence which provides health prac-titionersandmanagerswithcleardirectiononhowtoachievebestclinicalpracticeandstaycurrentwithever-changingknowledge.Partofthenurseeducators’jobswasdevotedtosupportclinicalpracticeteams,consistingofdiseasespecificmultidisciplinarypractitioners.Nurse educators became community coordinators within commu-nities of practice, an essential component for implementation ofchange.Inthisnewroleas“tumorgroupfacilitators(TGFs)”,nurseeducatorsliaisecloselywithtumorgroupstofacilitatethetransferofknowledgebetweentumorgroupsandrelatedhealthdisciplinesfos-teringanevidence-basedcultureofpractice.Nurseeducatorswere

educatedonfacilitationandleadership,knowledgesurveillanceandevaluation,and,mostimportantly,onhowtoobtainconsensusandbeasuccessfulchangeagent.Focusgroupswereformedtodevelopaframeworkforsuccessfulimplementationandevaluationofclini-calpracticeguidelines.

Thedecisionsupportteamassistedinthedevelopmentofaneffec-tiveoutcomemeasurementsystemincludingperformanceindicatorsanddatacollectionmethods.Theseoutcomeswillhelpustounder-standtheinfluenceofourworkonthepeopleweserve.Wewillusetheinformationtoimprovetheeffectivenessofourefforts.

NurseeducatorsfoundthattheywereabletotakeontheadditionalroleofTGFeasilyandapplynewlyacquiredskillstoallaspectsoftheirjob.Utilizingnursesforthispositionwithinthisprojecthassetprecedenceforthevaluethatnursescanbringtoanorganization.2157MANAGINGTHEPATIENTATRISKFORLUNGCANCERTHROUGHCTLUNGSCREENING INACOMMUNITYHOSPITALSETTING.PamelaMatten,RN,OCN®,St.JosephHospitalRegionalCancerCenter,Or-ange,CA;RichardFischel,MD,PhD,self-employed,CA;DanVu,MD,MoranRowen&Dorsey,Orange,CA; andSiu-FunWong,PharmD,FASHP,FCSHP,WesternUniversity,Pomona,CA.

As the most lethal cancer in the world, lung cancer presents anenormoushealthcarechallenge.Thekeytoreversingthedisease’slethalitymaybeinevidence-basedcomputerizedtomography(CT)imaginginearlymanagementoflungcancer.NewclinicalevidencefromtheInternationalEarlyLungCancerActionProject(I-ELCAP)suggeststhatCTscreeningcandetectcurablelungtumors.Withde-tectionandsurgicalremovalofearlylungcancers,92%ofpatientsmaylive10years.

Theaimofthisprogramistodetectearlystagelungcancerthatistreatableandpotentiallycurablebyimplementingalow-costCTlung-screeningprogram inacommunityhospital setting, focusingonindividualsat-riskfordevelopinglungcancer.Costisa1-timefeeof$125.00.Atriskindividualshavesmokedatleast20packyearsandareatleast50yearsofage.

AnoncologycertifiednurseimplementstheLungScreeningProgram,followingpatientsforatleast2years.Atweeklymultidisciplinarycon-ferences, the nurse facilitates case presentations of suspicious lungnodules.Thecoregroup includes thenurse,a thoracicsurgeon,andchestradiologist.Whenlungcancerorotherabnormalitiesarefound,thenursecoordinatescareandadditionalwork-upsasneeded.

Overaperiodof23months,245patientshavebeenscreenedforlung cancer with 8 positive findings. Six cancers were confirmedNSCLC(50%earlystage),onelyposarcoma,oneB-celllymphoma.Three patients had early stage lung cancer, treated with video-as-sistedthoracicsurgery.TheSt.JosephHospitalLungProgramwasrecognizedasa“bestpractice”model,bythe2005AdvisoryBoardCompany’sRoundTableannualsymposium,basedonourCTscreen-ingapproachtoearlydiagnosis.

Communityhospitalbasedlow-costCTlungscreeningprograms,ledbymultidisciplinaryteamscanmaximizetheopportunitytode-tectearlystagelungcancer.Findinglungcancerinanearlystagecanhelpsavelivesorimprovepatientoutcomesforlungcancer.

2158ASIANINDIANWOMENANDTHEIRVIEWSABOUTBREASTHEALTH.ClaraHergert,RN,MSN,OCN®,APRN,BC,KarmanosCancerCenter,Detroit,MI;andTsu-YinWu,RN,PhD,EasternMichiganUniversity,Ypsilanti,MI.

BreastcanceristhemostfrequentlydiagnosedcanceramongAsianIndianwomeninIndia.Littleisknownabouttheratesofbreastcan-

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cerfollowingimmigrationtotheUnitedStates.Onlyonestudy,intheUnitedStates,hasbeendonetoreviewhowAsianIndianwomenviewbreastcancerscreeningpractices.

ThepurposeofthisstudywastoexaminetheviewsofbreasthealthamongAsianIndianwomenandtoassess theirknowledgetowardbreastcancerscreening(i.e.,breastself-exam,clinicalbreastexam,andmammography).

TheframeworkchosenforthisstudywastheHealthBeliefModel.This study looked at the variables: perceived susceptibility, per-ceivedseriousness,perceivedbenefit,andperceivedbarriersrelatedtobreastcancerscreening.

Samplewasrecruitedfrom2HindutemplesinaMidwest,uni-versity-basedcommunity.Thestudygroupreceivedapretest,anintervention(educationalprogram),andtheposttestallinoneday.Therewasonlyonestudygroupusedinthisstudy.Theinstrumentused for thepretestandposttestwasdevelopedusing theHealthBeliefvariables related tobreastcancer screening.DataanalysiswasperformedusingSPSSsoftwaretocomparepretestandpost-testresults.

Asmallpercentage (9%)ofwomenreportedpracticingmonthlybreast self-exams,whereas just fewer than50%of thewomen re-portedyearlyclinicalbreastexams(46%)andmammograms(47%).Over50%ofthewomenreportedthattheydidnothavetheskills/knowledgetoperformbreastself-exams.Aftertheeducationalpro-gramtheamountofwomenthatstatedtheywouldperformmonthlybreastself-examincreasedfrom9%to80%and100%ofthewomennowfelttheyhadtheskill/knowledgetoperformbreastself-exams.Thewomenalsoreportedincreasedknowledgeaboutclinicalbreastexamsandmammogramsaftertheeducationalprogram,bystatingthattheywouldinitiateschedulingappointmentsforboth.Thestudyshowedthateducationisthekeytohelpingimproveperceivedbarri-ersandbenefitsforthegroupofAsianIndianwomenstudied.Oncol-ogynurseshavetheopportunitytoprovidethiseducationtoAsianIndianwomen.

2159HEPARINFLUSHESINCENTRALVENOUSCATHETERS:ARECANCERPATIENTS DIFFERENT? Terry Sylvanus, MSN, APRN, BC, AOCN®,andJeanHarrison,MSN,RN,AOCN®,H.LeeMoffittCancerCenter,Tampa,FL.

The use of central venous catheters in cancer patients providesconvenientaccessformultiplepurposes,but isnotwithoutconse-quencesorsafetyconcernsinthispopulation.Heparinflusheshavebeenusedtopreventlossofpatency,butcarrytheriskofdevelop-mentofheparin-induced thrombocytopenia/thrombosis,promptingclinicians to speculate about the efficacy of normal saline flushesaloneforthispurpose.

This review was designed to determine what evidence exists tosupport theuseofdiluteunfractionatedheparinversusnormalsa-lineasaflushsolution tomaintaincentralvenouscatheter (CVC)patencyinadultoncologypatients.

Twoexpertoncologynurses reviewedpublishedguidelines, re-viewsandstudiesfrom1979-2006locatedthroughPubmedusingevidence based practice filters, and through CINAHL using rel-evant search terms. Selection criteria for inclusion in the reviewwas limited to randomized, prospective, controlled trials of theefficacy of any strength, volume and frequency of heparin flushcomparedtoanyvolumeandfrequencyofnormalsalineflushinthepreventionof lossofpatencyor function,or thrombosisofacentralvenouscatheterinadultpatientswithanycancerdiagnosis.Pertinentstudieswerereviewedandsummarizedintoanevidencetableformat.

Guidelines available from national nursing organizations aboutcentralvenouscathetercaredidnotgivespecificinformationaboutflushingpractices,noruseinoncologypatients.Theliteraturesearchyielded468studies,102examinedsomeaspectofheparinoranti-coagulantadministrationandCVCfunction;fivemetourrigorousselectioncriteria.Nodefinitiveanswertoourclinicalquestionwasfound.

Nostudiesreviewedprovidedsufficientevidenceastothesuperi-orityofnormalsalineversusheparinflushesformaintainingcatheterpatencyincancerpatients.Ourcancercenter’sflushingprotocolsforCVCsare thereforeunchanged.There remains anurgentneed forwell-designed,randomized,controlled,interdisciplinaryresearchtoaddressthisissueinthispopulation.

2161RONEE: RADIATION ONCOLOGY NURSING ENHANCING EXCEL-LENCE—EDUCATIONOUTSIDEACLASSROOMTHROUGHTHEDE-VELOPMENTOFACOMPUTERIZEDLEARNINGPROGRAM.MaureneMcQuestion,RN,MSc,CON(C),PrincessMargaretHospital,Toronto,Canada;andMarilynHaas,RN,PhD,ANP-C,MountainRadiationOn-cology,Ashville,NC.

Radiationoncologynursing (RON)established their role amongthe interdisciplinary team in the early 1980’s, caring for 60% ofoncology patients, yet there were no formal educational trainingprograms.RONsreceivedorientationfromphysiciansortherapistsaboutthetechnicalaspectsofradiationtherapy(RT)anddevelopedtheirownnursingcare.Thistypeoftrainingisinsufficientbecausepatientacuitylevelstodayarehigher,requiringskillednursingcare.With rapid technological explosion, this opens opportunities fornovelapproacheswithnursingeducation.Computerassistedlearn-ing(CAL)hasshowntofacilitatelearningandenhanceknowledgeacquisitionthroughtheuseofinnovativeapproachestointegratingscientific, technologicalandnursingknowledge.Thereareno for-malspecializededucationalprogramsforRONs,thustheneedfordevelopmentCAL.

Thepurposeof thisprojectwas todevelopacomprehensive, in-depth,self-learningcomputerizedprogramthatcouldteachnoviceandadvancedRONsaboutthemanagementofpatientsundergoingradiationtherapy.

ExpertRONswithin theONSRTSIGwere selected todevelopRONEE, utilizing an evidence-based approach to educational in-struction.Scriptswerewritten,photographs/filmstaken,powerpointpresentationdeveloped,andfinalCDvideopresentationwascom-pletedovera2yearperiod.Instructionalcomponentswouldincludeconsultation,work-upandstaging,theprocessofsimulation,treat-mentplanningandnursinginterventions,alongwithdischargeandlong-termfollow-upguidelines.

This project highlights the development and curriculum of themodulesonmalignantandnon-malignanttumors,andspecialmod-ulesrelatingtoradiobiology,pediatrics,radiopharmaceuticals,andradioprotectants.Withover500sold,130returnedevaluations,75%werestaffnurses,88%wereemployedinRT,averaging15yearsofexperience,passingCEUtestswith95%.Allmoduleswererated>3.3(scale4.0).Participantspositivecommentsincludedworkingattheirownpace,having in-depthpresentations, andenforcingwithcasestudieshelpedmeettheirlearningneeds.

Inconclusion,thisprogramreflectsaninnovativeandcomprehen-sivespecializedRONeducationprogramforindependentselfpacedcomputerassistedlearningtosupportnursesbecomingskilledandknowledgeableinthecareofRTpatients.ExperiencedRONswhohaven’t receivedformal training, feltRONEEtobevaluable.ThisexamplecanbeamodelforotherCAL.

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2162CREATINGASELF-LEARNINGMODULEONCANCER-RELATEDPAIN.CherylElsadr,RN,BSN,KarmanosCancerCenter,Detroit,MI.

Approximately50percentofcancerpatientsreceivingtreatmentexperiencepain;70percentofpatientswithadvancedcancerhavepain,and80percentofthesepatientsrateitasmoderatetosevereorsevere.Pain isoftennot recognized incancerpatientsusuallyduetoinadequateassessment,doctors’fearofprescribingopiates,andnotacknowledgingpainasapriority.Manynursesbelievethatit is not necessary for them to understand pharmacological painmanagementsinceitisthe“physicians’responsibility”.Yet,afun-damentalnursingresponsibilityistoadvocateforpatientsandinorder to do this oncology nurses must understand the principlesof pain in general, cancer pain in particular, and pharmacologi-calmanagementofcancerpain.Theyaretheliaisonbetweenthepatientandthedoctor.

Inordertoprovidethiseducation,aself-learningmodule(SLM)wasdeveloped.Itprovidesareviewofthepathophysiologyofpaininadditiontopaintypes(especiallythoserelatedtocancer)andtheircauses. Inaddition,anoverviewofanalgesicscommonlyusedforpainincancerpatientsandgeneralprinciplesofpainmanagementarediscussed.

ThispresentationwilldescribehowaSLMonthePharmacologicalManagementofCancer-RelatedPainwasdeveloped.Itincludesthesearch methods; learning needs assessment approaches; determin-ingthelearningoutcomes,content,structure,andteachingmethods;continuingeducationunitsallocation;andtestpreparation.

Aconveniencesampleof10RegisteredNurseswillcompletetheSLMandtheevaluationform.TheevaluationswillbeanalyzedandtheappropriatechangeswillbemadetotheSLM.

There aremanybenefits tousingSLMs.Theyare cost effectivesincetheyarepreparedonce(andreviewedperiodically)andusedrepeatedly,withouttheneedforaninstructor.SLMsareconvenientsincethelearnercancompletethemattheirownpaceandinanenvi-ronmentoftheirchoice.UnderstandinghowaSLMisdevelopedandevaluatedwillgiveeducatorsanalternatewayofeducatingnurses.

2165INCIDENCE AND NURSING MANAGEMENT OF HAND FOOT SKINREACTION INPATIENTSTREATEDWITHORALTYROSINEKINASEINHIBITORSFORMETASTATICRENALCELLCARCINOMA.SuzyGra-ham,RN,BSN,OCN®,OurLadyofMercyMedicalCenter,Comprehen-siveCancerCenter,Bronx,NY;andJaniceDutcher,MD,VictoriaRo-sal-Greif,RN,MN,LindaSacris,RN,OCN®,andJacksonKoo,CCRP,OurLadyofMercyMedicalCenter,Bronx,NY.

Sorafenib and sunitinib represent a newclass of tyrosinekinaseinhibitors(TKIs)thatarehighlyeffectiveinthetreatmentofpatientswithmetastaticrenalcellcarcinoma(RCC).Skinreactionssuchashandfootskinreaction(HFSR)areclinicallychallengingadverseef-fectsofTKIs.Educatingoncologynursesontheidentification,pre-ventionandmanagementofHFSRinpatientsreceivingthesenovelagentsiskeytoensuringsuccessfultreatment.

Thepurposeofthispresentationistoprovidetheoncologynursewithinsightinto:1.ThepathophysiologyofHFSR2.The identification,management andneed for early intervention

ofHFSR3.AssessmentandevaluationofHFSR4.Nursingmanagementstrategiesforthepreventionandtreatment

ofHFSRAretrospectivechart reviewof78patientswithmetastaticRCC

treatedwithoralTKIsfromJune2005toNovember2006wascon-

ducted.57patientsweremaleand21femalewithamedianageof59 years (range 29-80 years). 60 patients received treatment withsorafeniband18withsunitinib.Patientswereencouraged thefre-quentprophylacticuseofOTCskinemollients,EucerinorAveeno.Patientteachingstressedtheimportancetoidentifyandreportskinreactionspromptly.

Grade1-3HFSRwasobservedinatotalof18ofthe78patients(23%).16patientsreceivedtreatmentwithsorafeniband2withsuni-tinib.Ofthese,9patientsdevelopedHFSRwithin14daysoftreat-mentinitiation.Painfulerythemia,calluses,peelingand/orblisteringof the skinof thehandsand/or feet typically represented the skinreactions.Grade1HFSRoccurredin5patientsandwasmanagedwith topicalOTCskincreamsEucerinorAveeno.Grade2HFSRwasobservedin7patientsrequiringtheuseofprescriptiontopicalemulsion,Biafineandalsorequiringdosereductionand/orinterrup-tion.Grade3HFSRwasobserved in6patientsmanagedbybothdoseinterruptionanddosereduction.

HFSRisapotentiallydoselimitingtoxicityofTKItherapy.Thisprojectdemonstratestheneedforearlyidentificationandinterven-tion for HFSR. Management guidelines and photographs will beshowntobettereducateoncologynursesonmanagingthischalleng-ingadverseeffect.

2167DEVELOPING A CRANIOTOMY POST OPERATIVE DISCHARGE IN-STRUCTIONSHEET:ALESSONINMULTIDISCIPLINARYCOLLABO-RATION.DeborahSendlak,RN,RoswellParkCancer Institute,Buf-falo,NY.

Acraniotomyisafrighteningexperienceforbothpatientsandfam-ilymembers.Despitemultipleteachingmomentsregardingpostop-erative instructions, it is theactivitiesofdaily living thatpatient’svoiceconcernsaboutpriortoandafterdischarge.Patientsareedu-catedandevaluatedbyoncologynursesfortheirabilitytoprovideself-care after discharge from the hospital, but still often expressanxietyaboutwhattheywillencounterathome.Inoursettingpa-tientsalsoreceivedinstructionsfromsurgeons,nursepractitioners,respiratorytherapistsandphysicaltherapists,butnoonedischargedocumentexistedtoprovideaconciseandintegratedresource.

Providingeducational support in thehospital canbe fragmentedamongdisciplinessoclearpostoperativeinstructionsforthemtouseat home is paramount for their well-being.A minimal amount ofprintedmaterialsexistedforpatientsbeingdischargedfollowingacraniotomythatfocusedonstep-by-stepessentialinformationinonecompletedocument.

Thepurposefordevelopingthistoolwastoprovideusefulinfor-mationthatcanbeeasilyunderstoodbyboththepatientsandtheircaregivers.Thedevelopmentof this tool from inception to accep-tancebyalldisciplinesinvolvedinthecareofpatientsexperiencingacraniotomywillbeoutlinedalongwithsamplesoftheactualtooldeveloped.Thistoolcanbereplicatedinothersettingsandforothertypesofsurgicalprocedures.

Ourfirst stepwas to review the current educationalprocess andthe instructionsprovided toourpatients for them touse athome.We identified that the informationprovidedwasoften fragmentedamongthedisciplines.Stepbystepessentialinformationinacom-pletedocumentwasnotavailable.Itwasquicklyidentifiedthatwehadanopportunitytoimprovehowwepreparethisspecialgroupofpatientsforself-carefollowingsurgery.

Thispresentationwill outlinehow thedisciplineswere involvedinthedevelopmentofaCraniotomyPostOpdischargeinstructionresourceweprovidetoourpatientsandtheevolutionoftheprocessimprovement.

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2168DEVELOPING AN INFORMATION VISUALIZATION TOOL FOR ORALMUCOSITIS.SusanBeck,APRN,PhD,AOCN®,FAAN,andJimAgutter,MArch,UniversityofUtah,SaltLakeCity,UT;WilliamDudley,PhD,UniversityofUtahCollegeofNursing,SaltLakeCity,UT;DouglasPe-terson,DMD,PhD,NeagComprehensiveCancerCenter,Farmington,CT; and Deborah McGuire, PhD, RN, FAAN, University of MarylandSchoolofNursing,Baltimore,MD.

Oralmucositis (OM) isacommonsideeffectofhighdosecan-cer therapy, and can lead to clinically significant sequelae. Toolstoenhanceknowledgeof thecomplex trajectoryofOMover timecouldinformbothresearchandclinicalpractice,particularlyinthesubstantialnumberofsolidtumorpatientsworldwidereceivingche-motherapy.

The aim of this study is to investigate and develop InformationVisualization(InfoViz)representationsthatprovidenewinsightintothecomplexandmulti-dimensionalaspectsofOMovertime.Theseaspectsincludeanatomic,physiologicanddynamicclinicalfeaturesofOM(e.g.,erythema,ulceration,painandwhitebloodcellcount).

ThecontemporarypathobiologicmodelofOMproposesthatclini-cal manifestations of OM are due to a complex dynamic processprincipallyinvolvingoralepitheliumandconnectivetissue.Despitethisunifyingparadigm,individualtrajectoriesinsolidtumorpatientshaveconsiderablevariabilitydueinparttopatient-related,therapy-related,andclinicalfactors.

Development of the visualization employed a user-centered de-velopmentmethodology.Thisinvolveddomainanalysis,schematicdesignofprototypes,focusgroupswithpotentialusers,andsubse-quentrefinementofthedesign.Duringthedomainanalysisphase,we conducted and recorded in-depth interviews with 7 prominentexpertsonOM,representingthefieldsoforalmedicine,nursing,andpsychology. The transcripts were analyzed for important themes,clinical variables and specific attributes and processes. Using theinformationgatheredduringthedomainanalysis,severalschematicprototypesweredeveloped.Theseprototypeswerethenrefineddur-ingfocusgroupsessionswithOMexperts.

Duringdomainanalysis,weidentifiedthemostimportantobjects(e.g.oralmucosa)andoperations(cellulardestruction)inthecho-sendomainofOM,theattributes(e.g.erythema)of theseobjects,andtherelationshipsamongobjects.Theseconceptswerethenen-codedvisuallyfocusingonthetemporalaspect.ThisapproachhasthepotentialtoenableclinicianstoidentifychangesinOMovertimeandtoadjusttheirassessmentandtherapeuticapproachesbasedonclinicallyrelevantchanges.Ifthisapplicationissuccessful,InfoVizinvestigationsmay lead tonew insight intocomplexmulti-dimen-sionalprocessesinoncologypractice.

2170CANCERPREVENTIONANDEARLYDETECTIONOFGASTRICCAN-CER: THE ROLE OF THE EARLY ONSET AND FAMILIAL GASTRICCANCERREGISTRY.JenniferRandazzo,RN,MeganHarlan,CGC,MS,ElaineSheehy,BS,andManishShah,MD,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Gastriccanceristhesecondleadingcauseofcancer-relatedmor-tality world-wide. US minority and underserved populations haveasignificantlyworseprognosis thatcannotbeexplainedsolelybyexternalfactorssuchasdiet,co-morbidities,oraccesstohealthcare.Therolethatgeneticsplaysingastriccancerisalsonotfullyunder-stood.Upto15%ofgastriccancercasesarerelatedtoaninheritedcomponent,ofwhich1/3areduetoamutationinCDH1,thegeneticcause of Hereditary Diffuse Gastric Cancer. In January 2006, theEarlyOnsetandFamilialGastricCancerRegistrywasestablishedat

thisComprehensiveCancerCentertocompileinformationonindi-vidualswithapersonalhistoryofgastricorgastro-esophageal(GEJ)cancerandtheirat-riskfamilymembers.Eligiblepersonsareeither‘EarlyOnset’(EOG),diagnosisage<50,or‘Familial’(FGC),onefirstortwoseconddegreerelativeswithdisease.

Aim: To prospectively collect epidemiologic data and create amatchedtissueandDNArepository,withanemphasisonminorityrecruitment.Withthismatchedprospectiveresourcewecan:identifysporadicCDH1mutations,exploreforothergenesassociatedwithhereditablegastriccancervialinkagestudies,exploreforatriggertodevelopingthediseaseinCDH1mutationcarriers,andstudythelinkagebetweenCDH1mutationsandothermalignancies.

Method:Allwhoagreetoparticipateareaskedtocompleteafami-lyhistoryandgastriccancerquestionnaire,andtoreferfamilymem-bersforparticipating.Thisquestionnaireincludespersonalmedicalhistoryanddietaryhabits.Afterenrollment,patientsmaychoosetocontributeabloodand/ortissuesampleforthetissuerepositoryandmeetwithageneticcounselortodiscusstherisks,benefitsandlimi-tationsofgenetictesting.

Sinceestablishingtheregistry,83participantshaveenrolled,59ofwhichareEOGand24thatareFGC.Wehaveopenedathirdcohorttoincludethosenoteligibleforeitherofthetwoprimarycohorts.Thisgroupisour‘controlarm’andconsistsof7membersthusfar.Theinformationgatheredbythisregistrycanbeappliedtoscreeningandpreventionguidelineswhichwillimpacttheoverallhealthcareofindividualsathigh-risk.

2174PREVENTION OF VAGINAL STENOSIS AFTER PELVIC RADIATION.EthelBeelingLaw,RN,MA,OCN®,andLaurenEcock,RN,BSN,Me-morialSloan-KetteringCancerCenter,NewYork,NY.

Pelvic radiation is an essential component of the treatment ofcolorectalandgynecologiccancers.Womenwhoreceive radiationwill experience varying degrees of vaginal stenosis, beginning asearlyasfourweeksanduptotwoyearsafterradiation.Thedimin-isheddimensionofthevaginahindersathoroughpelvicexamfortu-morsurveillanceandtheabilitytohavevaginalpenetration.Patients’qualityofsexuallifemayalsobeaffectedbypersistentdyspareunia,vaginaldrynessorbleeding.Studiesindicatethatdilatoruseisef-fective to minimize stenosis. Nurses play a key role in educatingpatientsaboutitsuseandencouragingcompliance.

Thisabstractreviewsthepathophysiologyandpresentationofvag-inalstenosisanddescribesinterventionspatientscantaketomini-mizeitsseverity.Conflictingissuesrelatedtovaginalstenosiswillalsobediscussed.AtthisNCI-designatedcancercenter,patientedu-cationisfocusedonmaintainingvaginalhealthaftertreatment.Thestandardistostartlife-timedilatorusefourweeksafterradiationiscompleted.Theradiationoncologynurseprovidesadilatorkitandafactcardonitsuse.Patientsareinstructedtousethedilatorthreetimesaweekfortenminutesatatime.PatientsarealsoinstructedontheuseofmoisturizersandlubricantsandonhowtoperformKegelexercises.NursesreferpatientstotheWomen’sHealthProgramtoaddresssexualityissues.Inreviewingtheevidenceaboutvaginalste-nosis,issuesthatarediscussedinclude:theoptimaltimingtobegindilatoruse,thefrequencyneeded,andtheuseoftopicalestrogen.

Byprovidinganunderstandingof the rationale forusingadila-torandinstillingconfidenceinitsuse,patientswillbemorelikelytocomply,minimizingstenosis,alleviatingvaginalsymptoms,andenablingthemtoresumesexualintercourse.

Nursescanapplythisinformationintheirpracticetoimproveedu-cationofpatientswhohave receivedpelvic radiation. Inaddition,itishopedthatnurseswillbeencouragedtoundertakeresearchto

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learnmoreabouthowtopreventandtreatthisproblem.Asanex-ample, we will discuss a study we will be conducting looking atvariationsinteachingtechniquesandfrequencyofuse.

2175DESIGNING A CHEMOTHERAPY PATIENT EDUCATION CLASS FORMULTIPLECLINICALSITESATANNCI-DESIGNATEDCANCERCEN-TER.PatriciaPohland,RN,BSN,OCN®,BethWestbrook,RN,BSN,OCN®, Debra Woo, RN, BSN, OCN®, Laura Balint, RN, Trish Galla-gher,RN,BSN,andDebSimo,RN,BSN,OCN®,UniversityHospitalofCleveland,IrelandCancerCenter,OrangeVillage,OH.

Providing high-quality, comprehensive education to the patientbeginning chemotherapy is essential to achieving good self-careoutcomes.However,creatingandimplementinganorganized,con-sistenteducationalapproachacrossmultipleoutpatientclinicalsitesofanNCI-designatedComprehensiveCancerCenterischallenging.Oncologynursesnotedseveralbarriersthatcontributedtoineffec-tive patient education: the absence of scheduled nursing time foreducation,variousteachingmethodsutilizedbynurses,andincon-sistentinstructions.Patient-relatedbarriersincludedlackofpatienttimeandhighlevelsofanxiety.

Thepurposeofthisprojectwastodesignandimplementaformal,evidenced-basedchemotherapyeducationclassforpatientsandtheirsignificantotherstooptimizethelearningexperienceandstandard-izeeducationacrosssettings.

Sixoncology staffnursesmetweeklyover sixmonths todefinegoalsandprocessesrequiredtocreateaformaleducationexperienceforpatients.Considerationwasgiventologisticsincludingtheset-ting,learningmaterials,lengthofclasstime,andtrainingofoncolo-gynurseinstructors.Evidenced-basedresourceswereusedtodesignthe curriculum, which reviewed basic concepts of chemotherapy,sideeffectsandsymptommanagement.APowerPointpresentationandachemotherapyclassfolder,includingspecificsymptomman-agementtools,weredevelopedtoreinforcekeymessages.ProjectedimplementationoftheclassisJanuary2007.

There were multiple evaluation steps throughout the project.Nurses critically reviewed course content and print materials forconsistencywithONSevidenced-basedpracticeguidelines.Furtherfeedback of the course content was obtained from a focus group,physicians,otheroncologynurseswithinthehospitalsystemandthecancercenter’spatienteducationcommittee.Apatientsatisfactionsurveywasdesignedtoaidinfuturerefinementoftheclass.

Although challenging, implementation of a chemotherapy classwillbenefitpatientsbyallowingeducationtooccurinatimelyandrelaxedmanner.Theuseofevidenced-basedresourcesnotonlyfa-cilitatedachievingconsensusonclasscontentamongoncologynurs-es,butalsoassuredestablishmentofahighquality,comprehensivestandardforpatienteducationacrossmultipleclinicalsites.

2177SOUTHERNJERSEYSHORECHAPTEROFONSRECOGNIZESLUNGCANCER AWARENESS MONTH WITH INAUGURAL EVERY BREATHCOUNTSWALKFORLUNGCANCERAWARENESS.MicheleGaguski,MSN,RN,AOCN®,APNC,OceanMedicalCenter,Brick,NJ;SharonPayran,RN,OCN®,andLouiseBaca,MSN,RN,AtlanticareRegionalMedical Center, Pomona, NJ; Lisa Aiello-Laws, MSN, RN, AOCNS,ShoreMemorialCancerCenter,SomersPoint,NJ;andSusanWilson,MSN, RN, AOCN®, APN-C, HOPE Community Cancer Center, Mar-mora,NJ.

In2006,anestimated162,460deathsoccurredfromlungcancer.LungcanceristheleadingcancerkillerinbothmenandwomenintheUnitedStatesandcausesmoredeathsthanthenextthreemost

commoncancerscombined(colon,breastandprostate).Inourchap-ter service area we discovered that we have higher rates for lungcancerthanintherestofthestate.Giventhisstatisticcoupledwiththelimitedfundingforlungcancer,thechapterdecidedtodeveloptheEveryBreathCountsWalkforLungCancerAwarenessOrgani-zation.

Ourgoalistomakeadifferenceinourcommunitiesbybringingaboutaheightenedsenseofawarenesstolungcancerwhileraisingfundsfor1)LungevityFoundationand2)theSouthJerseyCancerFund.These organizations fund lung cancer research and provideassistancetocancerpatients.

Acommitteewas formedwhich includedoncologynurses, hos-pitaladministrators,lungcancerssurvivorsandtheirfamilies,localteenagers anda representative from theNJCancerEducation andEarlyDetection(CEED)Program.InJanuary2006,thecommitteebegantomeetregularlyanddeterminedastrategicplan,designedalogoandaddressedmarketingbydevelopingbrochuresandpostersthatweredistributedthroughoutourservicearea;includingchaptermeetings.Severalhundredlettersseekingdonationsweredistributedtobusinesses.

OnNovember18,2006theeventtookplacewithover100walkers,includingtheMayor,ourCongressman,andalocalthoracicsurgeon.The dignitaries took this opportunity to speak about the need forlungcancerresearch.Wesold“Moonbaby”pinswhicharecreatedbyalocalbusinessandmadeforpurposesoffundraising.WehadT-ShirtsandchocolatelollipopsmadewithLungCancerFactsprintedontheribbon.TheWalkraisedover$10,000.Theproceedswillbedonatedto1)TheLungevityFoundationwhichfundsresearchde-signedtotreatandcurelungcancer,and2)theSouthJerseyCancerFund, which committed to earmark the funds for lung cancer pa-tientsinourcommunity

Thisisatestamenttothepowerthatoncologynurseshavetomakeapositivedifferenceintheircommunity.

2178CHEMOTHERAPY OCCURRENCE REPORTING . . . OR NOT. LaurieDohnalek,RN,MBA,CNA,LindaMiller,RN,MSN,OCN®,JudyWest-cott,RN,OCN®,andSabrinaBielefeldt,RN,BSN,OCN®,GeorgetownUniversityHospital,Washington,DC.

Sixyearsago, the InstituteofMedicine (IOM)publishedawellknown report on medical errors that emphasized the need forchangesinculturesandsystemstoimprovesafety.Thisdocumentprompted major initiatives to improve patient well-being howeverhealthcarecontinuestolagbehindotherfieldsinitsprogresstowardenhancingsafety.Inresponsetothecontinuedimperativeonpatientsafety,GeorgetownUniversityHospital’s(GUH)NursingDivisioncompletedtheAgencyforHealthcareResearchandQuality(AHRQ)CultureofSafetySurveyinJune2006.

Theresultsofthissurveyrevealedadisparitybetweenactualmedi-cationeventsandthefrequencywithwhichtheyarereported.Intheoncologysetting,deviationsinchemotherapypracticeandpolicydooccur,despiteveryfewreportsgeneratedfromnursing.Thesefind-ingsprompted theneed toevaluatenursingrecognitionofchemo-therapyoccurrences,cultureofoccurrencereportingandbarrierstooccurrence reporting in the oncology environment at GeorgetownUniversityHospital.

ThiswillbeaccomplishedwithaselfreportinstrumentdevelopedatGeorgetown,validatedbyexpertsintheoncologyfieldandbasedontheAHRQandIOMframework.Thisnon-experimental,explor-atory study will include a population of inpatient and outpatientchemotherapy trainednurseswith a sample sizeof approximately50.Ofspecificimportanceisidentifyingnurses’perceptionofwhat

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constitutesanoccurrenceandthereasonsforinconsistentdocumen-tation.ThefrequencyofGUHreportingandnationalreportingwillbecompared,alongwithdemographicdata.Thevaluesandbeliefsofthechemotherapy-certifiednursingstaffwillbeevaluatedtoun-derstandtheplanneededtoinfluencechange.

After thedataarecollectedandanalyzed,basedon thefindings,interventionswillbedevelopedwhichaddressthebarriersandmayincludethefollowing:increasingawareness,nursingeducation,oc-currencetrackingandsupportforreporting.TheChemotherapyOc-currenceSurveywillberetakenforcomparativepurposes.Inaddi-tion,comparisonofoccurrencereportingbynursingbeforeandaftertheseinterventionswillbeundertaken.

Theliteraturesearchrevealedinformationonmedicationincidentreporting, validity and errors involving chemotherapy but little isavailableon this topic.Additional researchon thisnurse-sensitiveindicator, chemotherapy occurrence reporting, is essential to im-provesafety.

2179“SHOWTHEMTHEEVIDENCE!”SUPPORTINGPATIENTSWITHTHEDECISION-MAKINGPROCESS.LeahScaramuzzo,MSN,RNC,AOCN®,CancerInstituteofNewJersey,NewBrunswick,NJ.

Researchshowsthatknowledgeempowerspatients’decision-mak-ingandthosethattakepartinhealthcaredecisionsaremorelikelytohavebetteroutcomes.Literaturesupportsthatcancerpatientswantinformationandengageininformationseekingbehavior.Yet,wherecantheygoforassistancewhensearchingforcredible,in-depthcan-cerinformationinunderstandableterminology?Manydiscoverthatpublic andhospital librariesdonotmeet theseneeds, the Internetisveryoverwhelming,andoncologyprofessionalsoftenhavetimeconstraintsthatpreventthemfromprovidingin-deptheducation.

Ledbyanoncologynurseeducator,theResourceandLearningCen-ter(RLC)wasdevelopedatanoutpatientNCI-designatedComprehen-siveCancerCenter,withthegoalofprovidingpatients/familieswithamyriadofevidence-basededucationresourcesaboutcancerpreven-tion,diagnosis,treatment,andsymptommanagement.TheRLCallowspatients/familiestoascertaininformationatanypointintheircare,cap-italizingonprinciplesofreadinesstolearn.Patients/familiesassistwithidentifyinglearningbarriersandtheirbestlearningstrategies.

Afterconductinganeedsassessmentofpatients/families,complet-ingliteraturereviews,andnetworkingwithothercenters,aproposalwasdevelopedandgrantfundingfortheRLCwassecured.Amul-tidisciplinary patient education committee provided guidance andidentified sources of best evidence. The RLC contains computerswithhealtheducationsoftwareandreputableWebsites,consumerhealth books, medical reference books, audio/visuals, journals,newsletters, brochures, and a designated area where educational/psychosocialclassesareheld.Amedicallibrarianisonstafftoassistwithinformationrequests.HealthcarepractitionersreferpatientstotheRLCbyusinga“PrescriptionforLearning”pad.

More than1200visitsoccurredduringthefirstyearofRLCop-eration. 100% of those completing evaluations indicated that theinformation obtained helped them make healthcare decisions andimprovedcommunicationwiththeirhealthcareteam.Basedonon-cologists’requests,tumorspecific“PrescriptionsforLearning”arecurrentlybeingdeveloped.

Oncologynurseshaveuniqueopportunitiestodeveloppatientedu-cationstrategiesandprogramsandenhancetheirprofessionaldevel-opmentandcontributionstooncologycare.Findingssupportthatthedevelopmentofconsumerlibrariesassistspatients/familieswiththeinformationsearchprocessenablingthemtobecomefullyinformedandusetheevidencetosupporttheirdecision-making.

2181THE ONCOLOGY SERVICE LINE’S USE OF SIX SIGMA IN THECOWDERY PATIENT CARE CENTER: CREATING STANDARDIZEDPROCESSESTOIMPROVEPATIENTFLOW,IMPROVINGSTAFFANDPATIENTSATISFACTION.KarenRoesler,RN,andDebDydyk,BS,MA,BSN,RN,C,NebraskaMedicalCenter,Omaha,NE.

TheCowderyPatientCareCenter(CPCC)isanoutpatient treat-ment center with approximately 110 patient visits daily. The ma-jority (85%) are Oncology/Bone MarrowTransplant patients withappointments rangingfrom30minutes to10hours. Inaddition toscheduled patients, the CPCC accommodates unscheduled, urgentcarevisitsforproblemssuchasnausea/vomiting,pain,orfever.Staffstruggled with patient flow and timeliness of treatments; patients/familiesexpressedconcernwithdelays.

TheCancerServiceLineinitiatedaPatientFlowProjectusingthedefined,measure,analyze,improve,andcontrol(DMAIC)processofSixSigmatoimprovepatientflowandreducedelays.Thepurposewastoidentifycausesofdelays,identifysolutions,andstandardizeworkpracticestoeliminatedelayswhilecontinuingtoprovidesafe,competentcare,andimprovesatisfaction.

ProcessexpertsincludingRN’s,techs,clerks,andmanagerswerechosen to participate on this project. The team used the DMAICprocesstoidentifyfactorscontributingtopatientflowproblemsandissuescontributingtodelaysintreatmentstarttimes.(1)Datawerecollected to validate if the factors identified were supported. (2)Theteamidentifiedimprovementswhichcouldbemade,(3)imple-mentedimprovements,(4)collectedfurtherdata,andifthechangewassuccessful,(5)developedacontrolplantoensureitwouldbesustainable.

Surveyshadindicatedpatientswerewillingtowaitanaverageof22minutesfortreatmentstostart.Whentheprojectstartedin2004,29%ofthetreatmentsstartedwithin22minutes;in2006,afterimple-mentingthechanges,thisincreasedto78%.Changesimplementedincludedadjustingtheschedulingtemplateandprocess,separatingouttheshortappointments,changingthecheckinprocess,andalter-ingtheroleofthechargeRNtoprimarilymonitorflowandtriage.Datacollectioncontinuesonamonthlybasis.

Nursingstaffaredirectlyinvolvedinpatientcareandplayapiv-otal role in patient outcomes and care efficiency. Providing staffwith tools and resources to improve care efficiency and involvingthemwith identificationofsolutionsfacilitates improvedstaffandpatientsatisfaction.Nurseswillbeabletousetheinformationinthispresentationtoguidesimilarimprovementprojectsintheirclinicalsettings.2182CHALLENGESTOPUTTINGEVIDENCEINTOPRACTICE:THEMUCO-SITISPROJECTONEYEARLATER.MeganDunne,RN,MA,APRN-BC,AOCN®,JoanneKelvin,RN,MSN,AOCN®,KristinCawley,RN,MSN,OCN®,CathyHydzik,RN,MS,AOCN®,MaryMontefusco,RN,MPA,OCN®, andSusanDerby,RN,MA,CGNP,ACHPN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

At ONS congress 2006, an evidence-based standard of care forthepreventionandtreatmentoforalmucositiswaspresentedbythisgroupofnurses.ApprovalforthenewstandardwasobtainedfromthisNCIdesignatedCancerCenter’smedicalboard,clinicalcouncil,andexecutivenursingcommittee.

Variationsinnursingpracticetriggeredthisproject.Thisnewstan-dardofcarehasbeenfullyimplementedthroughoutalldiseaseman-agementteamsoftheambulatory,inpatient,andchemotherapyareas.Thispresentationwilldescribechallengestoachievingthisevidence-basedpracticechangeandstrategiesusedtoovercomethem.

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Changes to institutional supplyof toothbrushes and rinse agentswererequestedbasedontheevidence,aspartofaneworalcarepro-tocol.Costanalysisandpotentialbenefitwerepresentedtoseveralcommittees,andfinallyapproved.Nursingeducationpresentedthegreatest challenge.A new assessment tool (CTCAEV.3) and oralcareprotocolwerepresentedataseriesofin-services.AnanimatedPowerPoint presentation enablednurses to grade varied photos ofmucositis and compare their assessment with the actual toxicitygrade for self-directed learning.Common termsweredefined andclarifiedtoincreasenurses’fluencyregardingmucositis.Videosweredevelopedsummarizingtheevidence,newtool,andoralcareproto-col.Thesewereused forunitbased in-servicesandplacedon theintra-nettotargetnursesatregionalsiteswhoseeducationpresentedageographicchallenge.Thesevideoshavebeen incorporated intoannualcompetencyreviewandorientationforallnurses.Advancedpracticenurseswererecruitedastrainersandresources.Asinglepa-tienteducationbookletreflectiveoftheneworalprotocolreplacedthree previous documents. Noted challenges included maintainingliteracyparametersandutilizingfeedbackfromexpertreview.

Mucositis assessment andmanagement aredocumentedonmul-tipleformsspanningthisinstitution.Arduousrevisionswereneces-sarytoreflectthenewmucositisgradingsystem.Documentationre-viewsandpracticesurveyswilldiscernimpactonnursingpractice.

Promotingdevelopmentof evidence-basedpracticeshasbecomeconventional at many institutions. However, implementing thesechangesprovedmorecomplexthaninitiallyanticipated.Eachchal-lengewasmetwithdifferentstrategiesforaccomplishingthegoal.Communication, flexibility, and cooperation proved imperative tosuccessfulimplementationofthispracticechange.

2187SWEET’SSYNDROME.JenniferMartin,RN,BSN,OCN®,John’sHop-kinsHospital,Baltimore,MD.

Sweet’ssyndrome,otherwiseknownasacutefebrileneutrophilicdermatosis,isararedisorderandpotentialcomplicationofG-CSFadministration.Thoughthediseasepathophysiologyisnotentirelyunderstood,anunderlyingneutrophil-mediatedhypersensitivityre-actionisbelievedtoplayacentralrole.Approximately20-25%ofpatients with Sweet’s syndrome have an underlying, typically he-matologicmalignancy.Sweet’ssyndromemanagementposesuniquepracticeissuesfortheoncologynurse.

Thispresentationwilleducatenursesintheclinicalpresentation,identificationandmanagementofSweet’ssyndromebylookingatdifferent case studies. Early identification, intervention and treat-mentapplicationsarenecessarytoeffectivelyhealthepatientwhilediminishingtheirriskforinfectionandcontrollingpain.

The nursing care matrix includes early identification of lesionmanifestations,ensuringappropriatedermatologicalandwoundcareconsults, administrationof suitable treatmentsandsymptomman-agement.Whilestandardmedicationtherapyiscorticosteroids,otherdocumentedeffectivetreatmentsincludepotassiumiodide,dapsone,indomethacin, colchicine, and cyclosporine. Skin biopsy confirmsthe diagnosis of Sweet’s syndrome, with rapid improvement inboth symptoms and dermatological abnormalities after initiationofsystemicsteroidtherapy.Antibiotictreatmentprovesineffective;thereforeproperdiagnosisiscriticalforappropriatepatientmanage-ment.Appropriatewoundcareperformedbynursingis imperativetopreventinginfection.Paincontrolalsoremainsapriorityinthesepatients.

Earlyidentificationofthisrarecomplicationandappropriatetreat-mentapplicationsarekeyinmanagingSweet’ssyndrome.Monitor-ing infectious complications, effectivepainmanagement interven-

tions and the administration and response to the poly-pharmaceu-ticals are important nursing outcome measures that will facilitatetreatmentplanningandrecovery.

TheimplicationsofSweet’ssyndromeforoncologynursesaresig-nificant.Whileadministrationofcorticosteroidtherapyinmalignan-cy-associatedSweet’ssyndromeoftenpromptlyresolvessymptomsand lesions, early identification is important. In addition, identifi-cationofSweet’ssyndromerecurrencescouldalsobeindicativeofrecurrenceofthemalignancy.ItisnecessarytodistinguishSweet’ssyndromefromotherskindisorders,suchasherpessimplexandvar-icellazostervirusesorleukemiacutis,toavoidunnecessaryuseofantimicrobialorothertherapies.Sweet’ssyndromepracticefindingsmustbeaddedtothegrowingbodyofoncologynursingsymptommanagementevidencetoguidefurthernursingpractice.

2188CASE STUDY: LEUCOVORIN HYPERSENSITIVITY, MORE COMMONTHANYOUMIGHTTHINK.MarySchumann,RN,MA,AOCN®,Memo-rialSloan-KetteringCancerCenter,NewYork,NY.

Manyofthechemotherapy/biotherapyagentsthatareusedinthetreatmentofcancerhavethepotentialtocausehypersensitivityre-actions.IntravenousLeucovorinCalcium(LV),orfolinicacid,hasbeenusedinthetreatmentofgastrointestinalcancersformorethan50years.Hypersensitivity/anaphylactoidreactionislistedasarare,butpossiblesideeffectbythemanufacturerandmultipledrugrefer-ences,andmayoccurwitheitheroralorparenteraladministration.AthoroughreviewoftheliteraturerevealedonlyonedocumenteddescriptionofananaphylactoidreactiontoLV.

LVisusedincombinationwithagentsknowntocausehypersensi-tivityreactions.Thepurposeofthispresentationistoeducateoncol-ogynursestoconsiderseeminglybenigndrugs,suchasLV,asthecausativeagentofahypersensitivityreaction.Acasestudywillbepresentedtoillustratethispoint.

Amultidisciplinarygroupwithrepresentativesfromnursing,phar-macy, and physicians was formed that undertook a retrospectivereviewofAdverseDrugReporting(ADR)formsaswellasthecor-respondingpatientchartsofpatientsreceiving5-FU/LVcontainingregimensfromJanuary1toDecember31,2004.

Fromthisreview,aclusterofsymptomscharacteristicofareac-tiontoLVweredetermined.AtotalofsixpatientsfelttohavehadareactiontoLVwereidentified.Asaresultofourfindings,oncologynurseshavebeeneducatedtorecognizeLVasanagentcapableofcausinghypersensitivity,andphysiciansarenowconsideringdiscon-tinuingtheLVinpatientswhohaveexhibitedthissymptomclusterratherthanroutinelychangingthetreatmentregime.2189DEVELOPMENTOFANINNOVATIVETOOLTOSTREAMLINEHEALTHEDUCATIONFORCHILDHOODCANCERSURVIVORS.WendyLandier,RN, MSN, CPNP, CPON®, Karla Wilson, RN, MSN, FNP-C, CPON®,KellyFranklin,CRA,CCRP,LitonFrancisco,BS,CCRP,SeiraKurian,MD,MS,MPH,andSmitaBhatia,MD,MPH,CityofHopeNationalMedicalCenter,Duarte,CA.

Mostchildhoodcancersurvivorsareatriskforlateeffectsrelatedtotheircancertreatment,manyofwhichcanbeseriousorlife-threat-ening.Therefore,avitalaspectofnursingcarefor thisvulnerablepopulation includespatient education regarding the importanceoftargetedhealthscreening,protectivehealthcareinterventions,and/ormodificationofhealthbehaviorsinordertoallowforearlydetec-tionorpreventionoflatecomplications.

Awealthofpatienteducationmaterialsforchildhoodcancersur-vivorsisnowavailablefromtheChildren’sOncologyGroup.These

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materialsprovidecomprehensiveinformationregardinghealthrisksandhealthprotectivebehaviorsandarespecificallydesignedtoac-company the Children’s Oncology Group Long-Term Follow-UpGuidelines(availableatwww.survivorshipguidelines.org).Althoughwehavefoundthat thesematerialssignificantlyenhancecarepro-videdinourlong-termfollow-upprogram,wehavealsofoundthattheirlengthanddepthmaypresentchallengestoclinicalapplication,particularly for patients with limited reading abilities or languagebarriers.

Toaddressthisneed,theCityofHopeChildhoodCancerSurvivor-shipProgramhasdevelopedaninnovativetemplatethatsummarizeskey information fromtheseeducationalmaterials.Our template isarrangedbysystem(e.g.,ocular,auditory,cardiac)inmodularfor-matandincludesvisualcues(icons)andsimpletexttoassistpatientswithretentionofkeycontent.Byusinginformationfromourclinic’sMicrosoftAccess©database,thenurseisabletousethetemplatetoeasilygenerateacustomizedteachingtoolforeachsurvivorbasedontheirtreatmenthistory.Inordertomeettheneedsofourpatientpopulation,thisteachingtoolcanbegeneratedinbothEnglishandSpanish.

Theeffectivenessofthisinnovativetoolwillbeevaluatedbyde-terminingpatientadherencetorecommendedhealthscreeningandtheirunderstandingofrecommendedhealthpractices.

Childhood cancer survivors are heterogeneous in terms of age,diagnosesandtreatmenthistory.Thenursemust thereforeprovidehealth education that is comprehensive yet individualized, memo-rableenoughtoimpactpatientrecallandinfluencehealthbehaviors,andstreamlinedenoughtoaddressmajorhealthrisksinareasonabletimeframe.Useofthisinnovativeteachingtoolcanassistinaccom-plishingthesegoals.

2191KOREAN IMMIGRANTWOMEN’SPERCEPTIONSONBREASTCAN-CERSCREENINGPRACTICES:ACOMPARISONWITHTHEHEALTHBELIEFMODEL.EunyoungSuh,PhD,FNP,RN,SeoulNationalUni-versity,Seoul,Korea.

Inthismulticulturalsociety,decipheringculturalhealthbeliefsofaminoritypopulationisthefirststeptoeliminateethnichealthdispar-ity.AlthoughthenumberofKIWremarkablygrowseachyearandthe incidenceofbreastcanceralso increases,nostudy todatehasinvestigatedKIW’sin-depthperceptionswithregardtobreastcancerscreeningsandhascomparedtheirtraditionalhealthbeliefswiththevariablesoftheHBM.

Korean immigrantwomen (KIW) in theU.S. reported far lowerbreastcancerscreeningratesthanwomeningeneral.Theirculturalhealthbeliefsareassumedtoplayanimportantroleinperformingthewestern screeningprocedures.This studywasaimed to inves-tigateKIW’sperceptionstowardsbreastcancerscreeningsqualita-tivelyandtocomparethefindingswiththevariablesoftheHealthBeliefModel(HBM).

Threetheoreticalunderpinningsofthisstudyincludesymbolicin-teractionism, themeta-conceptofculturalcompetence,andacon-ceptofKoreanwomanhood.

Using the GroundedTheory methodology, twenty KIW, age be-tween20and81,wereinterviewedtwotimesconsecutivelyinKo-reanlanguage.

DataAnalysis:Thequalitativedatawastranscribedandanalyzedusingtheconstantcomparisontechnique.Thefirstlevelcodingwascarriedout inKoreaninordertopreserveanyKoreanculture-em-bedded expressionsor nuances.English translationoccurred fromthesecondlevelcodingconstantlycomparingthecontextualmean-ingsbetweentwolanguages.

Theoverridingthemewas“gettingacancer-freesentence”whichindicates that KIW are aware of and have utilized breast cancerscreeningsbutused themonly toapprove their cancer-free status.ThereasonwhytheydonotmaintainthepracticesattributestotheirtraditionalKoreanhealthbeliefs,whichisdiscordwithwesternlogi-calreasoningregardingbreastcancerscreening.Inaddition,KIW’sperceptionsonclinicalbreastexamandmammographyarecultur-allyembedded,thus,generateKIW’snon-adherencetothewesternprocedures. The comparisons of these findings with the variablesofHBMwerediscussed.This study shed lightson futurenursingresearchhowtoexploreminoritypopulationsregardingtheirtradi-tionalhealthbeliefsrelatedtowesternmedicalpracticesandtore-constructthestandpointsofwesternhealthcareproviders.

2192IMPROVING NURSE RETENTION THROUGH A COMPREHENSIVEONCOLOGY ORIENTATION PROGRAM. Colleen O’Leary, RN, BSN,OCN®,BarbaraHolmesGobel,RN,MS,AOCN®,andLesleyVancura,RN,MS,NorthwesternMemorialHospital,Chicago,IL;ValerieSmith,RN,BSN,OCN®,HPCN,NorthwesternMemorialFacultyFoundation,Chicago,IL;andSarahWitt,RN,BSN,OCN®,andYvetteVo,RN,BSN,OCN®,NorthwesternMemorialHospital,Chicago,IL.

TheRNvacancyratewillbe20%withanestimatedshortageofonemillionnursesbytheyear2020.Nurseturnoverisacostlyprob-lemthatwillcontinueashealthcarefacesthisshortage.Thesecostsarebothfinancialandpatientcentered.Thecostofreplacinganurseis1.5-2.5timesthenurse’sannualsalaryputtingfinancialstrainoninstitutions.

Groupcohesionandsatisfactionwithwork,includingfeelingcon-fidentwithskillsarethegreatestpredictorsofanurse’sintenttostayin their institution.Aprogram focusedondevelopmentof criticalthinking skills, patient caremanagement and enhancementof selfconfidence will positively affect nurse retention rates and patientoutcomes.

TheFundamentalsofOncologyNursing(FON)programisacom-prehensive16weekprogramaddressingpsychosocialissues,criticalthinking,andskillacquisition.Eachclassincludesadiscussionad-dressingthepsychosocialissuesfacedbynurses,aswellasinstruc-torledmodules.Labtimeisincludedinsomemodules.Classesareheld on a continuous rotating basis. Continuing education credits(CEUs)areawardedforeachmodule.Aftercompletingtheprogram,enoughCEUswillhavebeenobtainedtoqualifyfortheOCNexam.Anevaluationisdoneatthecompletionoftheprogram.

Evaluations rate areasof logistics, critical thinking skills/patientcaremanagement,selfconfidenceandretention.AllareaswereratedonaLikertscaleof1-5.Scoresrangedfrom3.2–3.8withanaver-ageof3.7.Theyearlygoalfornurseturnoveris9orbelow.PriortoimplementingtheFONprogram,theturnoverratewas10.Sincebeginningtheprogramtheturnoverrateis4.Thesenumbersdonotclearly identify if someone leaving did or did not go through theprogram.Thiscouldaffecttheaccuracyofthenumbers.Nurseswereabletoidentifythathavingthisprogramhelpedintheirdecisiontostay.Furtherstudyshouldbedonetofindanycorrelationbetweentheprogramandimprovedpatientoutcomes.

The Fundamentals of Oncology Nursing program addresses thedevelopmentofcriticalthinkingskills,patientcaremanagementandimprovementofselfconfidenceandaffectsjobsatisfactionandre-tentionofnursesinourinstitution.

2193ONCOLOGYNURSINGCERTIFICATION:WHEREWEAREANDWHEREWENEEDTOGO.CarltonBrown,RN,AOCN®,TheGenevaFounda-D

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tion,Lakewood,WA;LoriNicholson,ColoradoSprings,CO;andJuliePonto, RN, AOCN®, APRN-BC, Winona State University, Rochester,MN.

Sinceitscreationmorethantwentyyearsago,theOncologyNurs-ingCertificationCorporation(ONCC)hasmadesignificantadvanc-esinthedevelopment,administration,andevaluationofcertificationprograms for oncology nurses. ONCC currently develops and ad-ministerscertificationprogramsinbasicadultandpediatriconcol-ogy,andadvancedcertificationforoncologyclinicalnursespecial-istsandoncologynursepractitioners.Over24,000oncologynursesholdoneoffivecredentialsofferedbyONCC.

Thepurposeofthispresentationisthreefold:1)explorethe20-yeargrowthofcertificationinoncology,2)describethegeographicaldis-tributionofoncologycertifiednurses,and3)summarizetheresultsofarecentnationalsurveyontheperceivedvalueofcertificationandfutureresearchquestionsofimportancetonursingcertification.

Thispresentationwillusetheuniqueapproachofpresentingase-riesofmapsshowing thedistributionofoncologycertifiednursescomparedtothelocationanddistributionofotherrelevantdatasuchas Magnet hospitals, ONCCAdvocates, ONS members, and RNsnationwide.ResultsofarecentAmericanBoardofNursingSpecial-ties(ABNS)surveyexaminingthevalueofcertificationwillbein-troduced.TheABNSsurvey,conductedwithONCCparticipation,wasadministeredtoanationalsampleofcertifiedandnon-certifiednursesandasmallsampleofnursemanagers.Studyresultsincludetheperceivedvalueofcertification;thebarriers,benefitsandrewardsofcertification;andtheimpactofcertificationonlostworkdaysandretention.Responsesfromoncologynurseswillbehighlightedandcompared to thoseof respondents inotherspecialties. Inaddition,this presentation will identify exciting future opportunities withinONCCintheareasofresearch.2194CREATING FUTURE ONCOLOGY NURSES THROUGH DIVERSITY,OUTREACHANDMENTORSHIP:THEONCOLOGYNURSEMENTOR-SHIPPROGRAM.KellyBrittain,RN,MSN,KarenGoldman,RN,MSN,AOCN®, Denise Henderson, RN, MSN, CHES, Carmen Stokes, RN,MSN,FNP,andElizabethGalvin,RN,MSN,AOCN®,KarmanosCancerInstitute,Detroit,MI.

Concurrentwiththegeneralnursingshortagethereistheshortageofnurses interested inpursuingoncologynursingasacareer. In2004,theBarbaraAnnKarmanosCancerInstitutedevelopedandimplemented the Oncology Nurse Mentorship Program (ONMP)toaddress thecurrentand futureneed formoreoncologynursesandtheprojectedneedforamorediversestaffofoncologynurses.TheprogramisapartnershipbetweentheDetroitPublicSchools,UnitedWayofSoutheasternMichiganandalocalbankinginstitu-tion.

ThepurposeoftheOncologyNurseMentorshipProgram(ONMP)istoincreasethenumberofDetroityouthsinterestedinpursuingoncol-ogynursingcareers.TheONMPprovideshighschooljuniorsandse-niorsamentorednursingexperienceattheKarmanosCancerCenter.

TheONMPprovidesstudentswithanoncologynursementoranda 6-week, 4-day per week paid experience providing exposure tooncologynursingthroughrotationsonthenursingunitsandoutpa-tientchemotherapy,learningbasicnursingskills,aswellasdidacticpresentationsfromvariousoncologynurses.Eighteenstudentshavecompletedtheprogram.

Short-termgoalsweremeasuredbycompetencyinbasicinfectioncontrol,executionofbasicnursingskills,assessmentofbasiccan-cerknowledgeandmentoringexperiencesatisfaction.Since2004,100%of the studentshaveattained the short-termobjectives.The

long-term outcomes have 50% of the students leveraging this op-portunitytoenhancecompetitivenessforadmissiontoundergradu-ateeducationprograms,50%ofthestudentsenteringandgraduat-ingfromanaccreditednursingprogramandasanoncologynurse,theformerstudentseeksopportunities tomentorotherstudentsoroncologynurses.Todate,88%of thecollegeeligiblestudentsareattending college. 57% of the students are either completing pre-requisitesfornursingorareinanursingprogramandareinterestedinoncologynursingupongraduation,and28%havechosenotherhealthcarecareers.

Programsforhighschoolstudents,liketheONMP,havefarreach-ing implications in proactively addressing the oncology nursingshortage and diversity issues.The ONMP incorporates education,outreachandmentorshipand reachesstudentsatacritical time intheirselectionofcareersandbringslighttooncologynursingarela-tivelyunexposedareaofnursing.

2195HOW MUCH BLOOD IS ENOUGH? AN EVIDENCE-BASED STUDYONTHEMINIMUMBLOODVOLUMEREQUIREDFORLABORATORYTESTS.WandaRodriguez,RN,MA,CCRN,DoreenMcCarty,BSN,RN,CPAN,AnnMarieO’Donnell,RN,JoyceKane,MSN,RN,CCRN,Steph-anieNolan,BS,RN,andCristinaCarlese,MA,RN,CCRN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Frequentbloodsamplingforlaboratorytestingcanbeanunneces-sarysourceofbloodlossinthecriticallyilloncologypatient.Theincreased number of analytes measured combined with increasedfrequency in testingandeasiercollectionwitharterialandvenouscatheterscandirectlyleadtoiatrogenicanemia.

Ascriticalcareoncologynurseswerecognizedourroleinperform-ingthemajorityofthesetests.Wewantedtoseekpreventivestrate-giestominimizeexcessivebloodlossanddecreasethepatient’sriskforanemia.

Anevidencebasedreviewoftheliteraturewasconductedtodeter-minetheminimumbloodvolumerequiredtorunselectedlabtests.Atotalof26articlesfromCINAHL,PubMed,MEDLINE,Google,TheCochraneLibrary,andEvidenceMatterswerereviewed.Therewerea limitednumberofmeta-analysis,randomizedexperimentaldesign,quasi-experimentalandnon-experimentalstudiesrelatedtobloodconservingmechanisms.Expertopinionsandguidelineswereevaluated.CommitteemembersfromthePACUandICUrankedtheevidencebasedontheStetlerModel.

Thecurrentevidencesupportsusingsmallervolumevacuumcol-lectiontubesforspecifiedlaboratorytestssuchastroponinandbasicmetabolicpanel.Thecommitteeconcludedthatbloodvolumeneed-edtoperformchemistrytestsinourdepartmentscouldbereducedbyhalf.InPACUandICUthisleadtotheuseofthesmallerplastic4mltubesversusthelarger8mlglasstubes.Inaddition,thesmallertubesarelesslikelytocausehemolysis,duetolessvacuuminsidethetube.

Currentlimitationstoapplyingtheevidencefromthisreviewcon-sistof restricting thechange tocritical careareas.This isprimar-ilydue to theexcessivenumberof“addon” tests requiredon theinpatientunits.However, thisisundergoingfurtherdiscussionandexploration.

Moving forward we will track blood product usage, specificallyRBCtransfusions,inanattempttodeterminethesuccessofthisnewpractice.

2198IMPROVING TELEPHONE SERVICE IN AN OUTPATIENT GYNECO-LOGIC ONCOLOGY CENTER. Catherine Burke, MS, APRN-BC, ANP,

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AOCN®,RussellContent,MBA,MaryJones,RN,BSN,ShineyKurian,MSN,WHNP,ValsammaPhilip,RN,andChristiMcLen,UTM.D.An-dersonCancerCenter,Houston,TX.

TelephoneserviceinouroutpatientGynecologicOncologyCenterneededimprovement.Thereceptionistshaddifficultymanagingthevolumeandcomplexityofincomingcalls,callsrequiringrapidreplyweresometimesmis-triaged,andcallswereoftennotdirectedtothemostappropriatepersonnel.Metricsoftelephoneserviceindicatedahighdegreeofinefficiency.Staffexpresseddis-satisfactionwiththeexistingprotocol.

Amultidisciplinaryteamrepresentingclinicnurses,APNs,physi-cians,receptionists,patientschedulers,andtheclinicbusinessman-ager was formed. OurAIM statement was to improve the patientphonecallexperiencethroughtheuseofamoreeffectivemessagingsystemandprocess.Wevoicedourcommitmenttoexcellentpatientcare,patientsatisfaction,efficientuseofresources,andteamwork.

Multipleproblemswiththeexistingsystemwereidentifiedandso-lutionsweredeveloped.Callvolumewasaddressedbyimplement-inganautomatedroutingmessagethatdirectedspecific,non-urgentcalls (i.e. scheduling an appointment) to the appropriate staff. Aprocesswasestablishedtodistinguishurgentfromnon-urgentcalls.Itwasdeterminedthatnon-urgentcallswouldbeansweredwithin24hours,andanalgorithmtoensurerapidresponsetourgentcallswasdeveloped.Acustomizedclinicphonedirectorylistingservices,personnel, and contact numbers was provided to patients. Provid-erswereencouragedtophonepatientsassoonaspossiblewithkeyresultsand treatment recommendationsasaproactiveeffort to re-ducecalls.Theteamalsorecognizedthatsuperiortelephoneservicewouldrequireongoingassessmentandrecommendedthatastandingcommitteeremaininplace.

After implementation of these procedures, metrics of telephoneserviceshoweda44.7%reductionintheabandonedcallrateanda32.8%reductionintheaveragespeedtoanswercalls.Subjectively,weobservedimprovedteamworkandstaffsatisfaction.Patientsatis-factiondataisbeingcollected.

Theinvolvementofkeystakeholdersresultedinimprovementsinourtelephonemessagingsystem.Thishaspermittedallclinicstafftobetterintegratetelephonerequestsforserviceintotheirregulardailyworkflow.Providingpatientswithexcellentphoneservicerequiresanongoingfocus.Adedicatedteamisessentialtomonitorandas-sessanexistingphonesystemsothatdeficienciescanberecognizedandcorrected.

2199A MULTIDISCIPLINARY APPROACH TO SAFE CHEMOTHERAPYADMINISTRATION—OVERSIGHT IN AN NCI-DESIGNATED CANCERCENTER.WendyMiano,DNP,MSN,RN,AOCN®,IrelandCancerCen-ter,Cleveland,OH.

Patient safety is an intrinsic value at University Hospitals CaseMedicalCenter(UHCMC).TheInstituteforSafeMedicationsPrac-tices(ISMP)providedanonsiteproactiveriskassessmentatUHC-MCinApril2006.TheIrelandCancerCenteratUHCMCcomprisescrossservicesandmultiplesettingsinambulatoryandinpatientser-vicesforchildrenandadults.ISMP’srecommendationshasencom-passed pediatric and adult chemotherapy practices and processes,withanemphasisoncommunication.

Amultidisciplinarytaskforcemadeupofoncologyservicespro-viderswasconvenedwithmedicalandnursingleadership.ISMPrec-ommendedaworkableprocesstocommunicateappropriateoncol-ogypatientinformation(chemotherapyprotocols,treatmentdate(s),andresponsetotreatment),bothInpatientUnittoICCAmbulatoryUnitandICCAmbulatoryUnittoInpatientUnit

Intheabsenceofanintegratedelectronichealthrecord,amanualprocedure for communicating and documenting inpatient chemo-therapy(adultandpediatric)intheIrelandCancerCenter(ICC)Am-bulatoryUnitmedicalrecordhasbeenimplemented.

ToaddresscommunicationofICCambulatorychemotherapygiv-entotheinpatientsetting,aninformationtechnologyconsultantisdevelopinga‘ChemotherapyandOncologicAgentsAdministrationReport’ (tied to current Clinical Physician Order Entry computersystem).

An audit specific to increasing communication of inpatient che-motherapytoICCAmbulatoryUnithasbeenconducted.Giventhetwo-foldprocessinadultpractice,inpatientchemotherapyMDor-dersfiledinICCmedicalrecordreflecteda90%successfulcompli-ance.Documentationof inpatientchemotherapygivenon the ICCchemotherapyflowsheetreflected70%successfulcompliance.ThepediatricinpatientchemotherapygivendocumentedinICCAmbula-torymedicalrecordwas70%compliantinfirstchartaudit.Pediatricnursingstaffeducationandreinforcementofdocumentationcontrib-utedtoa90%successfulcomplianceinthesecondaudit.Ongoingstaffeducationandauditswillcontinuewithabenchmarkof90%successfulcompliance.

Instilling a culture of patient safety across disciplines as it re-lates to overall oversight of chemotherapy administration is ourprimary focus. Communication of chemotherapy and oncologicagentsgiveninbothambulatoryandinpatientsettingsrepresentsacomplexchallenge.ICC’sOncologicServicesMedicationQualityandSafetyTaskForcewill continue tochampion initiatives spe-cifictopatientsafety,quality,andimprovedcommunicationacrossservices.

2200CREATINGACOMPREHENSIVESTAFFDEVELOPMENTPROGRAMINANEWCANCERCENTER.CarolBlecher,RN,MS,AOCN®,APNC,andJeanetteBarefoot,RN,MSSL,OCN®,TrinitasComprehensiveCancerCenter,Elizabeth,NJ;andNormaBellarmino,RN,BSN,TrinitasHos-pital,Elizabeth,NJ.

WiththeopeningofanewCancerCenterourintentwastocreateaworkculture inwhichnursesareable topracticeautonomouslywithinasupportiveandempoweringenvironment.Inreviewingtheliteratureoneofthemosteffectivemethodstoachievethisoutcomeistoeducatethestaff,givingthemthetoolswithwhichtoputtheoryintopractice.

The purpose of this program is to support education, empowerstaff,andpromotequalitycancercareinboththeCancerCenterandInpatientUnit.Asecondgoal is topromoteoncologycertificationthroughtheprovisionofprograms,educationandassistanceinpre-paringforthecertificationexam.

Alearningneedssurveywasdevelopedanddistributedforthepur-poseofassessingandidentifyingstaffneedsforeducationaswellascurrentpracticelevels.

ProgramsweredevelopedandpresentedthatbuiltontheidentifiedneedsandutilizedthecontentoftheCoreCurriculumforOncologyNursing.

Astudygroupwasformedasthenursesbeganpreparingforthecertificationexamandminiin-serviceswerepresentedbasedontheidentifiedneedsofthegroup.

SinglepagestudysheetsweredevelopedforOncologicEmergen-cies.

AJournalClubwasinstitutedtwomonthsagowithmeetingsonamonthlybasis.

TheLearningNeedsSurveydemonstratedknowledgedeficitsre-garding thebasic scienceofoncology, symptommanagementand

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criticalthinkingskills.Inanefforttomeettheseneedstheinterven-tionslistedabovewereinstituted.

Thestudygroupconceptappearstohavebeensuccessful,asthetwonurseswhoparticipatedbothpassedtheOCNexam.

2201THEUSEOFASTAFFRETREATWITHAGRIEFCOUNSELORFORIN-PATIENTMEDICALONCOLOGYNURSESTOASSISTWITHBEREAVE-MENT AND COPING. Susanne Fessick, RN, BSN, OCN®, HCA/CJWMedicalCenter,Richmond,VA.

Onadailybasis,inpatientmedicaloncologynursesmustcopewithdeathanddying.However,mostinstitutionsdonothaveaprocessinplacewhichallowsnursestheopportunitytoexpresstheirfeelingsofgriefandloss.Theendresultmaybestressandburnout.

Thepurposeofthisretreatwastogivethemedicaloncologystaffanopportunitytotalkaboutthelossoftheirpatients,howthisaffectsthem,andhowtheycopewiththisloss.Additionally,ithelpedthemtoidentifycurrentcopingskills,learnnewstrategies,andtocontinuetoprovidecareinacompassionateandcaringmanner.

Asixhourretreatfacilitatedbyagriefcounselorwasheldatourcancerresourcecenterattendedbytwentymedicaloncologynurses.Agriefcounseloreducatedthestaffonmethodstoimproveunder-standingofgriefandhowtohelponeselfthroughit.Thestaffwereinstructedonjournalingandencouragedtorecordtheimpact theyhadmadeontheirpatientsandfamilies.Alsostressreductionanddeepbreathingexercisesweretaughtandallweregiventheopportu-nitytodiscusstheirfeelings.

Attendanceattheretreatandverbalfeedbackwerestrongindica-torsof its success.Althoughnotmandatory, overhalf of the staffattendedandallrespondedpositivelyandfelttheprogramwasrevi-talizing.Somestatedtheyhadneverbeengiventheopportunitytogrieveanddidnotknowotherswerefeelingsimilaremotions.Thestafffelttheyweregivenkeytoolstohelpdealwiththeireverydaystressandtoimprovetheirabilitytocope.Anunplannedbenefithasbeenacloserandstrongerteam.Ayearlater,allthenurseswhoat-tendedtheretreatarestillemployed.

Practicingasanoncologynursecanbestressfulandattimesde-pressing.However,helpingnursestorealizetheimpactandcontri-butiontheymaketotheirpatients’andfamilies’livesandallowingstafftheopportunitytodiscusstheirexperiencewithdeathanddyingcanbebothpowerfulanduplifting.Theendresultmaybeincreasedvaluetoyourpatients/familiesaswellastoyouroncologyteam.

2202ONCOLOGYNURSES’PERCEPTIONSOFCOMMONPATIENTPROB-LEMSENCOUNTEREDINCARE.ElizabethJohnson,RN,MSN,AOCN®,AOCNS,MassachusettsGeneralHospital,Boston,MA.

Nursingcareinvolvesthemanagementofclinicalproblemsrelatedtodiseaseortreatment.Nursingcareisoftenmultidimensionalre-quiringongoingcriticalanalysisofcompetencyandstaffingneeds.Oncologynursingcanbeespeciallycomplexgiventhemultipleor-ganinvolvementrelatedtothemalignancy,diseaseprogression,andtreatmentsaswellastheoverlayofpsycho-socialconsiderations.

To describe the perceptions of oncology nurses in an academicmedicalcenterregardingcommonpatientproblemsencounteredindailyclinicalpracticeandtheirpreparednesstomanagethem.

BrendaLyon’sDisease/IllnessParadigmAsecondaryanalysisofdataobtainedfromnursesinanacademic

medical centerwhowere surveyedabouthow frequently theyen-counteredeachof27clinicalproblemsintheirdailypracticealongwith their self-perceived preparedness to manage each problem.The listofproblemswasgeneratedbyadiversegroupofclinical

nursespecialists.Subsetsofdataforinpatientandinfusiononcologynurseswerecomparedwitheachotherandwiththeresponsesofallnursesintheinstitution.

Amongthetopfiveproblemsmostfrequentlyencountered,anxietyandknowledgedeficitwereidentifiedbyallthreegroups.Theinfu-sionnursesand inpatientoncologynurseshadscoresnear90per-centonpreparednesstomanageanxietyascomparedwithascoreof83forallnurses.Preparednesstomanageknowledgedeficitscoresweresimilarat85percentinallgroups.Infectionwasamongthetopfiveproblemsforallnursesandtheinpatientoncologynurses,withpreparednessscoresnear90percent,but infectionwasnotamongthetopfiveproblemsencounteredbytheinfusionnurses,perhapsre-flectingabasicdifferencebetweeninpatientandoutpatientpopula-tions.Ontheotherhand,ethicaldilemmasrelatedtoend-of-lifecarewas themostfrequentlyperceivedproblembythe infusionnursesbutwasranked11.5/27bytheinpatientoncologynursesand18/27byallrespondents,perhapsreflectingthatinfusionnursesoftenseepatientsclosertothetimeoftheircancerdiagnosis.

The findings provide data to guide the clinical nurse specialistin planning quality improvement surveys and developing inter-ventions to meet the knowledge needs of oncology staff nurses.

2203EXTREMEMAKEOVER:THEADULTBONEMARROWTRANSPLANTCLINIC EDITION. Laura Turkel, RN, BSN, Duke University MedicalCenter,Durham,NC;andCynthiaBesas,RN,BSN,OCN®,DukeMedi-calCenter,Durham,NC.

Hospitaldemolition,constructionandrenovationprojectspresentimmunocompromised patients who receive treatment at an outpa-tientAdultBoneMarrowTransplantClinicwithincreasedriskofin-fectionduetotheintroductionandspreadofairbornecontaminantssuch as nosocomial fungal spores, long hidden behind walls andceilings,intotheoutpatientAdultBoneMarrowTransplantClinic.As hospitals expand their facilities to meet rising patient demandnursingstaffmusttakespecialcaretoprotectimmunocompromisedpatientsfromthedangersposedbyairbornecontaminants.

The purpose of this presentation is to illustrate, as an exemplarfromoneinstitution,keyinfectioncontrolriskassessmentandcon-structionguidelinesthatwereconsideredindevelopinga“Plan”toprotect outpatient Adult Bone Marrow Transplant Clinic patientsfromexposure toairbornecontaminantsresultingfromdemolitionandconstruction.Thispresentationwillalsoidentifyimportantin-fectioncontrolguidanceprovidedbytheCenterforDiseaseControlandtheJointCommissionforAccreditationofHealthCareOrgani-zations.

Routine hygiene and isolation protocols within the outpatientAdultBoneMarrowTransplantClinicarenotenoughtoprotectim-munocompromisedpatientsfromairbornecontaminantsintroducedduringdemolitionandconstruction.Clinicstaffmustpartnerwitharchitects,constructioncrews,housekeepingstaffandinfectioncon-trolpersonneltounderstandandassessthespecialneedsofClinicpatients,todevelopa“Plan”andtoimplementeffectivemonitoringandinfection-controlprocedures.

The success of the processes implemented will be measured bycomparinghistoricaldata reflecting incidencesof fungal infectionwithdataderivedduringtheperiodofdemolition,constructionandrenovation.Theshort-termvalueoftheprogramismeasuredbythecostoftheprogramversusin-patienthealthcarecostsresultingfromcomplicationsordeathduetoavoidableinfection.

OutpatientAdultBoneMarrowTransplantClinicstaffplayavi-talroleashealthcareprovidersandpatientadvocatesinassessingpatientrisks, indevelopingthe“Plan”andinpromotingprocesses

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andprocedurestomonitorandreducethepotentialforinfectiontooutpatientAdultBoneMarrowTransplantClinicpatientsduetoin-fectiousairbornecontaminants.

2204PROFESSIONAL BEREAVEMENT AND RESILIENCY: WHAT DOESTHISMEANTOONCOLOGYNURSES?MichelleGrover,MSN,MBA,RN,OCN®, andSharonKrumm,PhD,RN,SidneyKimmelCompre-hensive Cancer Center at Johns Hopkins, Baltimore, MD; JenniferWenzel,PhD,RN,CCM,andMayaShaha,PhD,MSc,RN,JohnsHop-kinsUniversitySchoolofNursing,Baltimore,MD;SusanBauer-Wu,DNSc,RN,Dana-FarberCancerInstitute,Boston,MA;andDiannSny-der,MSN,RN,JohnsHopkinsHospital,Baltimore,MD.

Oncologynursesinvestconsiderablephysicalandemotionalener-gyincaringfortheirpatients.Whenpatientsdie,nursesmayexperi-enceacuteorlatentfeelingsofgrieforasenseofmeaninglessness.Ifnursesareunsupportedwiththeselosses,theymayburn-out,choosetoleavetheworkplace,oroncologynursingaltogether.Whensup-portedintime-sensitiveandhelpfulways,nursescreateandshareaculture of self-care and self-respect.This supportive work culturepromotesawiderrangeofinterpersonalfunctioning,wellnessandresiliency, thereby potentially reducing staff inclinations to termi-natepositionsorthespecialty.

The purpose of the Staff Bereavement and Resiliency Program(SBRP) at this NCI designated comprehensive cancer center is topromoteasupportiveworkcultureforadultandpediatriconcologynursesbasedonresultsfromamixedmethodsstudy.

Focusgroupswereheldwithstaffnursesinordertoidentifydiffer-entaspectsofbereavementandwork-relatedstress,currentsupportfor managing stress, as well as potential stress-reducing self-careinterventions.Followinganalysisofthefocusgroupresults,anelec-tronicsurveywassenttoeveryadultandpediatriconcologynursetofurtherclarifythemesidentifiedinthefocusgroupsandtolearnmoreabouttheimpactofstressonthenurses.Specificinterventionsidentifiedbythesurveyresultswillbeimplementedtobettersupportthesenursesatindividual,unit,anddepartmentallevels.

Eachintervention’seffectivenesswillbeevaluatedbythenurses.Nurse satisfaction,patient safety, absenteeism, andnurse turnoverandvacancydatawillalsobeevaluated.

Itisimportanttolearndirectlyfromthestaffwhattheyidentifyassignificantwork-relatedstressorsandwhatinterventionstheybelievecan best support them. Experienced, professional oncology nursescontributesignificantlytopatients’well-beingandclinicaloutcomes,andtotheadvancementoftheartandscienceofoncologynursing.Oncologynursesarepreciousresourcesandshouldbenurturedandsupported.ThisSRBPprogramcanserveasamodelforothercancercentersinsupportingandnurturingtheironcologynurses.

2205DEVELOPMENTANDBENEFITSOFAMINIMALLIFTPROGRAMONANIN-PATIENTONCOLOGYUNIT.MaryMielnicki,RN,BSN,andLisaLewis,RN,BS,MBA,CNA,NorthwesternMemorialHospital,Chicago,IL.

In-patientoncologyunitsareseeinganincreaseofadmissionswithadiagnosisofcancerwith treatmentsplansforsymptommanage-ment,treatmentgoalsandpalliativecare.AccordingtotheAmericanCancerSocietyitisestimatedthattherewillbeover1,399,790newcases of cancer in 2006. Oncology patients experience increasedmobilityproblemsrelatedtosideeffectsofchemotherapytreatmentregimens,boneymetastasesandgeneralizedde-conditioning.

NorthwesternMemorialHospital(NMH)experiencedariseinbar-iatricpatientshospitalwideaswellasanincreaseofpatientswith

mobilityissuesontheirthreeoncologyunits.InsupportofNorth-westernMemorialHospital (NMH)“BestPeopleandBestPatientExperience”,NMHpiloted4in-patientunitswithaminimalliftpro-gram.Oneofthepilotunitswasathirtybedhematologyoncologyunit.Thegoaloftheprogramwastodecreasethepatienthandlingandemployeeincidents,lostandrestricteddaysandrelatedcostby20%.

Eachpilotunitreceivededucation,training,mechanicalliftequip-mentandotherapprovedpatienthandlingaids.Anassessmenttoolalgorithm that identified physically dependent patients and proce-durestosafelyaddressthehandlingandmovementofeachpatientwas provided. Documentation was performed on each patient pershift and updated as patient’s needs changed; this was one of themetricsusedforprogram.Superuserswereassignedoneachpilotunittoassistwithtroubleshootingandthetrainingofnewstaffandongoingeducationontheunits.

Keymetricsusedwere:lostandrestrictedworkdays,workersandcompensation cost, assessment and documentation, pre and postimplementationsatisfactionsurveys.Results,thepilotprogramsur-passedtheoriginalgoal toreducepatienthandlingrelatedinjuriesandcostby20%.Insteaditachievedthefollowing:77%reductioninincidents,99.9%reductioninlost&restricteddays,and99.6%reductioninincurredandreplacementcost.

Ontheoncologyunittherewasanaddedbenefitoftheminimalliftprogram.Patientswhohadusedtheliftequipmentfortransfersfrombedtocartorbedtochairexperienceddecreasepainonmovementandanaddedsenseofsafetyandsecurity.

2206GASTROINTESTINAL SYMPTOMS AND GROWTH PATTERNS INCHILDREN POST BONE MARROW TRANSPLANT. Cheryl Rodgers,RN,MSN,CPNP,CPON®,PatriciaWills-Alcoser,RN,MSN,CPNP,Re-becca Monroe, RN, MSN, CPNP, Lisa McDonald, RN, MSN, CPNP,MelisaTrevino,RN,MSN,CPNP,andMarilynHockenberry,PhD,RN-CS,PNP,FAAN,TexasChildrensCancerCenterandHematologySer-vice,Houston,TX.

Childrenareatriskfor long-termmalnutritionafterabonemar-row transplant (BMT) due to poor oral intake, altered absorptionandincreasedmetabolicdemandsasaresultofmedicalcomplica-tionsand/ormedicationtoxicities.Despitetheseknownrisks,littleresearchhasbeenperformedtoevaluatelong-termnutritionalissuesinchildrenpostBMT.

The purposes of the study were to identify the growth patternsandgastrointestinal(GI)symptomsinchildrenduringthefirstfourmonths post BMT, and to assess if an association exists betweenacutegraft-versus-hostdisease(GVHD)andgrowthpatternchangesorGIsymptoms.

TheUniversityofCaliforniaSanFranciscoSymptomManagementModel,whichemphasizestheneedforathoroughassessmentofthesymptomexperiencetoguidesymptommanagementandavoidneg-ativeoutcomes,providedaconceptualframeworkforthisresearch.

Thisdescriptivestudyusedaprospective,longitudinalcohortde-sign.Aconveniencesampleof45childrenreceivinganallogeneicBMT completed the Memorial Symptom Assessment Scale andanthropometric measurements before BMT then 2 months and 4monthspostBMT.Dataanalysiswasperformedwithrepeatedmea-sureANOVA to evaluate anthropometric changes, descriptive sta-tistics to analyze GI symptoms and a t-test and chi-square test toevaluateanthropometricmeasurementsandGIsymptomsbetweenchildrenwithandwithoutGVHD.

Allanthropometricmeasurementsofchildrenshowedasignificantchange over the 4-month period.The mean height increased over

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the 4 months with all other anthropometric measurements includ-ing weight, skinfold triceps and midarm circumference showed asignificantdecrease.Therewasacommonoccurrenceofsymptomssuchaslackofappetite,nauseaanddiarrheathroughouttherepeatedmeasures.Nostatistical significantdifferencewasnoted inanyoftheanthropometricmeasurementsorfrequencyofGIsymptomsbe-tweenchildrenwithandwithoutGVHD.Childrenexperiencesever-alGIsymptomsthroughouttheBMTrecoveryphasethatcanleadtopooroutcomes,suchasweightloss.Nursesneedtomonitorpatients’GI symptoms frequentlyduring theacuteBMTrecoveryphase toidentifychangesthatrequirenutritionalassistanceinordertoguidesymptommanagementtoachievepositiveoutcomes.

FundingSources:OncologyNursingFoundationthroughanunre-strictedgrantfromOrthoBiotechProducts,L.P.2208HUMAN PAPILLOMA VIRUS AND CERVICAL CANCER: AN EDUCA-TIONALPROGRAM.ElizabethJohnson,RN,MSN,AOCN®,AOCNS,ColeenCaster,MSN,FNP,MarthaHaverly,MSN,WNP,ShelleySen-nott,BSN,RN, andPatriciaHojnowski-Diaz,MSN,MPH,RN,Mas-sachusettsGeneralHospital,Boston,MA.

Human PapillomaVirus (HPV) is the leading cause of cervicalcancer, raising concerns about transmission, sexual practices, andageofsexualactivity.Therecentavailabilityofpapillomavirusre-combinantvaccine(Gardasil)shouldhaveasignificantimpactwitha potential for reducing the incidence of this malignancy by wellover90percent.

Toeducatenursesabout thepathophysiologyofHPVleading tocervical cancer and new clinical strategies to prevent this malig-nancy

AgroupofgynecologiconcologynursesplannedandpresentedaNursingGrandRoundsprogram,whichwasaccreditedforcontinu-ingeducationcredit,onHPVandCervicalCancer fornursesatamajormedicalcenter.Theprogrampresentedevidence-basedinfor-mationonthehumanpapillomavirus(types6,11,16,and18),shorttermconsequencessuchasgenitalandbuccallesions,longtermcon-sequencessuchascervicalcancerandheadandneckcancers,pre-ventionofinfection,andtheprojectedimpactofthepapillomavirusrecombinantvaccine.Presentersalsodiscussedhowtoeducatepar-entsabouthavingtheirpuberty-ageddaughtersvaccinatedaswellasdiscussingconcernsaboutpastexposurewithpatientsinactivetreat-mentforcervicalcancer.Twenty-fournursesattendedtheprogram,andtheevaluationformswereoverwhelminglypositive.

Giventhatnursesingeneralareofteninapositiontodiscusshealthpromotionwiththeirpatients,theyshouldbeknowledgeableabouttherisksofcervicalcancerrelatedtosexualpracticesandtheavail-abilityofapreventativevaccine.ThispresentationwasrecordedandwillbeavailableforviewingonDVDforthenextyear,sothatnursesonoffshiftsorotherwiseunabletoattendtheoriginalpresentationcanbenefitfromtheinformationandreceivecontinuingeducationcredit.

2210NURSINGLEADERSHIPROLESINTHEPHARMACEUTICALINDUS-TRY. Susan Newton, RN, MS, AOCN®, AOCNS, Oncology NursingAdvantage,Dayton,OH;andChristinePence,RN,MSN,OCN®,Glaxo-SmithKline,Collegeville,PA.

Theincreasingcomplexityofthedrugdevelopmentprocessaswellastheadvancedsophisticationofnewlyapprovedoncologyagentshascreatedaheightenedneedfornursestoassumeleadershiprolesbothduringthedrugdevelopmentprocessandin theeducationofclinicalprofessionals.

ThePINSIGhasbrainstormedideasforapodiumpresentationandagree that the followingareasarewhatnursesmostaskquestionsabout,anditisourroletoexploreandanswerthem.

Thepurposeof this analysis is to explore thevarietyofnursingleadershiproleswithinthepharmaceuticalindustryandunderstandwhat it takes to enter this unique career path and develop into astrongnursingleaderwithinindustry.TherolesandresponsibilitiesoftheClinicalMonitor,ClinicalEducatorandClinicalScientistwillbediscussedandskill setswhichareexpectedof thosenurses in-terestedinenteringthefield.Non-traditionalindustryroleswillbementioned,includingtheconsultantrole,marketing,andmanagerialopportunities.

Thefollowingprocesses/questionswillbeaddressed:a.What shouldone considerwhendeciding topursueworking in

industry?b.Whatcredentialsandexperiencearerequired?c.Howdoesoneinvestigateopportunitiesandsecureaninterview? Shouldacontractorganizationbeconsidered?d.Howtoexplorethiscareerpath:

1.Internshipprograms2.Journals3.Websites4.Networking5.Jobshadow6.PINSIG

e.Arethereotherrolesinindustrythatcanbeexplored?Thecontributionsthatnurseshavemadeintheirleadershiproles

willbereviewed.Thiswillallownursestoseehowtheycanmakeadifferenceeventhoughitisoutsideofatraditionalclinicalrole.

2211QUALITY OF LIFE AND SOCIO-DEMOGRAPHIC CHARACTERISTICSINKOREANWOMENWITHBREASTCANCER.YoungRanChae,RN,DepartmentofNursing,KangwonNationalUniversity,Kangwon-do,Korea.

Canceranditstreatmentadverselyaffectbiopsychosocialaspectsofpatients’qualityoflife(QOL).

ThepurposeofthisstudywastodeterminewhetherarelationshipexistsbetweenQOLandthesocio-demographiccharacteristicsandelapsedpost-diagnosistimeofbreastcancersurvivorsinKorea.

The research design was exploratory study using a conveniencesampling method. The subjects were 253 women out-patients ofSeoul National University Hospital in Seoul who had undergonemastectomy after a breast cancer diagnosis. The data were col-lected using face to face interviews. Research variables includedQOL,maritalstatus,educationallevel,age,occupation,incomeandelapsedpost-diagnosistime.ChaeandChoe’sQOLscale(2001)forKoreanbreastcancersurvivorswasusedtomeasureQOL.ThedatawereanalyzedwiththeSPSSWIN12.0program.T-testandANOVAwereusedtoidentifythedifferencesonQOLofbreastcancersur-vivorsaccording to socio-demographiccharacteristicsandelapsedpost-diagnosistime.

Findings:Individualsatmarried,upperlevelofeducation,ageofforty,andmorethan1yearpost-diagnosishadhigherQOLscores.QOLscoresof the individualswerenotsignificantdifferencesac-cordingtooccupationandincome.

Implications:ThisstudysuggeststhattheQOLofindividualswithbreastcancerinKoreacouldbedifferenceaccordingtothesocio-de-mographiccharacteristicsandelapsedpost-diagnosistime.Accord-ingly,futurenursingresearchshouldbedirectedtowardtheimple-mentationofinterventionsthatpromotetheQOLofthesubjectswhohadlowerQOLscores.

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2212CLINICALPATHWAYSINBREASTCANCERTEACHEVIDENCEBASEDPRACTICE AND MONITOR NURSING SENSITIVE PATIENT OUT-COMES.JaneBryce,RN,MSN,NationalCancerInstitute,Naples,Italy;CarolBell,BSN,StanfordCancerCenter,PaloAlto,CA;andMariannaConnola,RN,NationalCancerInstitute,Naples,Italy.

Oncologynursesarechallengedtodevelopprogramsthatpromotetheplanninganddeliveryofevidencebased(EB)careandtheevalu-ationof treatmentoutcomes.Clinicalpathwaysare tools forplan-ning,documentingandevaluatingpatientcare.

ThepurposeofthisprojectwastoimplementEBsymptomman-agementofbreastcancerpatientsusingclinicalpathways(CP)witha specific focus on EB interventions and nursing sensitive patientoutcomes(NSPO)measurement.

Amultidisciplinary teamatNCINaplesdevelopedCPsforpa-tientsundergoingbreastcancersurgery,radiationtherapy,adjuvanttherapyandlong-termfollow-up.Nursingidentified4initialprior-ityareasforprovidingEBsymptommanagement:fatigue,lymph-edema,oralmucositis,cognitivedysfunction.FatigueassessmentandinterventionswerebasedontheNCCNfatigueguidelinesandallow for individualized nursing interventions, facilitated duringpatientvisitswith theuseof theONSPEPfatiguecard.Lymph-edemapreventionguidelineswerebasedonphysiologicrationaleand standardized measurement criteria were integrated with pa-tienteducationmaterials.Earlydiagnosisandpromptreferralforlymphedematreatmentarekeyoutcomesmeasures.Oralmucositisguidelineswerebasedonexistingsystematicreviewsandincludedstandardgradingandoralcareinstructions.Cognitivedysfunctionis screened using subjective patient reports and thresholds thatprompt further investigationsbasedonclinicianfindingsand theminimentalstatusexam.

Thisprocesswasusedasamodelfor teachingEBpractice(andsomeofitsinherentdifficulties)tonurses.Somelessonslearned:Fa-tigueinterventionsmustbebothEBandindividualizedforthiscom-plexandmultifactorialsymptom.Lymphedema:rationalpreventionguidelines may be used in the absence of experimental evidence,simplemeasurement criteria are important for prospective evalua-tion. Mucositis: Systematic reviews are helpful in teaching aboutlevelsofevidenceand littleexperimentalevidencewasapplicabletooursetting.Cognitivedysfunction:Indepthtestingisimpracticalinthenonresearchsettingbutincreasedclinicianawarenesspermitssimplifiedscreeningandreferral.

Theclinicalpathwaymodelprovidesamethodforplanningevi-dence based care with clear measurement and outcome criteria.Themodel facilitates teachingnurses theprocessof evaluationofevidencewithitsapplicationinclinicalpractice,linksinterventionswithNSPOwhenapplicable,andpermitsongoingreview.

2213THE SAFE HANDLING OF CHEMOTHERAPY. Jennifer Martens, RN,OCN®,BSN,andCeciliaSuh-Priest,BSN,WilliamBeaumontHospital,RoyalOak,MI.

Oncologynursesareresponsibleforsafeadministrationandcon-tainmentof spillsduringchemotherapyadministration.Casestud-iesinvolvingaccidentalchemotherapyexposurewerepresentedandweidentifiedknowledgedeficitsandtheneedforoncologynursingpracticechanges.Itwasfoundthatthecurrentchemotherapypolicywasoutdatedandneededtoberevised.

ThepurposeofthisprojectwastorevisetheexistingchemotherapysafehandlingpolicyusingthecurrentOncologyNursingSociety’sChemotherapy and Biotherapy Guidelines and RecommendationsforPracticeasaguideline.Itiscrucialforthesafetyofpatientsand

oncologynursingstaffthataccidentalexposureofchemotherapybeavoided.

HospitalpolicyandcurrentOncologyNursingSocietyguidelineswerereviewed.Aliteraturewascompleted.Aninterdisciplinaryteamwasformed.Equipmentneedsandsystemchangeswereidentified.Theexistingpolicywasrevisedandimplementedthroughoutthein-stitutionthrougheducationalinservices.Chemotherapyprecautionswereaddedtocomputerizedreportsheets.Therevisedpolicywasaddedtothenursingorientationmanual.Anannualmandatoryskillsvalidationwasinitiated.

Aposttestwasconductedtodetermineiftherewasanincreasedawarenessofthenewchemotherapysafehandlingpolicy.Casestud-ieswillbecontinuedtoidentifyfurtherneeds.Afluorescentstudywillbeconductedtoevaluateaclosesystemforchemotherapyprep-arationandadministration.

Thesafetyofpatientsandoncologynursingstaffisthepriorityintheadministrationofchemotherapy.Therevisedchemotherapysafehandlingpolicyprovides theknowledgeneeded tominimizeacci-dentalchemotherapyexposure.Thispolicywillbeutilizedthrough-outourinstitution.

2216DEVELOPMENTOFANURSINGTELEPHONETRIAGEPROGRAMINANONCOLOGYAMBULATORYSETTING.SuzelleSaint-Eloi,RN,MS,LillianVitalePedulla,RN,MSN,ElizabethTracey,RN,PhD,PrabhjyotSingh,RN,MPH,LynnThompson,RN,MPH,andRobynSouza,RN,MPH,Dana-FarberCancerInstitute,Boston,MA.

Advancesincancercarecontinuetoshiftcarefromtheinpatientto theambulatorysetting,andwith the increase in theuseoforalchemotherapyandinjectiontherapies,tothehomesetting.Thisshiftin care delivery settings has resulted in more frequent calls frompatientstotheircaregiversforadviceandpossibleintervention.Inresponsetothisgrowingtrendamongthepatientsbeingtreatedatour NCI-designated Cancer Center, the nursing staff developed acomprehensivetelephonetriageprogramtoaddresssymptomman-agement,follow-upandcoordinationofcare.

ThepurposeofourinitiativewastodevelopastandardprocessfornursestofollowwhenperformingtelephonetriageforpatientsbeingtreatedatourCancerCenter.This initiative included thedevelop-mentof apolicyandprocedure,guidelines for symptommanage-ment,standardizeddocumentationandnursingeducation.

Nurses fromvariousdirect care and leadership rolesworked to-gethertodeveloptheNursingTelephoneTriageProgrambycarryingoutthefollowingactivities:• Conductedadocumentationassessmentsurveytodeterminethe

nurses’perceptionandpracticeoftelephonetriage• Usedthesurveyresultstoguidethescopeandworkofthecom-

mittee• Conductedaliteraturereviewtoidentifyexistingevidenceontele-

phonetriage• Developed a triage policy incorporating feedback from legal

counselandtheBoardofRegistrationinNursing.• Adoptedpublishedsymptommanagementguidelines fornurses

touseduringtelephonetriage.• Developed,pilotedandimplementedanelectronicandpaperdoc-

umentationtool.Asix-monthpostimplementationfocusedauditisplannedtoiden-

tifyareasforfurtherenhancement.Oncologynursesareinauniquepositiontoinfluencepolicydevelop-

mentatthelocalandbroadestlevels.Theprocessweimplementedtodevelopastandardizedmethodfornursestofollowduringtelephonetri-agecouldbeadaptedforusebyothernursesforavarietyofpurposes.

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2219NURTURE YOUR HOPE: A RETREAT FOR CANCER PATIENTS ANDCAREGIVERS.FrankBrown,RN,MS,OCN®,andBethLenegan,PhD,RoswellParkCancerInstitute,Buffalo,NY.

Traditional supportgroupsare an importantvenue formanypa-tientsandcaregiversintheircancerjourney.Therearetimeswhenthese typesofsupportgroupopportunitiesdonotfit into thebusylivesofourpatientsandtheirfamilyconstellation.Therefore,novelapproachestomeetingthevaryingneedsofpatientsandtheirfam-ilymembersmustbedevelopedandimplementedintheOncologyarena.

This innovative retreatwasplannedbyourpastoral caredepart-mentandmultidisciplinaryteammembers,eachbringinganareaofexpertiseinrelevantpatienttopicsselectedandpresented.

Thistwodayretreatwasanon-denominationalweekendofrenewal,prayer,inspiration,education,personalreflectionaswellaslearningaboutimportantissuesandemotionsthattheseparticipantsweredeal-ingwith.Theretreatwasplannedforatotalof20patientsandcaregiv-ers,eachpayinganominalfeeforregistration.Participantswereabletoattendsessionssuchas:Journalingyourjourney;Gentleyogaandhealingbreathing;Artasacopingtool;Aromatherapyandmassage;Family/caregiver’s journey(care for the caregiver). These breakoutsessionswererepeatedin theafternoonsoparticipantscouldattendasmanyastheywantedwithtimetorestandreflectwiththeirlovedonewiththem.Someofthesessionswereledbyaphysician,direc-torofpastoralcare,oncologycertifiednurseandsocialworker.OthersessionleadersweresecuredfromthelocalareawheretheretreatwasheldatthePeterNolascoRetreatCenter,Leroy,NewYorkaboutonehourfromourComprehensiveCancerCenter.

Empirical evaluation will be discussed as both participants andstaffmemberswerehighlysatisfiedwiththeoutcomesoftheretreatandthebenefitstheyexperiencedasaresultofattending.

Thisprototyperetreatcanbereplicatedatanothercancercenterorfacilityasanovelapproachtomeetingthevaryingneedsofpatientsandcaregiversintheircancerjourneyandtheirquestforhope.

2220DEVELOPINGANDIMPLEMENTINGAFAST-TRACKBS-PHDNURS-ING PROGRAM IN HEALTH POLICY RESEARCH TO ADDRESS DI-VERSITY ISSUES IN ONCOLOGY PRACTICE, EDUCATION AND RE-SEARCH.PatriciaReidPonte,DNSc,RN,FAAN,Dana-FarberCancerInstitute,Boston,MA;GreerGlazer,PhD,RN,CNP,FAAN,andCarolEllenbecker,PhD,RN,UMASSBoston,Boston,MA;andMaryCooley,PhD,RN,andMarshaFonteyn,PhD,RN,OCN®,Dana-FarberCancerInstitute,Boston,MA.

Theproblemoftoofewdoctorallypreparednurses,especiallymi-nority nurses, is further complicated by the paucity of those withresearch expertise in health policy, cancer nursing care or healthdisparities.Nurse leaders fromourNCI-designatedCancerCenterformedapartnershipwiththenursingfacultyfromanearbyminor-ity-servinguniversitytodesign,pilot,andevaluateafasttrackBStoPhDprogram,enablingbothinstitutionstotakeadvantageoftheircomplimentaryresources.

ThepurposeofthisNCI-fundedprojectwastodevelopatrainingandmentorshipprogramthatwouldpreparePhDnursingstudents,especiallyunder-representedminority,tobecomeeducatorsandsci-entistswithexpertiseinhealthpolicytargetedtocancernursingcareandhealthdisparities

Duringthisfirstyearofathree-yearplan,weimplementedthefol-lowinginterventions:1.FormedInternalAdvisoryBoardthatmeetsmonthlyandiscom-

prisedofnurseswithexpertiseinresearchorteachingincancer

care,healthpolicy,healthdisparities,PhDinNursingprogramsand/orworkingwithminoritystudentandresearchpopulations

2. Formed an ExternalAdvisory Board to provide counsel to theprojectleaders

3.Plannedanddevelopedatrainingandmentorshipprogram4.Plannedacommunity-basededucationalprogramforcancerpre-

vention5.Beganmarketingandrecruitmentfortheprogram.

Formalevaluationisplanned.Ourfirstyeargoalshavebeenmet:the curriculum has been developed, integrating content on theoryandclinicalresearchmethods,cancernursingcareandhealthdispar-ityissuesintotheuniversity’sexistingPhDPrograminNursing;acomprehensivereviewofexisting(54)fasttrackprogramshasbeencompleted;focusgroupsofpotentialstudentshavebeenheldtocol-lectadditionalinformationtoguidefurthercurriculumdevelopment.AdatabasehasbeencreatedofnursescientistsandminorityleaderstoserveasmentorstothePhDstudents.First-yearstudentrecruit-mentgoalshavebeenmet.

Informationaboutaninnovativegraduateprogramtocreatemoredoctorally prepared nurses with research knowledge and skill toaddress issues in health policy, oncology and health disparity hassignificantimplicationsforoncologynursingpractice,researchandeducation.

2222DESCRIBING NURSING TRIAGE OF ONCOLOGY PATIENTS’ TELE-PHONECALLS.MarieFlannery,RN,PhD,AOCN®,JamesP.WilmotCancerCenter/UniversityofRochesterSchoolofNursing,Rochester,NY;andShannonPhillips,RN,MS,AOCNS,andMicheleHaller,RN,BSN,JamesP.WilmotCancerCenter,Rochester,NY.

Nursingtriageoftelephonecallsareacriticalcomponentofcom-municationinoncologypracticeandserve,as theprimarymecha-nism for informing providers about changes in patient status be-tween scheduled appointments. However, limited descriptive dataexistsinthisfield.

Describe the characteristics (volume, distribution, and nursingworkload)oftelephonecallsplacedtoanoncologypractice.ThispurposefitswithONSresearchprioritiesthatstresstheexamina-tionofnursesensitiveoutcomes; telephone triage isonecompo-nent of independent nursing functions that have implications foroutcomes.

Anursingworkloadmodelwasused.This descriptive study was conducted at a large, hospital based

outpatient adult medical oncology clinic using a retrospective de-sign.AlldocumentedRNtelephonecallsfora4-monthperiodwereincluded.Datawereabstractedfrommedicalrecordsandcodedus-ingaPhoneCallRecord;inter-raterreliabilitywas93%.Descriptivestatisticswerecomputed.

Therewere3,028phonecallsweremadeoverthe4-monthperiod(87workdays).Callvolume ranged from29-61perday (M=35).Lengthof timetoanswercallaveraged12minutes(range1-105).Calldistributionvariedsignificantly;morecallsweremadeduringthemorning(55%)andonMondays(24%).Overall,7phonecallsweremadeforevery10scheduledappointments.Callerswerepri-marily patient/family (65%) or Community Health Nurse (13%).Only8%ofthecallswereinitiatedbyoncologynursingstaff.Themajority of calls (61%) required multiple contacts to manage theconcern(M=2.5).Althoughtheoncologistwasconsultedfor53%ofthecalls;only8%ofcallsrequiredphysiciandirectresponse.Callsweregeneratedby869patients,anaverageof10differentpatientseachday.Themajority(56%)ofpatientsplacedrepeatcalls(range1-43).

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In thisoncologypractice,callvolumerepresentsa largecompo-nentofnursingresponsibility.Calldistributionvariedby time,re-quiringaflexiblenursingassignment.Nursingtriageresponsibilitieswerecomplex,requiringmultiplecontacts.Telephonemanagementreflectsindependentrolefunctioning(47%ofcallsmanagedbyRN)withdirectimplicationsfornursingorganizationalpracticeandedu-cation.Onlya smallpercentofcallswereproactively initiatedbynursingstaffaninterestingareaforfuturestudy.

2227THEDIAGNOSISOFBREASTCANCER:FAMILYHISTORYMATTERS.MarciaBoehmke,DNS,ANPC,RN,UniversityatBuffalo,StateUniver-sityofNewYork,Buffalo,NY.

Differentexperiencesexistinwomendiagnosedwithbreastcancerwhen there is a familyhistoryversuswomen that haveno familyhistory.Theinformationalandself-caremanagementneedsofwom-enwithno familyhistory aregreater. Initially itwas thought thatwomenwhoperceivedthemselvesatgreatriskofdevelopingbreastcancer,becauseofasporadicfamilyhistory,experiencedheightenanxietyandincreaseduncertaintythatleadtoanincreaseddistressexperience. However, in a recent study investigating attitudes andsymptom distress experiences in women newly diagnosed withbreastcancer,theconverseemerged.

Inconcertwith theONS researchagenda that addresses family-focusedpsychosocialresearch,thepurposeofthisstudywastoex-amine thedifferentexperiencesanddistress levels inwomenwithandwithoutafamilyhistoryofbreastcancerduringdiagnosisandtreatment.

Hermeneuticphenomenologythatfocusesonthelivedexperiencesof individuals undergoing an event, guided this study in that theywereaskedtotelltheirstoryaboutthebreastcancerexperience.

Narrativeswereanalyzedusingtheseven-stagehermeneuticpro-cess.ThePrincipal Investigatorwas theprimaryreviewer; if therewere any questions/concerns an expert in this phenomenologicalmethodwasconsulteduntil100%agreementwasachieved.

Three themes emerged: expectation, understanding/knowledge,andsupport.Womenwithafamilyhistoryapproachedmammogra-phywitha“when,notif”mentation;wereprovidedbyfamilywithhelpful,practicalmanagementstrategiesoftennotprovidedbytheoncologyhealthcareteam;felttheycouldopenlycommunicatewithandweregivenunrequitedsupportby their family.Thosewithnohistorywereparalyzedbyshockatdiagnosis;felttheyhadto“en-dure”sideeffectandemployednoself-caremanagementstrategies;oftenfelttheycouldnotcommunicatetheirtruefeelingstofamilymembers,astheyfeltaneedtoprotectthem.

Oncologynursesshouldrecognizethisdifferencein“familyhisto-ry”andprovidehelpfulsuggestionsforself-managementstrategiesoftennotfoundinpamphlets;spendmoretimewiththesewomentoandallowthemtosharethefeelings;supportthembyexplainingthatmanysymptomscanbemanagedratherthan“endured.”

2228EPIDERMAL GROWTH FACTOR RECEPTOR KINASE INHIBITORS(EGFR-TFI):THENURSE’SROLEINMANAGEMENTOFPATIENTSRE-CEIVINGMOLECULARTARGETEDTHERAPIES.MariaGuerrero,RN,MSN,ANP-C,OCN®,M.D.AndersonCancerCenter,Houston,TX.

Moleculartargetedtherapyisthenewandinnovativemethodbe-ingusedtotreatcancerpatientswithsolidtumors.Inthisparticulartreatmentmodalitytargetmoleculesarefocusedmoreonitsessen-tialeffectstothegrowthandprogressionoftumors,andnottoitseffectsonnormalhealthytissue.Thisissignificantlydistinguishedfromcytotoxicchemotherapy inwhich theseagentsdonotdistin-

guish between killing only tumors cells from normal cells; theyannihilateeverythingleadingtodevastatingdrugrelatedtoxicities.Thegoalfortargetedtherapiesistoprovideantitumorbenefitswithbettertolerability.EpidermalGrowthFactorReceptorKinaseisoneofmanytargetmoleculesontumorcellsthatisresponsibleforacti-vatingmultipledownsignalingpathwaysgoverningtumorgrowth.SeveralapproacheshavebeencreatedtoinhibittheEGFRpathwayinthisparticularpaperwewilldiscussEGFR–TKIwhichhavebeendescribedtoprovidebenefitsinpatientswithsolidtumorsandhavebeenassociatedwithspecificclinicalfeaturesandsafetyprofilesascomparedtoconventionalchemotherapytoxictherapies.Moleculartargeted therapies are opening many doors of opportunity for pa-tientswithadvancedsolidtumorswhilereceivingchemotherapyorforthepatientwhomaybeunabletotoleratethetoxicitiesassociatedwithchemotherapy.Researchiscurrentlyongoingforeffectiveplansinorder to incorporatemolecular therapies forpatientswith solidmalignancies.

ThegoalforthispaperistoeducatethenurseontheroleofnewtreatmentmodalityEGFRKanditsroleinthedevelopmentofsolidtumors.

(1)identificationofEGFR-TKI(2)thepotentialefficacyandsideeffectsassociatedwithmoleculartargetedtherapies(3)Informationthatthenurseneedstobeableidentifyandobtaininordertoman-agethepotentialsideeffectsassociatedwiththisparticulartypeoftherapy,andsignsandsymptomsthatneedtoreportedpromptlytothephysicianornursepractitioner.

Evaluationwouldbenurse’sabilitytorecognizetypeoftherapy,sideeffects,andneedformanagementofpotentialsideeffectsas-sociatedwiththistherapy.

Themethodologytodisseminatethisinformationwillbeaposterpresentationdepictingallthreecategoriesmentioned

Thispresentationwillbeofbenefittooncologynurseswhopro-vide care to patients experiencing craniotomies and to nurses inanysettingthatarelookingforaprocesstoimprovepatienteduca-tion.

TheJournalClubisstillinitsinfancystages,aswehaveonlyhadtwomeetings.However,progresshasbeenmade,asthestaffisnowbeginningtobemorepreparedintheirdiscussionofthearticles.

Continuededucationisplannedforthecomingyearwiththegoalofatotallycertifiedoncologyprogram.Staffhasbeenencouragedtoattendandreportaboutvariouseducationalprogramsbothwithinand outside the facility including Fall Institute and Congress.Wewillcontinuetodevelopprogramstoencourageautonomousprac-ticethroughtheexpansionofstaffskillsandknowledge.

2229UTILIZATIONOFSIXSIGMAMETHODOLOGIESTO IMPROVEEFFI-CIENCYINANOUTPATIENTONCOLOGYINFUSIONAREA.AnnMarieRonsman,RN,MSN,FroedtertMemorialLutheranHospital,Milwau-kee,WI;andKevinKirchoff,RN,BSN,KristenScott,RN,BSN,andBrainBair,OTR-L,MHA,FroedtertHospital,Milwaukee,WI.

Administrationofchemotherapyandothersupportive treatmentstolargevolumesofoncologypatientsinawaythatisefficient,ef-fectiveandsafe isaconstantchallengein theoutpatientoncologysetting.Abilitytomanagescheduledpatientsalongwithwalkinpa-tients and patients with acute needs is paramount. Data collectedfromourpatients,physiciansandstaffidentifiedthatdelaysinthetimetreatmentwasactuallystarted,comparedtothescheduledtime,leadtoasignificantdissatisfaction.

Hospital Cancer Center decided to use a Six Sigma process toimprovepatientflowinthetreatmentarea.SixSigmaisaprocessimprovementstrategythatusespowerfulstatisticaltoolswhichhave

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beensuccessfullyappliedinindustryformanyyearsthatfocusesondefect/errorreductionbyeliminationofvariation.Froedtertwasoneofthefirstsixhospitalsinthecountrytotransferthisbodyofknowl-edge to healthcare. More than 50 Six Sigma projects at Froedterthavebeeninitiatedsincetheprogrambeganin1999.

TheSixSigmaprocessrelatesvariationtocustomerexpectationsorspecifications.Wefoundthattherewaswidevariabilitybetweenthepatient’sappointmenttimeandthetimethatpatient’streatmentsactually started. This occurred for a variety of reasons including:treatmentroomschedule,thewaychairsandbedswerescheduled,schedulingparameters,thewayacutepatientsweremanaged,phar-macyworkflows,RNworkflows,andphysicianscheduling.

Thegoaloftheprojectistodecreasethevariabilityinthetimethepatientisseatedintheirchairtobegintreatmenttowithin15minutesofthescheduledstarttime95%ofthetime.

Themethodsutilized in thisprocess and the informationgainedcanbeappliedinotheroutpatientoncologysettingstoensuredeliv-eryofefficientandtimelycare.

2230PATTERNS AND PREDICTORS OF COMPLEMENTARY THERAPYUSEINTHEU.S.CANCERPOPULATION.JudithFouladbakhsh,PhD,APRN,BC,AHN-C,WayneStateUniversity,Detroit,MI;andManfredStommel,PhD,MichiganStateUniversity,EastLansing,MI.

Complementary and alternative medicine (CAM) therapies areoftenusedwith‘mainstream’medicaltreatments.Estimatesofusebycancersurvivorsrangefrom7-64%.ItisimportantforoncologynursestounderstandfactorsinfluencingCAMuseandimplicationsfornursingcare.

Thisstudyaimedtodeterminepatterns,predictorsandpurposeofuse of CAM providers, practices and products in the U.S. cancerpopulationinrelationshiptosymptommanagement.

TheCAMHealthcareModel,anextensionoftheBehavioralMod-elforHealthServicesUse,guidedthestudy.Predisposing,enablingandneed-for-carefactorswereexaminedforabilitytopredictCAMuse.

A secondary analysis of the National Health Interview Survey(NHIS) using STATA 9.2 software for population estimation wasconducted.Thesample includedall individuals reportingacancerdiagnosis in the NHIS (N=2262). Study participants were askedif theyusedanyof the22CAMtherapieslistedintheAlternativeHealthSupplementoftheNHIS.CAMtherapieswerecategorizedasproviderservices,practicesorproductsforanalysis.Dependentvariablesincluded:(a)overalluse/non-useofatleastoneoftheiden-tifiedCAMtherapies, (b)use/non-useofspecificCAMcategoriesand (c) purpose of use (treatment/health promotion). Independentvariables included:Predisposing factors (gender,age, race,educa-tion, marital status), Enabling factors (income, health insurance,provider-contact),andNeedfactors(cancersite,symptoms,co-mor-bidity,healthstatus).BinaryandMultinomialLogisticRegression,theprimarystatisticalmodelsemployedintheanalysis,focusedonbetween-subjectdifferencesinCAMuse.Astepwiseprocedurewasfollowedandpotentialpredictorvariableswereexcludedfromthemodeliftheirp-valueexceeded0.10

MultivariateanalysishasidentifiedcharacteristicsthatdistinguishCAMusersfromnon-usersintheU.S.cancerpopulation,represent-inganestimated14.3millioncancersurvivors.EmpiricalfindingsconfirmCAMusewasmoreprevalentamongfemale,middle-aged,white, and well-educated people; women were specifically morelikelytouseCAMpracticesthanmen.Higherincome,privateinsur-ance,contactwithnursepractitioners,reportedpainandco-morbid-itywerestrongpredictorsofCAMusebycancersurvivors.CAM

usewas reportedby39%ofall cancer survivors,highlighting theneedforoncologynursestoassessCAMusebytheirpatients.

2233DEVELOPMENT OF A COMPREHENSIVE PATIENT CARE PLAN—FROMPRE-OPERATIVEAMBULATORYCENTERTOPOSTHOSPITALDISCHARGE.LisaM.Boris,RN,andMargaritaCoyne,RN,BSN,Ro-swellParkCancerInstitute,Buffalo,NY.

In anoncology facility that is growing,we identified a problemwithlatedischargefromourinpatientbedscreatingabarriertoad-missions.Thispromptedamultidisciplinarygroup toexamine thedatafordischarge.Thereviewofdataidentifiedthatlessthan30%ofpatientswereactuallydischargedasexpected.Aspatientacuityandvolumescontinuedtoincreasetheneedforahighlyefficientandstreamlineddischargeplanningprogramwasidentified.

Amultidisciplinary teamwasconvened to identify improvementstrategies.Theteamincludedoncologynursesfromthepre-surgicalambulatorysettingandfromthepost-surgicalinpatientarea.Inordertoimproveandenhancetheprocessofpatientcareplanningwehaveimplementedapilotprojectthat“tracks”thepatientfrominitialac-cessto“final”dischargehome.Dischargepracticesandtimeswereexamineddetermininggapsinpatientflow.

The teammeets bi-weekly to evaluate theneedsof patients andidentifywhatnewmeasureswillbe implemented.Teammembersdevelopedprocessesandchanges thathaveprovidedfor improvedefficiencyofpatientcareduringhospitalization.Patientpost-surgi-cal orders sets were completely rewritten with a focus on currentevidenceandeliminatingbarrierstothedischargeprocess.Theordersetsarecomprehensiveandaddressthescopeofcarefrompre-optopost-op.

Patienteducationprovidedbythestaffnursespreparestheoncol-ogypatientintheambulatorycentersfortreatmentorsurgeryintheinpatientareas.ThepilotprojectwasimplementedwiththeGastroIntestinaloncologyservice.GIambulatorynursesandGIInpatientnursesworkedcollaborativelytodesignaprogramthatwillbeex-pandedtootheroncologyservices.

Theinpatientandoutpatientnursingstaffhavechangedthedeliv-eryofoncologycarebyimplementinganticipatorydischargeordersandeducationuponprimarynursingassessment.Thispresentationwillincludedatapreandpostimplementation,includingdischargetimes,patientsatisfactionandpatientcomplications.Thismaterialwillberevealedtooncologynursesinanysettingthathaveaninter-estinimprovingtheintegrationofcareprovidedtotheirpatients.

2235EFFICACYOFGABAPENTINONPRURITUSINDUCEDBYINTERLEU-KIN-2 (IL-2) TREATMENT IN PATIENTS WITH METASTATIC RENALCELLCARCINOMAANDMELANOMA.ValerieRusciano,RN,SungHoLee,MD,andJaniceDutcher,MD,OurLadyofMercyMedicalCenter,Bronx,NY.

IL-2treatmentcausespruritus.Theroleofhistaminecontributingtopruritus iscontroversial,andeosinophilia inducedbyIL-2doesnot seem tocorrelatewith thepruritus.Direct stimulationofpainnervefibers,suchasA-deltaandCfibersbythecytokinesinducedbyIL-2treatmenthasbeenproposedasapossiblecause.WehaveusedGabapentintostabilizethenervemembraneornervesynapsestoimpactonthepruritus.

ToprovidetheoncologynursewithinsightintotheidentificationandnoveltreatmentoptionsforpruritusinpatientstreatedwithIL-2formetastaticrenalcellcarcinomaandmelanoma.

BasedonthemechanismofactionofGabapentin,wehypothesizedthatitcouldalleviatepruritus.

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DirectinterviewandreviewconcurrentfollowupnotesaswellasIRBapprovedquestionnairewasutilized.54patientstreatedwithIL-2 fromJanuary2005 toDecember2006werescreened.Among30patientswhocomplainedofpruritus,17weregivenGabapentin.Wequantifiedthese17patient’spruritusaccordingtoCTCAE3.0criteria,beforeandafterGabapentin.TheCTCAEgradingscalei10-3,fromnone,localized,widespreadpruritusinterferingwithdailyactivities.

DatawasanalyzedwithpairedstudentT-testusingSPSS13.0fordataanalysis.

Meanagewas56.12maleand5female.15patientshadrenalcellcarcinomaand2hadmelanoma.Gabapentinwasstartedinhospitalin9patientsandoutpatient in8.Mean initialdoseofGabapentinwas865mg/dayandthemeantimeforGabapentintoprovidesymp-tomreliefwas1.088hoursaftereachdose.According toCTCAEscale,themeanpruritusbeforeGabapentinwas2.41anditdecreasedto0.65afterGabapentintreatment.PairedstudentT-testforthedif-ferenceofmeansbeforeandaftertreatmentwasstatisticallysignifi-cant (p<0.0005). In conclusion, pruritus induced by IL-2 infusionrespondswelltoGabapentin.Althoughotherconfoundingcausesofprurituscannotbeexcluded,themajormechanismislikelyduetodi-rectorindirecteffectofIL-2,whichthenstimulatesthenervefibers.Thus,weproposetoeducatetheoncologynursesaboutGabapentinasaneffectivetreatmentagainstpruritusinducedbyIL-2.

2236BRADENSCALEFORGYNECOLOGICALRADIATIONPATIENTS.Mar-gie Trojanowsky, RN, BSN, OCN®, M.D. Anderson Cancer Center,Houston,TX.

TheBradenScalehasbeenwellvalidatedasatooltoassessriskofskinbreakdown,however, therehasonlybeenonestudyconductedwithoncologypatients.Gynecologicalradiationpatients,becauseoftheirtreatmentmodalities,haveahigherriskforimpairedskininteg-rityandbreakdown.TheBradenScaleoffersthenursetheopportunitytoassesstheriskforimpairedskinintegrityrelatedtopressurethatthegynecologicradiationpatientpopulationmayexhibit.ThesepatientsrequireamorespecificBradenScalewithinterventionsandoutcomesthatarespecifictothisparticularpopulation.

ThepurposeofthisprojectistodevelopaBradenScalespecifictogynecologicalradiationpatients(specificallycervical,endometrial,andvaginalcancerpatientsreceivinginpatientradiationimplants)toensureaccurateandadequateassessmentoftheirpotentialforskinbreakdown.

Ourprimarygoal thus farhasbeen todevelop interventionsandoutcomesspecifictothegynecologicalradiationpatientpopulation.The intervention will be piloted on the radiation unit.The resultswillbepresentedtotheSharedGovernanceCouncilforpracticeandpolicyreview.

Results will be evaluated in the following manner: incidence ofStageI/II/III/IVulcerswillbemeasuredbothasinpatientandoutpa-tient,nurseswillbesurveyedregardingperceptionofworkload,andtheSharedGovernanceCouncilwillevaluatedpolicyimplications.

The resultshave the following implications:decreasing the inci-denceofpressureulcersinradiationpatients,developmentofappro-priateassessmentintervals,developmentofnewpoliciesandstan-dardizedinterventionsaswellasanalysisofnurseworkeffort.2237CLINICAL TRIAL RECRUITMENT OPPORTUNITIES WITH OLDERADULTSWITHCANCER.JudithPayne,PhD,RN,AOCN®,DukeUni-versitySchoolofNursing,Durham,NC.

SignificanceandBackground:Cancerisadiseaseofaging.Sixtypercentofallcancercasesoccurinthoseover65yearsofage.Older

adultsareunderrepresentedinmostrandomizedclinicaltrials,espe-ciallyinoncologypharmaceuticalandsymptommanagementtrials(<1.5%).Althoughstudiesinvestigatingsymptommanagementandresponsestovarioustreatmentshaveincludedolderadults,studiesspecifictoolderadultsarelimited.

The purpose of this presentation is to examine barriers encoun-tered,andstrategiesusedtoincreasesubjectaccrualinaninterven-tionstudyforolderwomenwithbreastcancer.Specificaimsareto:1))identifypatient,physician,andsystem-relatedbarriersencoun-teredduringaccrualandenrollmentofolderpatientstorandomizedclinicaltrials,2)integrateconceptsfromRogers’DiffusionofInno-vationstheorytoenhancecommunicationskills,education,andtrustwith older oncology patients, and 3) describe an evidenced-basededucationprotocolforrecruitmentofolderpatientstorandomizedclinicaltrials.

Intervention:Thedevelopmentprocessofaprotocolusefulforen-hanced recruitment of older oncology patients for participation inrandomizedclinicaltrialswillbepresented.Protocolcontentfocusesonidentifiedbarriers,patientrecruitment,education,organizationalstructure,communityresources,andmembersoftheresearchteam.

Rogers’DiffusionofInnovationsprovidesatheory-drivenframe-workforidentifyingbarriers,strategies,anddevelopmentofaproto-coltoenhancerecruitmentofolderadultstoclinicaltrialparticipa-tion.Subjectaccrualandenrollmentincreasedsignificantlyfollow-ingprotocoldevelopment.

Althougholderadultsrepresentapproximatelytwo-thirdsofcan-cerpatients, theyaccountforasmallnumberofoncologyclinicaltrialparticipants.Minimalresearchhasbeenconductedwitholderpatientswithcancertohelpusunderstanddifferencesintreatmentresponseandwhetherandhowsymptomsdifferinolderadultscom-paredtoyoungeradults.Itisconcerningthatwehavefewevidence-basedsymptommanagementinterventions,andthatwehavelimitedknowledgeontreatmentanddose-relatedresponsesinolderadultswith cancer. Researchers must integrate innovative strategies withexistingrecruitmentproceduresat their institutionsandcommuni-tiesinordertosuccessfullyrecruit,enroll,andretainoldersubjectswithcancertorandomizedclinicaltrials.Collaborationamongtheresearchteam,organizationalpersonnel, institutions,andthecom-munity isessential for successful subjectaccrual rates in researchtrials.

2240DEVELOPMENT OF OUTCOMES FOR AN ONCOLOGY NURSE IN-TERNSHIP PROGRAM. Debbie Parchen, RN, BSN, OCN®, NationalInstitutesofHealth,Bethesda,MD;KathleenCastro,RN,MS,AOCN®,andCynthiaHerringa,RN,BS,National InstitutesofHealth,ClinicalCenter,Bethesda,MD;ElizabethNess,RN,MS,NationalInstitutesofHealth,NationalCancer Institute,Bethesda,MD;andMargaretBev-ans,RN,PhD,AOCN®,National InstitutesofHealth,ClinicalCenter,Bethesda,MD.

Inthecurrenthealthcareenvironmentorganizationsmustshowfa-vorableoutcomestojustifyeducationalprograms.Writingoutcomeswhichcanbemeasuredefficiently,effectivelyandeconomicallycanbeachallenge.Outcomeswererevisedtoreflectconcreteorganiza-tionalgoalsfortheOncologyNurseInternshipProgram(ONIP),inexistence formore than twentyyears,at theNational InstitutesofHealthClinicalCenter.

Ourpurposeistodescribetheprocessusedtodevelopmeasurableoutcomeswhichprovideuseful information including justificationofavaluableONIP.

OutcomerevisionsbeganwithastakeholdersmeetingoftheONIPtodeterminedesiredoutcomes.BenchmarkingourProgramagainst

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twelve similar facilities revealed that the majority of these oncol-ogyinternshipprogramsdidnotutilizestandardoutcomemeasuresforprogramevaluation.Agroupincludinganurserecruiter,anurseresearcher, nurse administrators, a clinical nurse specialist, andourpartnersattheNationalCancerInstitutewasassembledtobe-gindraftingdesiredProgramoutcomes.Anextensiveliteraturere-view was conducted to identify tools and methods for measuringoutcomes. The evidence revealed available resources which werecustomized tobestfitour requirements.Specificoutcomesfor theONIPweredevelopedbyaligningourorganizationalgoalswithourProgramgoals.Theseoutcomes included the following: enhancedoncology knowledge, retention of oncology specialty nurses andleadershipdevelopmentinnewnursegraduates.Futureeffortsmayincludepartneringwiththerecruitment-retentiongroupforcomple-tionofajobsatisfactionsurveyasonewayofdeterminingiftheseoutcomesledtoadditionalorganizationalbenefit.

Threeprimarygoalswereidentifiedalongwithaccompanyingob-jectivesandoutcomes.Ouroutcomesmeasuresinclude:successfulcompletionofanationalcertificationexam,developmentofapro-fessionalportfolio,improvementinstudentscoresontheLeadershipProgramInventory,andemploymentinoncologynursingspecialtyone year/five years post-ONIP completion. Future outcomes datawillbeusedtoguideimprovementsinourProgram.

Theprocessofouroutcomesrevisionmaybenefitotherorganiza-tionswhoareinterestedinjustifyingprogramssuchasanONIP.

2243HYPERVISCOSITY SYNDROME: NURSES’ ROLE IN THE MANAGE-MENT AND TREATMENT OF THIS ONCOLOGIC EMERGENCY. EllenMullen,RN,BSN,ANP,GNP,NoelMendez,RN,BSN,OCN®,andDan-ielMullen,RN,ADN,M.D.AndersonCancerCenter,Houston,TX.

Hyperviscositysyndrome(HVS)isacomplicationthatisassoci-atedwithplasmacelldyscrasias.Plasmacelldyscrasiasisagroupof related disorders such as Multiple Myeloma (MM), Walden-strom’s macroglobulinemia. It is seen approximately 2-10% inMM and 10-30% inWM. HVS is the term used to describe theclinicalsymptomsrelatedtoincreasedbloodviscositywhichistheresult of increased circulating serum immunoglobulins producedby abnormal plasma cells. Increased viscosity can lead to tissuedamageandevenmulti-organfailure. It is imperative thatnursesareknowledgeableaboutthisoncologicemergencyinordertorec-ognizeitsclinicalpresentationsandfacilitateimmediatetreatment,educatepatients/familiesaboutthissyndrome,andprovidesymp-tommanagement.

Thepurposeof thispresentation is to increaseawarenessof thisemergingoncologicemergency.ClinicalmanifestationsofHVSaretheresultofincreasedcirculatingserumimmunoglobulins.

The clinical presentationofHVSpresents as a triadofmucosalbleeding,neurologicalabnormalitiesandvisionabnormalities.Oth-erpresentationsthathavebeenreportedarehearingloss,kidneyfail-ure,CHFandstroke.

The immediate treatment of this oncologic emergency includeshydrationwithdiuresisandplasmapheresis.SingleplasmapheresisusuallyresultsindramaticimprovementinpatientswithWMbutinMM,usuallyitrequiresmorethanoneplasmaexchange.Theulti-matetreatmentofthissyndromeisaimatcontrollingtheunderlyingillness. InMM, the treatmentmay includeXRT, steroids, thalido-mide,andchemotherapy.InWM,thetreatmentmayincludemono-clonalantibodysuchasrituximabandchemotherapy.

Afterthepresentation,nurseswillbeabletoidentifytheclinicalpresentationsofHVS.Thenursewillbeabletoidentifydiagnostictoolsforhyperviscositysyndrome.Thenursewillbeabletodiscuss

theimmediateandlongtermtreatmentofthisoncologicemergency.Thenursewillbeablediscusssymptommanagementofthispatientpopulation.

Theposterpresentationwillincludebriefoverviewofthepatho-genesis,clinicalfeaturesandtreatmentofHyperviscositySyndrome.Theultimatetreatmentof thissyndromeis treatingtheunderlyingdisease, so treatment of plasma cell dyscrasias most respectively,MMandWMwillbebrieflydiscussed.It is important thatnursesstaycurrentorupdatedwiththetreatmentofMMandWMthroughresearchandcontinuingeducationprograms.

2244STRENGTHENING YOUR PRECEPTOR SKILLS USING EVIDENCE-BASEDSTRATEGIES.JoanSuchLockhart,PhD,RN,CORLN,AOCN®,CNE,FAAN,DuquesneUniversitySchoolofNursing,Pittsburgh,PA;andMelindaOberleitner,RN,DNS,APRN,CNS,UniversityofLoui-siana at Lafayette, College of Nursing & Allied Health Professions,Lafayette,LA.

Clinical nurses employed in health care settings often serve aspreceptorsfornursingstudentsand/ornewlyemployednursesdur-ingtheirorientation.Predictionsrelatedtothefacultyshortagewillimpact theutilizationof competent preceptors in clinical settings.Whileclinicalnursesareexperts inoncologynursing,manyoftenhavelittleornoformalpreparationfortheirpreceptorrole.Lackofpreparationmaycontribute to role strain, jobdissatisfaction, turn-over,orunsatisfactory learningexperience/outcomes forbothpre-ceptorandlearner.Therefore,aneedexiststoprovideclinicalnurseswithstrategiesthatcanassistthemtodeveloptheirknowledgeandskillsforapreceptorrole.

Thepurposeofthispresentationistoprepareoncologynursesem-ployedinclinicalpracticesettingsfor thepreceptorrole.Perspec-tivesfromstakeholders,suchashealthcaresettingsandschoolsofnursingwillbeaddressed.Availableevidence-basedstrategieswillbeincludedinanattempttostrengthenpreceptorskills.

Keyfeaturesofthispresentationwillinclude:assessmentoflearn-ingneeds/outcomes;planningeffective clinical learningactivities;implementing clinical teaching with constructive feedback; han-dlingdifficultpreceptor-learnersituations;anddocumenting/evalu-atingclinicalperformance.Participantswillhaveanopportunitytoconductaself-assessmentandpersonalcareerplanforfuturedevel-opmentinthepreceptorrole.Avarietyofactiveteaching-learningstrategieswillbeusedduringthepresentation.

Participantswillhaveanopportunitytoconductaself-assessmentand personal career plan for future development in the preceptorrole.A variety of active teaching-learning strategies will be usedduringthepresentation.

Thesessionwillconcludewithimplicationsforoncologynursingpractice,explorationofclinical-academicpartnerships,andsugges-tionsforutilizationofpreceptorinformationonaunit-basedlevel.

2246ARE WE STILL DOING THE RIGHT THING? AN EVIDENCE-BASEDREVIEWOFTHEMANAGEMENTOFCONSTIPATION.MaureenBland,RN,BarbaraGaines,RN,BSN,OCN®,EthelLaw,RN,MA,OCN®,andMaryElizabethDavis,RN,MSN,AOCNS,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Constipation ranksamong the top three sideeffects experiencedby cancer patients and has a significant impact on quality of life.Causesmaybedisease-relatedoriatrogenicallyinduced.Oncologynursesare integral in themanagementandpreventionofconstipa-tion.At thiscomprehensivecancercenter,nursingstaffdiscussionrevealedvariationsinpracticerelatedtoassessment,prevention,and

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managementofconstipation.Areviewofcurrentpracticestandardswasinitiated.

Thisprojectwasimplementedtodeterminewhetherourexistingstandards for constipation management were clear, accurate andbasedonthelatestevidence.Clinicalquestionswereframedtofocusprimarilyonevidence-basedpractices forpreventionandmanage-mentofconstipation.

Anambulatorynursingsubcommitteeestablishedaconstipationtaskforceandaliteraturesearchwasperformedtodeterminethepresenceofanynewdatasinceourpracticestandardwas last reviewed.Theevidence-based review included current literature, published guide-lines and expert consultation.Our current standards andpreviouslyestablishedtreatmentalgorithmwerereviewedforclarity,thorough-nessandclinicalusefulness.Theevidencereviewdidnotrevealanynewtreatmentstrategiesalthoughongoingclinicaltrialsofnewopioidinhibitorsholdpromiseforthefuture.Reviewofourcurrentstandardandalgorithmrevealedtheabsenceofcausativefactors,adequatein-formationforassessmentandnon-pharmacologicinterventions.Thestandardandalgorithmwererevisedtoincludepossibleetiologyandnutritionalandbehavioralmanagementstrategies.

Aneducationprogramisplannedforallnursingstaff.Apreandpostevaluationofknowledgewillbedonetoassesslearning.Afol-lowupsurveywillbeconductedtoevaluatepracticechange.

Constipationisafrequentclinicaloutcomeofcancerandtreat-ment.Althoughwefoundnochangesintreatmentintheevidencereview,ourstandardrequiredrevisiontoincludeadditionalinfor-mation for nurses to practice consistently. Re-education of staffabout constipation management was needed to improve patientcare.

2247SYMPTOM EXPERIENCE AMONG BREAST CANCER SURVIVORSANDTARGETEDINTERVENTIONS.FrancesCartwright-Alcarese,RN,PhD,AOCN®,NYUHospitalsCenter,NewYork,NY.

Breast cancer survivors report continued distress resulting fromsymptom experience associated with the diagnosis, treatment andrecovery.Breastcancersymptomshavebeenidentifiedasapriorityareaforresearch(NCI,ONS,IOM).

The purpose of this study was to describe a baseline of symp-tomsamongbreastcancersurvivorsandtoexploretherelationshipamong the dimensions of symptom experience: number of symp-toms (NOS), severityof symptoms (SOS),andamountofdistressexperienced (ADE), symptomclusters andmultiplicativeeffectofnumerous symptoms.This informationwasused to identify inter-ventionsthatwouldtargetspecificproblemsandconcerns.

LazarusandFolkman’sStressandCopingTheoryguidedthisstudyandsuggestthatsymptomexperiencegeneratesspecificneedsthatwillguide theneedforspecificnursingsensitiveproblem-focusedandemotion-focusedinterventions.

Usingadescriptive,correlationaldesign,datawerecollectedfrom131breastcancersurvivors(onemonthtofiveyearsposttreatment)usingtheBreastCancerTreatmentResponseInventory,atoolthatdemonstratedstrongpsychometricpropertiesinwomenwithbreastcancer.DescriptivestatisticsandaPearsoncorrelationmatrixwerecalculatedandreportedforNOS,SOS,andADE.

Themeanswere:NOSonarangeof0to23=6.6(SD=4.04),SOSandADEonarangeof0–40=10.9(SD=8.40)and10.4(SD=8.92)respectively.NOSwassignificantlycorrelatedtoADE(r=0.883, p = 0.000) indicating a multiplicative effect.This suggeststhat women may perceive low levels of associated distress whenconsideringsymptoms individually,butwhenNOSincrease,ADEsignificantly increases. Reported symptoms in descending order

are:sweats/hotflashes(61.8%),difficultysleeping(61.1%),fatigue(57.3%),emotionalupset(56.7%),vaginaldryness(48.1%),shoul-der/armdiscomfort(46.6%),difficultyconcentrating(38.2%),sex-ualproblems(36.5%),pain(33.6),numbness/tinglinginhands/feet(29%),temperaturefluctuations(27.5%),hairloss/thinning(24.4%),bowelproblems(22.9%),increaseinappetite(22.9%),referredsen-sation(22.1%),arm/breastswelling(16.9%),andvaginaldischarge(12.2%).Symptomclustersthatincludethesesymptomswereiden-tifiedfromtheliterature.Thefindingswereusedtoidentifynursingsensitiveinterventionsthatwouldaddressspecificaspectsofsymp-tomexperience.

2248NEUTROPENIAMANAGEMENT:USEOFAJOURNALCLUBTOFOR-MAT CHANGE. Colleen O’Leary, RN, BSN, OCN®, Barbara HolmesGobel,RN,MS,AOCN®,andLesleyVancura,RN,MS,NorthwesternMemorialHospital,Chicago,IL.

An evidence based neutropenia journal club was initiated to re-viewcurrentevidenceregardingourinstitutionalneutropeniaman-agementpolicies andprocedures.The current precautions seemedoverlyrestrictiveformanypatients,resultinginlowerpatientsatis-factionandnursesquestioningtherestrictions.Threeareasofcarewere identified to review:neutropenicdiets, restrictionofflowers,plantsandballoons,andtheuseofmasksbypatientswhileoutoftheirroom.

Journalarticlesfrom1994to2004werereviewed.Majorgapswereidentifiedasexistinginevidenceregardingnursinginterventionsinpreventing and controlling infections in neutropenic patients. Theroleofdietinthedevelopmentofinfectioninneutropenicpatientswasunclear.Thereviewfoundlittleevidencefortherestrictionofplants,flowers,andballoons.Therewasnoevidencethataneutro-penicpatientneededtowearamaskwhileoutoftheirroomsaslongastheyremainedontheunitthatwashepafiltered.

Practice changeswerepurposed to the existingneutropenicpre-cautionspolicybasedoncurrentpublishedevidence.Thesechangesalso correlate with the latest ONS Putting Evidence into Practice(PEP)guidelines.Thechangesincludeddiscontinuingtheuseofaneutropenicdiets,allowingfreshflowersandplantsaswellasbal-loons for non-neutropenic patients (excluding the stem cell trans-plantunit), allowingsilkflowers forneutropenicpatientsanddis-continuationofmasks forpatients remainingon theunit. Inordertomake thesepracticechanges, theproposalswere taken throughthenursinggovernancestructure,patientcarecommitteeandmedi-calexecutivecommittee.Theoutcomewasthattheneutropenicdietwas discontinued with specific restrictions, patients would not berequiredtowearmaskswhileontheunit,andsilkflowersandbal-loonswouldbeallowedinpatientrooms.

Therehasnotbeenanyincreaseinthenumberofnegativeeventsrelatedtoneutropenia.Patientsatisfactionscoreswillbereviewedtoverifyanincreaseinsatisfaction.Nursesinvolvedintheprocessfeelempoweredtoadvocatefortheirpatientsbasedonevidence.

Allowing nurses to identify nursing sensitive patient issues andgivingthemtothetoolsnecessarytomakechangeempowersthemtoprovidethebestpossiblecare.

2250BMTCORECURRICULUM:EVOLUTIONOFEDUCATION.LenoreRees,RN,BSN,MBA,OCN®,andTerrySylvanus,MSN,APRN-BC,AOCN®,H.LeeMoffittCancerCenterandResearchInstitute,Tampa,FL.

BMT nursing is recognized as an extremely challenging oncol-ogy nursing specialty. Consequently, newly hired graduate nursesornursesinexperiencedinoncologymayfeeloverwhelmedbythe

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specializedskillsandknowledgerequiredtosafelymanagepatients’highlytechnicalcriticalcareneeds.Thissituationwasexacerbatedinourinstitutionbya2-dayBMTeducationprogramoriginallyde-signedforexperiencedoncologynurses,butevaluatedbyrecentlyhiredstaffasinadequatetomeettheirneedsforunderstandingthebasicprinciplesunderlyingBMTnursingcare.

This abstract describes the transformation of our institution’sBMTnursingeducationprogrambasedonchangedneedsreportedbyournewlyhirednurses.Theeducationalcontentoftheprogramsand improvement inevaluationscoreswillbeexplained.Nurses’response to theeducationalprogramsand the relationshipof jobsatisfaction, performance and retention to education will be dis-cussed.

After reviewingprogramevaluations, our BMT nursing educa-tionwaschanged froma2-dayprogramoffered2-3 timesannu-ally to threesequentialprograms:aone-dayprogram, the“BMTCore Curriculum”, followed by two half-day classes, “EssentialBMT Nursing Skills” and “BMT Supportive Care Issues”. Eachisofferedquarterly,andpresentedbyexperiencedcliniciansfromourownstaff.Educationalcontentandtimeallotmentswerefur-theradjustedtomeetthespecificeducationalneedsofnewlyhiredBMTnursingstaff.

NewlyhiredBMTstaffnurses’responsetotheseeducationalpro-gramswasoverwhelminglypositive,rankingconsistentlyhigherona1to5pointLikertscalethanthepreviousprograms.Inaddition,severalofourexperiencedstaffsubsequentlyaskedtoattend,andareviewprocesshasbeendesignedbyBMTProgram leadership tomaintaintheprogram’srelevanceandcurrencyin2007.

The focus and content of our BMT nursing education programsweresubstantiallyrevisedtobettermeettheexpressedneedsofournurses.Further,aperiodicreviewprocesswasimplementedtoen-suretheprogramcontinuestoevolvewiththescienceoftransplan-tationandfeedbackofournursingstaff.Similarnursingeducationprogramsgearedspecificallytotheneedsidentifiedbythetargetau-diencecouldbeimplementedinotherfacilitiestoimprovenursingknowledge,skills,satisfactionandretention.

2251DEVELOPMENT OF A NURSING RESEARCH FELLOWSHIP PRO-GRAM.NancyKline,PhD,RN,CPNP,FAAN,andBridgetteThom,MS,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Inordertoexpandthebodyofknowledgethatdefinesthenursingdisciplineandprovidesevidencetosupport thedeliveryofpatientcare,researchmustbecurrentandongoing.TheResearchFellow-shipsponsoredby theDepartmentofNursingatMemorialSloan-KetteringCancerCenterwasdesignedtoteachnursestherequisiteskillstoenablethemtoindependentlyconductclinicalresearchproj-ects.

ThepurposeoftheFellowshipistopreparenurseswiththenec-essary knowledge and skills regarding the research process, andparticipateinscholarlyactivitiesrelatedtothecareoftheoncologypatient.Participantsareexpectedtodeveloparesearchquestionorhypothesisintheirparticularareaofinterest,anddesignandconductaresearchproject.

Interestednursescompleteaone-pageapplicationindicatingtheirinterestandcommitmenttotheprogram,andareselectedbyare-viewcommittee.Thenine-monthprogramconsistsofdidacticpre-sentations, and one-on-one mentoring with a doctorally-preparednurse,andresearchanalyst.Nurseparticipantsaregiven twodayseach month to work on their projects.They also must devote ad-ditional time to reading and preparing for their monthly researchclasses.Didacticcontent includes the following;protectionofhu-

mansubjects,reviewingtheliterature,developingaresearchques-tion/hypothesis,selectingaresearchdesign,conceptualframeworks,quantitative research methods, qualitative research methods, datacollection,basicstatisticalanalysis,andsubmittingandpresentingaresearchabstract.

TheFellowshipprogramhasbeenconductedannuallysince2005,and todate22nurseshaveparticipated.Nurseswithvaryingedu-cationalbackgroundsandallpatientcareareas(e.g.,inpatient,am-bulatoryandperioperativeservices)haveparticipated.Emphasisisplaced on both physiologic and psychosocial research; qualitativeandquantitativemethods;anddesigningstudies thatwillnotonlyimprovesymptommanagement,butalsopatientoutcomes.

Challengesencounteredhaveincludedassistingtheparticipantsinnavigating the researchprocesswithin the institution, andprovid-ingongoingmentorshipsimultaneouslyto22nurses.However,theFellowshiphasbeenmetwithresoundingsupportfromadministra-tionandfromthenursingstaff.Thisinitiativeisexpectedtoincreasesatisfactionamongthehospital’snursesbypromotingprofessionaldevelopment,ultimatelyleadingtohigherratesofretentionanden-hancedpatientcare.

2252ACLINICALMODELOFCARINGFORTHEADULTSURVIVOROFPE-DIATRICCANCER.RoseannTucci,MSN,ANP,DeborahDiotallevi,RN,MSN,CPNP, ElainePottenger,RN,MSN,CPNP, andBethWhittam,RN,MSN,CFNP,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Thereareapproximately270,000survivorsofpediatriccancersintheUnitedStates.Approximately1in640youngadultsisasurvivorofapediatriccancer.TheCancerChildhoodSurvivorStudydemon-stratedthatapproximately66%ofsurvivorshaveatleast1chroniccomplicationrelatedtotheircancertherapy.

Many of these adult survivors have to navigate a complicatedmedicalsystemthatoftenisnotsensitivetotheirneeds.Inresponseto thevariedhealthneedsofpediatriccancersurvivors, long termfollowupprogramsweredeveloped in the1990s. In1991our in-stitution established thePediatricLongTermFollowupProgram.Theteamconsistsofapediatricendocrinologist,twopediatricnursepractitionersanda socialworker.Since its inception thisprogramhas seen1117patients.Manyof thepediatricpatients enrolled inthisprogramarenowintheir20sandarereadytotransitionintoaprogramthatcanaddresstheiradulthealthcareneeds.

In 2005, in conjunction with a major survivorship initiative attheCenter,MSKCCintroducedanewprogramforAdultSurvivorsof Pediatric Cancers (ASP). Since its inception inAugust 2005,theASP team has seen 125 patients, 46 of which have been di-rectreferralsfromthePediatricLTFUprogram.Thisteamconsistsof a family physician, two adult nurse practitioners and a socialworker.

TheASPprogramisanextensionof theLTFU.Communicationbetweenthetwoteamsisvital.TheASPprogramaddressesmanyoftheissuesthatareproblematicforthesurvivorofapediatriccancer.Theseincludesecondmalignancies,cardiac,pulmonary,renal,andendocrinedysfunction,aswellasavarietyofqualityoflifeissues,suchasfertility.

Bothprogramsassess, educate, counselandscreensurvivors forlongtermeffectsrelatedtotheirindividualcancertreatment.Atreat-mentsummary,alongwithrecommendationsforfollowupisgiventoeachpatient.Preventivehealthpracticesareemphasized.

Asthenumberofchildhoodcancersurvivorsincreaseitiscriticalthat oncology nurses have an understanding of the complexity ofcareneededandtheservicesavailable.

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2253REGISTEREDNURSES’PERCEPTIONSANDDESCRIPTIONSOFTHEBNEMANDATEDPEERREVIEWPROCESSINTHESTATEOFTEXAS.TerryThrockmorton,PhD,RN,JasonEtchegaray,PhD,andDeboraSimmons,MSN,CNR,CCRN,UniversityofTexasM.D.AndersonCan-cerCenter,Houston,TX.

Peer reviewofnurses isa formalprocess inTexas,butexistsasaninformalprocessinmanystateBNEs.Althoughpeerreviewwasestablishedtosupportnursesin1987aspartoftheNursingQualityAssuranceAct,thegeneralconsensusisthatitisneitherwellunder-stoodnorwellperceived.

Todeterminenurses’perceptionsofthepeerreviewprocess,howtheprocessshouldbedesigned,andfactorsrelatedtothesepercep-tions.

TheframeworkforthisstudyisderivedfromtheIOMreportToErrisHumanandtherecommendationsforerrorpreventionincludingafocusawayfromtheindividualtothesystem.

This is adescriptive study.Apacketofquestionnaires includingdemographics,perceptionsoftheenvironmentforreportingerrors,andperceptionsofthepeerreviewprocessandrecommendationsforrevisionhasbeenmailedtoarandomselectionof1%(1400)oftheRNsfromtheTexasBNEroster.Thisfirstmailingwillbefollowedwith a postcard for nonrespondents and then by a second packet.Descriptivestatisticsandregressionanalysiswillbeusedtoanalyzethedata.

Thefindingsderivedfromthequestionnaireswillincludepercep-tionsoftheenvironmentforreportingerrors,ofthecurrentreviewprocess, and recommendations forappropriate review.Thesefind-ingswill provideabasis fordecisions related to theBNE regula-tions and for managing error reporting in health care institutions.ThestudywillbecompleteinMarch.

2254STAFFEDUCATIONALPROGRAMS: “MULTIDISCIPLINARYTEAMS:HOWTHEYWORKANDTHEBENEFITSTOOURPATIENTS.” JoanLivingstone, RN, BScN, OCN®, Marica Lodej, RN, BSN, and ClaraHergert,MSN,RN,OCN®,APRN,BC,KarmanosCancerCenter,De-troit,MI.

Theoutpatientclinicsinourcancercenterhaveadoptedtheuseofmultidisciplinaryteamstoprovidedqualitypatientcare.Theuseofmultidisciplinaryteamswasanewconcepttoourcancercenterandtheinpatientstaffexpressedandaninterestinlearningaboutwhatroletheoncologynurseplayedinthisteam.

The objective of the educational program was to educate theinpatient staff what role oncology nurses plays in the outpatientclinicmultidisciplinaryteams.Educationincludedhowamultidis-ciplinaryteamworksandhowitbenefitsthepatientinourcancercenter.

Educational power point presentation was presented to the staffintheinstitutionwidenursepractice,preceptormeetingandduringnursinggrandrounds.Thepowerpointpresentationincludedtheev-idencebehindamultidisciplinaryteam,whoisincludedintheteam,howtheteamworkstogethertoprovidequalitypatientcareandtheoncologynursesrolewithintheteam.

Thefeedbackfromthestaff thatattended thenursepracticeandpreceptormeetingwaspositive.Theprogramwas thenmade intoanursinggrandroundpresentationforallstafftobeabletoattend.Thestaffmembersthatattendedthepresentationstatedtheyhadaknowledgeofhowthemultidisciplinaryteamsworkedandwhattheoncologynursesrolewithintheteam.

Thedivisionofinpatientandoutpatientstaffoftenmakesitdifficultforeachtoknowwhattheotherisdoing.Byprovidingeducational

programsabouttheroleoftheoncologynurseineachsettinghelpstoincreasethisknowledgeofthestaffmembers.Thestaffmemberslearnhoweachteammemberworkswithinthecancercenteraswellaswiththepatients.

2255TELECOMMUTINGFORNURSES:DEVELOPINGAMODELFORTHEOUTPATIENTONCOLOGYNURSE.DianePaolilli,RN,MSN,AOCN®,Kim Mertens, MSN, RN, AOCNS, Catherine Wickersham, BSN, RN,OCN®, andElizabethRodriguez,MA,RN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Thecurrentnursingshortagehasstressedeffortstorecruitandre-tain oncology nurses in the outpatient setting. Providing opportu-nities forflexibleworkenvironmentscouldaddresssomeof thesechallenges.Telecommutingisdefinedasanemployeewhousestele-communicationequipment toworkfromhomeorasecureremotelocation.Although workers have been telecommuting for over 20years, there is limited literature and use of telecommuting withinnursing.Thispresentationwilldiscussaninnovativeapproachtode-velopingatelecommutingproposalfortheoutpatientofficepracticenurse.

ThethoraciconcologynursesatthisNCIdesignatedcomprehen-sivecancercenterexploredtheuseoftelecommutingintheoutpa-tientofficepracticesetting.Thepurposeofthisprojectwastode-velopandpresentaproposalfortelecommuting.

Basedonareviewoftheliteratureandconsultationwiththehu-man resourcesdepartment,writtenguidelines andaproposal forpresentation were developed. This proposal outlined criteria forstaff selection, responsibilitiesof the staff, and timeframeof thepilot.Humanresourcesprovidedinformationontheexistinginsti-tutionalpolicyandcurrentstatisticsonhospitalstaffwhotelecom-mute.Securityconcerns,equipment,andtechnicalsupportissueswereaddressed.

The proposal was presented to the nursing leadership group forconsideration,andlaterpresentedtoanursingcouncilaspartoftheirinquirytoconsidertelecommutingasaretentionstrategy.Thepro-posalwaswellreceivedbyallgroups.

Thispresentationwillreviewtheprocessfordevelopingatelecom-mutingproposalanddiscussthebenefitsoftelecommutinginhealthcareasdemonstratedintheliterature.Thecreationofthisproposalisanexampleofhownursescanapplyanovel idea intopractice.Furtherdevelopmentofthisprojectwouldincludepilotingthetele-commutingproposalandassessingtheimpactonnurserecruitmentandretention.

2256NURSINGTHEVIRTUALBREASTCANCERPATIENT.KathleenTaylor,RN,GwenWright,BSN,RN,AnitaWinston,BSN,RN,CindyZelko,RN,andJoAnnMaklebust,MSN,RN,APRN-BC,AOCN®,FAAN,Kar-manosCancerCenter,Detroit,MI.

Nursesexpressedadesiretolearnmoreaboutwhattheirpatientsmay encounter during all phases of treatment so they would bebetterprepared toanswerpatientor familyconcerns.Nursepre-ceptorsfromfourclinicalareas(theout-patientbreastclinic,theinpatient surgical unit, the Radiation Oncology Center and theoutpatientchemotherapyarea)expressedaknowledgedeficitcon-cerning what a patient may experience in areas other than theirown.Itwasdecidedtocreateapresentationtoeducatethenursepreceptors.

Thepurposeofthepresentationwastoeducatethepreceptorswhocould, in turn, educate staff nurses about the experiences abreastcancer patient may encounter as she progresses through the com-

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prehensivecancercenter.Thepresentationemphasizedthepatient’spointofview.

A“virtual”patientwascreatedandherexperiencesinthecancercenterweredescribedbynursepreceptorsfromfourdifferentareasofthehospital.Eachpreceptorpresentedanoverviewofwhatmayoccur as the “virtual” breast cancer patient received treatment intheirarena.Theprocesswasdescribedfromdiagnosisthroughsur-gery,recovery,chemotherapy,and/orradiationtherapy.Thepatient’svarioustests,treatments,sideeffectsandemotionalneedsweread-dressedbythenursepreceptorfromeacharea.

After the program was presented at the Preceptor meeting, anabstractwas submitted, acceptedandpresented twiceatNursingGrandRounds.Formalevaluationformsweredistributedandcom-pletedandthenurseswereawardedContinuingEducationUnits.ThenurseswhoattendedGrandRoundsexpressedgratitudefortheknowledgegained.Theynotonlylearnedwhatthepatientexperi-encedbutalsowhatcarewasprovidedbynursesfromthevariousareas.

StaffnursesattendingNursingGrandRoundsrequested thatvir-tual patients experiencing other diagnoses be offered. Offeringeducational opportunities for staff nurses increases their ability toprovideabetter levelofcare for theirpatients.Whenstaffnursesgainadditionalknowledge,theybecomemorecompetentaddressingpatient’sconcerns.Asjobperformanceimproves,nursesatisfactionincreases. Increased nurse job satisfaction also positively impactspatientsatisfaction.

2257REVELATIONSANDREFLECTIONSOFTHREECOMMUNITYBASEDGENETICSPROGRAMS.MarilynO’Donnell,RN,BSN,OCN®,MercyCancerCenter,DesMoines, IA;LilaCourtney,ARNP,MercyCancerCenter,MasonCity,IA;andTwillaWestercamp,RN,BSN,OCN®,GCN,AlegentHealth,Omaha,NE.

Cancer genetics continue to revolutionize the field of oncologyforpatients,professionalsand thepublic. Inorder toserve the in-creasingnumbersofpatientsinneedofcancerriskassessmentandpossible genetic testing, community based genetic programs havepositionedthemselvestoprovideawideraccesstoservicesoutsidetheacademicsetting.

This presentation will compare and contract the successes andchallengesofthreecommunitybasedoncologygeneticprogramsintheMidwest:• MercyCancerCenter-DesMoines,Iowa• MercyCancerCenter-MasonCity,Iowa• AlegentCancerCenter-Omaha,Nebraska

These community based cancer centers identified the need forgeneticstobeincorporatedintotheirpracticesettingsandsetouttoaccomplishthatgoal.Theseprogramswerenurseinitiatedandarenursecoordinated.Eachprogramwasuniqueintheirdevelop-mentandthemodelsthatwereadapted.Thesenursecoordinatorsrealizedtheimportanceoftranslatingscienceintoalanguagethatcanbeunderstoodbyallandrecognizedtheopportunityandchal-lengetoprovideleadershipinthedesignofhealthcareservicesinthe field of genetic cancers. Each center was unique in how theprogramwasinitiatedanddesigned,aswellasthesuccessesandsetbacks they encountered along the way. This presentation willcompareandcontrastthethreeprogram’sdevelopment,initiationandevolution.

Each center was unique in how the program was initiated anddesigned, as well as the successes and setbacks they encounteredalongtheway.Thispresentationwillcompareandcontrastthethreeprogram’sdevelopment,initiationandevolution.

All centers needed administrative and physician support whichwasachievedbyavarietyofmethods.Whilegenetictestingmaynotberightforeveryone,itisthebeliefandmissionofthesecan-cercenters,thatallappropriateindividualsshouldbegiventheop-tion.

Theoneoverridinggoalwas toopenupaccess togenetic infor-mationat the local/regional area,whichallowsall cancerpatientsservedat these facilities to receive themostcurrentgenetic infor-mationnecessary.Thesenursesalsorecognizedtheopportunityandchallengetoprovideleadershipinthedesignofhealthcareservicesinthefieldofcancergenetics.

Theuniquenessandsuccessesofthesethreecommunitybasedpro-gramspointtoexcitingpathwaystothefutureofoncologygeneticservicesofferedincommunitiesacrossthecountry.

2258OPTIMIZINGCOMBINEDMODALITYPATIENTOUTCOMESTHROUGHINTENSENURSINGCARECOORDINATIONANDMANAGEMENT.Lor-raineMcEvoy,RN,MSN,OCN®,andJanineKennedy,RN,BSN,MA,OCN®,MemorialSloan-KetteringCancerCenter,BaskingRidge,NH;andMaryElizabethDavis,RN,MSN,AOCNS,MemorialSloan-Ketter-ingCancerCenter,SleepyHollow,NY.

Patients’ receiving combined modality treatment (CMT) withbothchemotherapyandradiationtherapypresentasignificantchal-lengeformanagement in theoutpatientsetting.Thesideeffectsfromboththerapiescanoverlapandcausesignificantpatientcom-plications.Toxicities, such as mycositis, diarrhea, pain, and my-elosuppressionhavehistoricallyledtodisruptionsinthetreatmentdeliverytothepatient,andinextremecircumstances,hospitaliza-tionsordeath.

In order to meet the challenge of preventing complications andimproving patient outcomes, nurses in two ambulatory centers ofamajorcancercentercreatedtheCMTNursingMeeting.Patients’beginning,currentlyon,orhavingrecentlycompletedCMTaredis-cussedinamulti-disciplinaryforum.

At the weekly CMT Meetings radiation, medical oncology andchemotherapynurses,facilitatedbyClinicalNurseSpecialists,meetandreviewthepatients.Socialworkers,PharmacistsandDietitiansalsoattend.Problemlistsarecreatedforeachpatient,whichincludepotentialandactualproblemsandthestrategiestodealwiththem.Thelististhenpresentedbythenursesataweeklymulti-disciplin-arymeeting,whereitisreviewedbythephysicians.Theinputfromthephysiciansroundsoutthecoordinationofcareforthesecomplexpatients.

Thisapproachhasledtothecreationofasupportivenursingrole.TheInterventionNursewascreatedtoassisttheprimarycarenurseswithdailycomprehensiveassessments,on-goingpatienteducationforselfcare,mouthsprays,skincare,andnutritionalsupport.TheInterventionNurses atboth sites are experiencedoncologynurseswho receivedadditional training at the cancer center’smain cam-pus in Radiation Oncology and wound care. Through electronicdocumentation of the Intervention Nursing visits, all staff is wellinformedofeachpatient;thisfacilitatesarapidresponsewhennewissuesareidentified.

Thispro-activemanagementoftoxicitieshasreducedthenumberoftreatment-relatedhospitaladmissionsandhasimprovedpatientcare–all, inanout-patientcommunitysetting.Wehavebeenabletocapturetoxicitiesandcomplicationsatthebeginningstages,thusleadingtoimprovedpatientoutcomes.

Thisnewmultidisciplinarymethodhasbeensuccessfulinimprov-ingsafetyandthecoordinationofcarefor theseverycomplicatedpatients.

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2259RAISINGTHEANTE:ATTRACTINGANDRETAININGHIGHQUALITYCANDIDATESINACOMPETITIVEHEALTHCAREENVIRONMENT.De-niseRutkowski,RN,MS,OCN®,CRC,RoswellParkCancerInstitute,Buffalo,NY.

Previousresearchhasdemonstratedthechallengesanddifficultiesinrecruitingandretaininghighlydesirableemployees.Recruitmentstatisticsdefinecritical factors that influenceanurse’sdecision toacceptajoboffer.

Thispresentationwilldefinekeyfactorsthathavebeenidentifiedas influencing a decision to accept employment at Roswell ParkCancer Institute (RPCI) over other healthcare facilities. Programsandinitiativesthathaveencouragedlongevitywillbeidentifiedanddiscussed.

Thefollowingfactorshavebeenshowntofavorablyeffectanurse’sdecisiontoacceptanemploymentofferatRPCI:• Staffingratios• Educationalopportunitiesandprofessionaldevelopment• Sharedgovernanceandautonomy• Longevityofcurrentstaff• Careerladders

Staffing ratios have emerged as a critical value to interviewees.Inthistimeofnursingshortages,RPCIisstillabletoprovidegoodnursetopatientratios,withoutsupplementingstaffwithtravelnurs-es.Thishelps toensure staffingconsistencywhich isattractive torecruits.Newstaffdesirecoworkerswithexperienceandapredict-ableworkenvironment.

Career ladders are attractive to novice and seasoned employees.Providingopportunityand the tools for the"bedside"nurse in theformatofacareer ladderallowsstaff todevelopandbe rewardedwhilemaintainingdirectpatientcare.

Ourstatisticshaveillustratedthatseveralfactors,includingasenseofautonomy,combinedwithjobsecurityandfavorablestaffingra-tioshaveallowedRPCItoattractthe"BestandtheBrightest"nurs-ingcandidateswhenfacedwithsignificantcompetitionfromotherhealthcarefacilities.

Bycreatingaprofessionalenvironment,RPCIrecruitsandretainsnursespassionateandcommittedtoOncologyNursing.Thisresultsinastableandgrowingworkenvironment.Mostimportantly,itfos-tersgoodpatientoutcomesandpositivepatientsatisfactionscores.

2260HELPINGTOCROSSTHEBRIDGETOONCOLOGY:DEVELOPINGTHEPRECEPTOROFONCOLOGYNAIVENURSEINAMBULATORY.DianePaolilli,RN,MSN,AOCN®,ElizabethRodriguez,MA,RN,andAltagra-ciaMota,MSN,RN,OCN®,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Thecurrentnursingshortage,coupledwithanagingworkforcepresentsmanychallengesforrecruitingandretainingnursesintheoutpatientoncology setting. In thepast, twoyearsof experiencewasrequiredinordertobeconsideredforemploymentinthetreat-mentunit.Thislimitedourrecruitmentpoolandexcludedtheon-cologynaïveandgraduatenurses.AtthisinstitutiontheBridgetoOncologyprogramwascreatedtorecruitandsupporttheoncologynaïveandnewgraduatenurse.Consequently,itwasidentifiedthatthepreceptorsfor thenovicenursewouldalsorequireadditionaltraining.

Novicenursespossessuniquecharacteristicsandlearningneeds,challengingthemostseasonedpreceptor.Asaresult,aspecializedprogramwasdevelopedforthepreceptor.Thispresentationwillout-linetheBridgetoOncologypreceptorprogramandsharetheevalu-ationsfromtheparticipantsofthisprogram.

In collaboration with a certified human resource specialist andnurse educator, a two day preceptor workshop was developed.Auniquecomponentofthisworkshopwastheapplicationofthepro-gram, Situational Leadership®. This program is designed to helpthe preceptor understand various leadership styles so they can bematchedtothereadinessandabilityoftheorientee.Additionaltop-icsincludedinthisworkshopwerecommunicationtechniques,mar-ginalization,andrealityshock.

Theprogramwasevaluatedat thecompletionofeachworkshopand at six months post completion. This presentation will sharethoseresults.Atthecompletionofthisprogrampreceptorsfeltbet-terequippedtohandleandunderstandissuesforthenovicenurse,whichtheyfeltultimatelyledtotheoverallsuccessofthesenurses.

Thepreceptorsinvolvedinthisuniqueprogramrequireadditionalsupport inorder tosucceed in their roleaspreceptor.Apreceptorworkshopwascreatedandtailoredtomeettheseneeds.Thispresen-tationwill shareourexperienceandprovide recommendations forfutureimprovements.

2261ANURSINGJOURNALCLUBTOHELPPROMOTEEVIDENCEBASEDPRACTICEINTHEPRIVATEPRACTICESETTING.CathyFortenbaugh,RN,MSN,AOCN®,andKimConsalvo,RN,BSN,OCN®,PennsylvaniaOncologyHematologyAssociates,Philadelphia,PA.

Integrating new research findings, best practices, and guidelinescanbechallengingforbothstaffnursesandadvancepracticenursesintheprivatepracticesetting.AJournalClubcanbeestablishedtomeetthesechallenges.

ToestablishaJournalClubforallnursesinaprivatepracticetoaddressrelevantclinicaltopics,increaseinteractionamongnursesinvariouspartsofthepractice,increasenursingknowledge,standard-izecare,andpromoteevidencebasedpracticechanges.

Aquarterlyjournalclubwasestablishedandallpracticenursesin-cludingstaffnurses,managers,researchnurses,andadvancepracticenurseswereinvitedtoparticipate.Onepersonwasassignedtoselectthetopic,distributethearticle/sandleadthediscussion.Participantswereresponsibletoreadthearticle/sandcomepreparedtodiscussthetopic.TheJournalClubwashelddirectlyafterclinichoursintheconferenceroomanddinnerwasprovided.Findingtheidealtimeandplaceforthegrouptomeetandsustaininglong-terminterestwereperceivedatthegroupsinceptiontobepotentialchallenges.Topicsin2006includedperipheralneuropathy,mucositis,neutropeniaandpain.

Thejournalclubwasverywellreceivedandattendedthroughouttheyear.Excellentdiscussiontookplaceateachmeeting.Contacthourswereofferedwithsomeof thearticles.Staffverbalized thattheyappreciatedthismethodoflearningandinteraction.Inadditionitincreasedteamspirit.Practicechangeswereintroducedasaresultofthediscussions.BasedonthepositivefeedbacktheJournalClubwillcontinueforwardin2007.

Journal clubs are an ideal way to disseminate evidence and im-provenursingcare.Itworkedwellintheprivatepracticesettingbutcouldbeadaptedtofitanysetting.

2262HPV VACCINE—AN EVALUATION OF THE EVIDENCE SUPPORTINGITSUSE.CarolDallred,RNC,MSN,WHCNP,andJoyceDains,DrPH,JD,RN,FNP,BC,NAP,UniversityofTexasM.D.AndersonCancerCen-ter,Houston,TX.

Cervicalcanceristhesecondmostcommoncancerinwomenintheworldand,theAmericanCancerSocietypredictsthattherewillbeabout9,710newcasesofinvasivecervicalcancerintheUSwithabout 3,700deaths from this disease in2006.Theuseof thepap

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smearoverthelastfourdecadeshasresultedina70%reductioninthemorbidityandmortalityofcervicalcancer.Yet1.7billiondollarsisspentintheU.S.annuallyoncervicalcancertreatment.Additionalresearchoverthelast30yearshasindicatedthatHPVmustbepres-ent in order for cervical cancer to occur. During the past year anHPVvaccinewasapprovedbytheFDAforuseinfemalesbetweenage11and26.IsthemostcosteffectivewaytoreducetheburdenofcervicalcancerinallpopulationspreventionofthediseaseitselfthroughvaccinationagainstHPV(HumanPapillomavirus)?

The purpose of this project is to provide outpatient nurses andadvanced practice nurses, involved in cervical cancer prevention,evidenceabouttheeffectivenessandtolerabilityoftheHPVvaccineanditsuseinclinicalpractice.

AcomprehensiveexplorationoftheonlinedatabasesCINAHLandPubMed was executed using the following search terms: cervicalcancer, HPV, vaccine, effectiveness, tolerability, administration ofvaccine,andsideeffects.Asummarytablewasdevelopeddescribingevidenceofpopulationsstudied,researchdesigns,andoutcomesandrelevantfindingsthatmaybeappliedtopractice.

Theliteraturerevealedthatextensivedataisavailableonthetopicdue to large research studies regarding the target populations andHPVvaccine.Furtherresearchregardinguseinmalesanddevelop-mentofmultivalentvaccinesstillneedstobecompleted.

Theresultsfromthisevidence-basedpracticeactivitywillbepre-sentedwithsuggestionsfornursingpracticeguidelinesregardingtheuseofcurrentandfutureHPVvaccines.

2264NEWGRADUATENURSESINTHEOUTPATIENTTREATMENTUNIT—NEWAPPROACHESTOSTAFFING.DianePaolilli,RN,MSN,AOCN®,andElizabethRodriguez,MA,RN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Inlightofthecurrentnursingshortageandincreasingvolumeofpatienttreatmentsinoutpatientcareatthisinstitution,seekingnewapproachestohiring,orientingandretainingnursestoworkinam-bulatoryoncologyisparamount.

Historicallyonlynurseswithtwoyearsoncologyexperiencewerehired.Ataskforceformedtoconsidernewapproachestohiringin-cludingtherecruitmentofnewgraduateandoncologynaïvenursetotheoutpatienttreatmentunit.

Akeygoalofthetaskforcewastoprovidethesupportnecessarytoensurethesuccessofthenovicenurse.Thetaskforcedesignedacom-prehensiveprogramtohire,educateandsupportthenovicewithintheoutpatientsettingofferingthesenursesa“BridgetoOncology”.

The group developed a program with a multi-faceted approachbaseduponareviewoftheliteratureandconsultationwithexpertsbothwithinandoutsidetheinstitution.Eligibilitycriteriaandapro-cess for interviewing were developed in collaboration with nurserecruitment.Thetaskforcedividedintotwogroups,onededicatedtodevelopingapreceptorprogram,theotherfocusedonthedevelop-mentofanorientationpathway.

The task forceutilizedseveraldifferent strategies to influence theorganizationalcultureasitrelatestohiringnovicenursesintheoutpa-tientsetting.Initiativestosupportchangeincludedinservicingforthecurrentstaff,trainingforthepreceptingnurse,andongoingsupportforthenewnurseandpreceptorscheduledthroughoutthefirstyear.

Expandingtherecruitmentpoolmaybeaneffectivewaytoaddressstaffingconcerns.Todatesevennurseshavesuccessfullycompletedthisprogram.Thesuccessrateofthesenursessuggeststhatnewgrad-uatenursesareaneffectiveresourceforanoutpatienttreatmentunit.

Basedonevaluationfeedbackastructuredandfocusedorientationarenecessarycomponentstoensurethesuccessofthenewgraduate

nurse.Givenourexperiencetodate,theprogramcontinuestobeof-feredonabiannualbasis.Futuredirectionsmayincludeapplicationofthismodeltootherpositionswithintheoutpatientsetting.

2265“UNIQUE OPPORTUNITIES IN BREAST CARE MANAGEMENT”: ANEDUCATIONAL SYMPOSIUM BRINGING BEST PRACTICE MODELSFORBREASTCANCERMANAGEMENTTOCOMMUNITYHOSPITALS.ElaineSein,RN,BSN,OCN®, FoxChaseCancerCenter,Rockledge,PA;JoanWagner,RN,MSN,CRNP,FoxChaseCancerCenter,Phila-delphia,PA;DarcyBurbage,RN,MSN,AOCN®,ChristianaCareHealthSystem,Christiana,DE;andPamelaVlahakis,RN,CEN,CRN,Hunter-donMedicalCenter,Flemington,NJ.

Inordertoprovidecomprehensivecaretopatientsclosetohome,more community-based cancer programs are developing interdis-ciplinarydiseasemanagementprograms.Breastcanceristhelarg-estcancerpopulationtreatedinthecommunity.Thustheneedwasidentified to offer an educational symposium for Oncology NurseBreastCareNavigators (ONBCNs) inorder toprovide themwithaccurateinformation,availableresources,andaccesstoavarietyofsuccessfulbestpracticemodelprograms.Additionally,theAmericanCollege of Surgeons is discussing possible certification for breastcentersandtheOncologyNursingCertificationCorporationisex-ploringcredentialingforbreasthealthnurses.

The purpose of this symposium was to provide a clinical andadministrative track with a special focus on Breast Care ProgramDevelopmentandNovelPatientCareManagementStrategies.ThisprogramwouldhelptheONBCNsuccessfullycoordinatethedevel-opmentofbreastprograms.

FoxChaseCancerCenter(FCCC)andFCCCPartner(FCCCP)insti-tutionsplannedthecontentfor“UniqueOpportunitiesinBreastCareManagement” based on results of an educational needs assessment.DistinguishedfacultyincludedmembersofFCCCandFCCCPBreastCareNavigatorgroupaswellasnationaloncologyspeakers.Thetwo-dayprogramofferedclinicalpracticeupdates;strategiesforsuccess-fuldevelopmentofcommunity-basedbreastcareprogramsandbestpracticemodels forprogram implementation.A resource toolboxofbestpracticesinprogramimplementationwasdisplayedandONBCNsfieldedquestionsrelatedtotheirrole,modelsofcareanduniquepro-grams.Aneveningsocialeventallowedforinformalnetworking.

Ninety-eightoncologynursesandcancerprogramadministratorsfrom10statesattendedthesymposium.Thevastnumberofpositiveresponsesfromtheprogramevaluationsindicatedthattheattendeeshad their learningneedsmet.Theyappreciated the forumfordis-cussiononcomprehensivebreastcarewithhighcaliberpresenters,networking,andsharingofbestpractice.Somesuggesteditbeof-feredannually.

Theoutcomesof this symposiumhavebroad implications foren-hancingcancercareinthecommunity.Blendingtheexpertiseofaca-demicinstitutionswithcommunitypartnerinstitutionstheyservepro-videspatientsandhealthcareprofessionalswithbestpracticeguide-linesandmodelsforcare.Similarcancereducationsymposiumscanhelponcologynursesdevelopcomprehensivecancerprograms.

2267A PROJECT TO PROMOTE EDUCATION AND PROFESSIONAL DE-VELOPMENT: INCREASINGTHENUMBEROFAMBULATORYSTAFFTHATHAVEONCOLOGYNURSINGCERTIFICATIONS(ONC).ChristineLiebertz, RN, CS, MSN, AOCN®, Memorial Sloan-Kettering CancerCenter,NewYork,NY.

Asoncologynursingcarebecomesmorecomplexandasthechal-lengesofanaginganddwindlingworkforcecomplicatethefutureof

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patientcare,newstrategiesareneededtoengage,developandmain-taintheprofessionalcommitmentofourworkforce.Studiesindicatethat certified nurses experience personal and professional growthanddevelopment, leading togreater jobsatisfactionandretention.Examinationpreparationincreasesknowledgeofthecomplexitiesofoncologynursingcareandstandardsforpractice.

AtthisNCIdesignatedcancercenterourAmbulatoryEducationandProfessionalDevelopmentCouncilchoseanONCprojectasastrategytoaffecttheeducationanddevelopmentofournursingstaff.

Ourcouncildevelopedasurveythatqueriedtheambulatorynurs-esaboutcertificationstatusandattitudes.Ofthe337(42%ONC)nurseswereceived207(48%ONC)responsestoourinitialsurvey.Themajorityof nurseswere certified forpersonal or professionaldevelopment(68%)andthemainreasonfornotbeingcertifiedwaslackoffinancial(42%)orinstitutionalsupport.

ToraiseawarenessandeducatenursesaboutONC,aslidepresenta-tionwasdevelopedforpresentationatstaffmeetingstoreviewbene-fits,availablefinancialsupport,applicationprocesses,andpreparationmethods.Councilmembers serve as resources and thepresentationandinternetsourcesareavailableonthenursingwebforfuturerefer-ence.Surveyresultsweresharedwithnursingleaderstoexploremeth-odsofaddressingbarriersidentifiedinthesurvey.Coordinatedeffortswithother ambulatory councils are exploringotherways to rewardnursesforONCsuchasplaques,ceremonies,andnewsletters.

Theambulatorynursingstaffwillberesurveyedin12-18monthstoreassesscertificationstatusandattitudestowardONC.

ONCisonemethodforencouragingprofessionaldevelopmentandeducation.Ourcouncildevelopedaplantoeducatenursesaboutcer-tificationandisexploringwaystoimproveinstitutionalsupport.Thispresentationwill reviewour council’s survey andongoingprojecttoincreasethenumberofambulatorynurseswhohaveONC.Thispresentationcanofferdirectiontootheroncologysettingswherethechallengeof ensuringnursingcommitment tooncologycare is soimportanttoourfuture.

2270SUPPORTINGCOMMUNITYEDUCATION:ACOLLABORATIVEEFFORTBETWEENVOLUNTEERORGANIZATIONSTODEVELOPAHEMATO-POIETICSTEMCELLTRANSPLANTPATIENTANDCAREGIVEREDU-CATIONALSYMPOSIUM.KathleenCastro,RN,MS,AOCN®,NationalInstitutesofHealthClinicalCenter,Bethesda,MD;KatherinaSampl,RN,MSN,AOCNP,Arlington-FairfaxHematology-Oncology,Arlington,VA;SophiaGrasmeder,RN,BSN,OCN®,NationalInstitutesofHealthClinicalCenter,Bethesda,MD;BeatriceMiller,RN,MS,OCN®,HolyCross Hospital, Silver Spring, MD; Sandra Mitchell, CRNP, MScN,AOCN®,National InstitutesofHealthClinicalCenter,Bethesda,MD;SarahSinger,BCD,LICSW,Leukemia&LymphomaSociety,NationalCapital Area Chapter, Alexandria, VA; and Claudia Soho, RN, BSN,OCN®,CCRP,Westat,Inc.,Rockville,MD.

HematopoieticStemCellTransplantation(SCT)isapotentiallycu-rativeyethighlyintensivetreatmentforavarietyofhematologicandoncologicdiagnosis.Withimprovedsupportivecareandreduced-in-tensityconditioningregimens,thisoptionisavailabletoanexpand-ednumberofpatients.AforumforpatientandcaregivereducationconcerningSCTandtheeffectiveself-managementofearlyandlateeffectsoftreatmentwasidentifiedasaneedinourcommunity.

OncologyNursingSociety(ONS)chaptershaveahistoryofpro-vidingoutreacheducationandsupporttolocalcommunities.Partner-ingwiththelocalchapteroftheLeukemiaandLymphomaSociety(LLS),ourONSchapterdevelopedaone-daysymposiumdesignedto educate SCT recipients and caregivers about optimal self-careduringandfollowingtransplant.

AplanningcommitteeofWashington,DCONSchaptermembersand LLS staff was formed. Evaluations obtained from LLS-spon-soredsupportgroupsandpatienteducationprogramswerereviewedtodetermineneeds.The targetaudiencewas identifiedaspatientsandcaregiverspreandpostSCT.Thesymposiumkickedoffwithakeynotepresentationbytwocancersurvivorsonpositiverefram-ingandcourageousproblem-solving.Participantswerethenoffereda variety of breakout sessions (addressing topics such as fatigue,nutrition,symptommanagement,medicationmanagement,caregiv-ing, graft-versus-host disease (GVHD) and complementary thera-pies)andchosethosesessionsmostrelevanttotheircircumstances.Demonstrationsofcomplementarytherapieswereavailableforpar-ticipantsthroughouttheday.ThesymposiumendedwithanExpertPanelcomprisedofapost-transplantpatientandtwophysicians.

Thirty-fivepeopleattendedthesymposium,23completedanevalu-ation(approximatelyhalfpatientsandhalfcaregivers).ThemajorityofrespondentshadcompletedtheirSCTprocedure.Approximately85%reportedthatthesymposiumwasbeneficialandthecontentwasappropriateandcomprehensible.TheExpertPanelandbreakoutses-sionsonfatigueandGVHDwereidentifiedasmosthelpful.Manyparticipantsaskedforfuturesymposiumsandgavesuggestionsfortopicsofinterest.

Ourpartnershipcapitalizedonthesupportivecareexpertiseofon-cologynursesandtheadvocacyandprogramplanningskillsofLLS.Thisprogramoffersamodelthatotherchaptersmayapplyindevel-opingcommunityoutreachinitiatives.

2272STRESSORS IN ONCOLOGY NURSING: POTENTIAL SOURCES OFABSENTEEISMANDTURNOVER.TerryThrockmorton,PhD,RN,Uni-versityofTexasM.D.AndersonCancerCenter,Houston,TX.

Itisestimatedthat,bytheyear2020,theU.S.willneed2.8mil-lionregisterednurses,almost1millionmorethanwillbeavailable.Oldernursesareretiringandenrollmenthasbeendown.Retentionofskillednursesisbothasafetyissueandafinancialneedforhealthcare institutions. Attention to personal and environmental factorsthataffectnursesisessentialforretention.

Thepurposeofthispresentationistoexploresourcesofstressforoncology including personal and secondary post-traumatic stresssyndromethathavepreviouslybeenoverlooked.

Areviewoftheliteraturewasconductedtodefineandlinkthesesourcesofstressintermsoftheireffectonnursesingeneralandon-cologynursesinparticularusingFigley’sworkonPTSDasabegin-ning.Explanatoryarticlesandresearchwereexploredforsupportingevidenceandpotentialapproachestomanagement.

UsingthecriteriafromFigley’smodelandtheavailableresearch,sources of stressors, symptoms, and potential interventions wereidentified.

Although thisconcept is relativelynewin relation tonursesandtheirwork,thereisbeginningevidencethatnurses’personalstress-orsthroughoutlifeandtheirexposuretopatientswiththetraumaticexperienceofcancercandisposethemtoatypeofsecondarypost-traumaticstresssyndromethatistobedifferentiatedfromburnout.Preventionandtreatmentfollowasimilarpatterntothosefordisas-terworkersandmilitarypersonnelwhoareexposedtotrauma.

2273ENEMAUSEPROHIBITED INTHENEUTROPENICANDTHROMBO-CYTOPENICPATIENT:WHATISTHEEVIDENCE?ElizabethSorensen,MSN,APRN,BC,UTM.D.AndersonCancerCenter,Houston,TX.

Constipationisacommonside-effectexperiencedbymanycancerpatientsthatmayberelatedtochemotherapyagents,opioidsforpain

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management,dietchange,decreasedmobility,oralteredbowelhab-its.Anothercommonside-effectrelatedtocanceranditstreatmentisbonemarrowsuppressionresultinginneutropeniaandthrombocy-topenia.Currently,enemaandsuppositoryadministrationisprohib-itedinpatientswithneutropeniaand/orthrombocytopeniaduetotheriskofbowelperforation,infection,oruncontrolledrectalbleeding.Althoughthepolicyisbasedonsolidrationale,noevidenceexiststo support it.Furthermore, thenurseandpatientare leftwith fewoptionsforconstipationmanagementasidefromoralroutemedica-tions,whichmaybedifficulttotoleratebecauseofnausea,vomiting,or NPO status.Also, in the case of possible bowel obstruction orimpaction,oral routemedicationsmaybe lesseffectiveand rectalroutemayberequiredfortreatmentoftheconditionandtopreventperforation.

Thepurposeofthisprojectistoidentifyandevaluatetheevidencesupportingthepracticeofenemaprohibitionfor treatmentofcon-stipationinthethrombocytopenic/neutropeniccancerpatientandtooutlineguidelinesregardingtheapproachtotreatmentinthisspecialpopulation.

AnextensivesearchoftheonlinedatabasesCINAHLandPubMedwasperformedusingthefollowingsearchterms:constipation,che-motherapy, enema, thrombocytopenia, neutropenia, infection, andbowel perforation. Institutional policies and procedures and theOncologyNursingSocietyguidelineswerereviewed.Anevidencesummarytablewasdevelopedthatdescribespopulationsstudied,re-searchdesigns,outcomesandrelevantfindingsthatmaybeappliedtopractice.

Acriticalappraisaloftheliteraturerevealedthatlimiteddatawereavailableon the topicdue to lackof research regarding the targetpopulation and intervention.The results from this evidence basedpracticeprojectwillbepresentedwithsuggestionsfor furtherfol-low-up and investigation into the practice using randomized con-trolledtrialsinordertoupdatepracticeguidelines.

2275IMPLEMENTING EVIDENCE BASED PRACTICE IN A COMMUNITYBASEDFACILITY.TeresaMcLaughlin,RN,MSN,AOCN®,CindyCzap-linski, RN, MSN, and MaryAlice Koleszar, RN, OCN®, St. VincentsMedicalCenter,Bridgeport,CT.

Oncologynursing isalwayschangingandoncologynursesmustupdate and maintain practice controls to achieve safe and qualitycareforourpatients.Fromfebrileneutropeniatochemotherapyad-ministrationtherearemanychallengesfortheoncologynurse.

DevelopmentofaUnitBasedOncologyPracticeCouncilwases-tablishedtoexaminetimerestraints,attentiontodetail,andimple-mentevidencedbasedpracticeasitpertainstooncologynurseprac-tice.Itisimperativetoachievethequalityoutcomeswedesiredbyimplementingevidencebasedpractice.OneoftheissuestheCouncilfocusedonfirstwascreatingoncologyspecificplanofcaresetsandexaminingnursesensitiveoutcomeslikepreventionofinfectionandsafechemotherapyadministration.

The Unit Based Oncology Practice Council worked together toensurethatnursinginterventionsandnursepracticewasdrivenbydedicatednursingpractice,research,andincorporatedpatienteduca-tion.ThecouncildevelopedandimplementedaChemotherapyPlanofCareandaMyelosuppressionPlanofCare.

Evaluationsweredonevia activeopenchart audits andongoingnurse education. Audits looked at timeliness of implementation,proper completion, timeliness of interventions, and documenta-tion of achieved goals. Conclusions thus far conclude that nursesarededicatedtoqualitycareanddesirebetteroutcomesforpatients.Practiceisevolvingawayfromineffectiveinterventions.

Providing theCouncil toenforceevidencebasedpracticehelpedthenursesdeterminetheinterventionsthataremosteffectivetoim-prove outcomes. The Council also realized that nursing sensitivepatient outcomes provides a means for nurses to define their roleobjectivelyandachievequalitypatientcare.

2276REDUCING THE INCIDENCE OF PHLEBITIS IN GI SURGERY UNIT:NURSE’SROLE.EllenMullen,RN,BSN,ANP,GNP,andDanielMullen,RN,ADN,M.D.AndersonCancerCenter,Houston,TX.

Phlebitisisthemostcommoncomplicationofintravenousinfusionand its reported incidencevariesbetween30and70%of infusions.Manyfactorscontributetoitsdevelopment,whichmakespreventiondifficult. In theoncologysurgicalsetting,patientsareadmittedwithmultipleIVsitespost-operatively.Mostofthetime,patientsalreadyhavefragileveinsfrompreviouschemotherapytreatmentoftheircan-cer.ThismakesitveryimportantfornursestopreservetheIVsites.However,preservingtheIVcanleadtomoreproblems.Nursesmustbeknowledgeableonhowtoassessandrecognizesignsofphlebitis.ThemonitoringoftheIVsitesisonlydoneoncepershift.Duetoincreasedincidenceofphlebitisandknowingthatpreventioncanpreventfurthercomplications,frequentmonitoringofIVsiteshasbeenimplemented.

ThepurposeofthisprojectistoreducetheincidenceofphlebitisthroughfrequentmonitoringofIVsites.AllpatientsadmittedfromPost-anesthesiacareunitwillbeassessedbyaregisterednurseandallIVsiteswillbedocumented.

Thenurse’sroleinthepreventionofphlebitisincludesbaselineas-sessmentofIVsitesanddocumentingthegradingcriteria.Frequentmonitoring isdefinedasevery4hrs insteadofonceper shift.AllperipheralIVsshouldbeflusheddailyanddocumentedinthemedi-cationadministrationrecord.Oncesymptomofphlebitisoccurs,thenursemustmonitorthesiteverycloselyandifcontinuestoprogress(redness and warmth, edema and even fever), the IV needs to beremovedimmediatelyandtheprimaryteamisnotified.Warmmoistcompressover72hrsisthebesttreatmentalongwithnonsteroidalanti-inflammatorydrugs(ifordered).

Theoverallgoaloftheprojectistoreducetheincidenceofphlebi-tisthroughfrequentmonitoringofIVsites.ThenurseshouldbeabletoidentifyearlysignsofphlebitisandknowwhentoremovetheIVcatheterandwhentonotifytheprimaryteam.

The presentation will include discussion of causes of phlebitis,gradingcriteria,andnursinginterventionsinthepreventionandman-agementofphlebitis.ThenursingimplicationisincludingcheckingIVsitesaspartofvitalsignsandproperdocumentation.

2278HISTORICAL PERSPECTIVES ON DO NOT RESUSCITATE ORDERSANDADVANCEDIRECTIVESINPATIENTCARE.JudithPayne,PhD,RN,AOCN®,DukeUniversitySchoolofNursing,Durham,NC.

Advancesinmedicaltechnologyhavecreatedanewrelationshipbetween medicine and society. Decisions about resuscitation andotherlife-sustainingtreatments,onceintenselyprivate,havebecomematters of public debate and community concern. It is no longerclearwhetherallavailabletechnologymustbeusedtopreservelife.Rather,inlightoftheincreasingarrayoftechnologiestoextendlife,societyhasbecomemoreconcernedabouttheindividual’srighttodeterminehowthattechnologywillbeused.Theuncertainty,confu-sionandgenerallackofknowledgeaboutdonotresuscitate(DNR)ordersandadvancedirectiveshascreatedaslipperyslopeforall,andespeciallydifficultforthoseinoncology.

Thepurposeofthispresentationistoprovideanoverviewofthehistory of DNR orders and advance directives, and examine the

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clinicalimplicationsfornursingpractice.Thetheoreticalframeworkguidingthispaperarecomponentsfromethicalandlegaldoctrinesandfromtheconceptualizationofself-determination.

A synthesized review of relevant literature provided a historicaloverviewofDNRordersandadvancedirectives.Areviewoflegaldoctrines,pertinentguidelines,andprofessionalpositionpaperscur-rentlyguidingclinicaldecisionmakingregardingthesesensitiveis-sueswillbepresented.

Areviewofpapersintheraredocumentssectionofauniversity-basedlibraryandliteraturerelatedtoDNRandadvancedirectiveswas conducted. Examination of historical and current documentsprovidedanevaluativemeasureofhow theseconceptsdeveloped,reflectcurrentpractice,andhowtheyinfluenceourclinicaldecisionmakingandeducationeffortstoday.

The development of new technologies has made it increasinglyclearthatmedicalchoicesinvolvemoralchoices.Theneedtobal-ancecompetingvaluesinourdeliveryofcareoftengivesrisetocon-flictanduncertainty.Thisuncertaintyisheightenedbylimited,andsometimesconflicting,informationfromlegalandethicalscholarsinafieldwheretechnologicaladvancesincreasefasterthanlegalprec-edents.Since the legalprocess isoftennotwell-suited to respondtourgentclinicaldecisionsabout individualmedical treatments, itisimperativethatnursesandphysiciansdevelopaprocesswherebythesedecisionswillbehandledeffectivelyandtimely.

2280ADDRESSING TREATMENT CHALLENGES IN THE OLDER PATIENTWITHCANCER.AnneAnselmo-Murphy,MSN,RN,APRN,BC,AOCNP,CancerInstituteofNewJersey,NewBrunswick,NJ;andFrancesCart-wright-Alcarese,PhD,RN,AOCN®,NYUHospitalsCenter,NewYork,NY.

Intheyear2030,20%oftheU.S.populationwillbe65yearsandolder. Because the majority of cancers are diagnosed in this agegroup,cancerintheolderadultwillreachepidemicproportions.Datafromtreatmentstudiesthatincludeolderpatientsrevealthatsurvivaloutcomesaresimilarwhencomparedtotheiryoungercounterparts.Theolderadultisoftennotconsideredeligiblefortreatmentbasedsolelyonchronologicalage.“Suchassumptionshaveandcontinuetolimittheadequacyofresearch,appropriatenessofcare,andcur-rencyofeducationwithincancercare”(OncologyNursingSocietyandGeriatricOncologyConsortiumJointPositiononCancerCareintheOlderAdult2004).

Thispaperwillproposeastandardizedmethodtoprovideevidencebased care to the older patient with cancer. Strategies to evaluatephysical,psychological,social,andfinancial factors that influencetreatment decision making is included. Symptom experience andqualityoflifeoutcomesarediscussed.Professionalandpatientedu-cationisdescribed.

Theelementsofaprogramofcarefortheelderlypatientwithcancerinclude:1)TheComprehensiveGeriatricAssessment (CGA), a sys-tematicreviewofpatientfactorsthataffectthecourseofthediseaseandtreatmentoutcome,2)Interventionsthatinfluencenursingsensi-tiveoutcomes:symptomexperienceandqualityoflifetosupportthepatient throughandbeyond treatmentgoals,3)ProfessionalEduca-tion:a)promotetheCGAasastandardscreeningtoolinoncology,b)descriptionofcurrentevidencebasedtreatment,c)discussionoftheelderlyoncologypatientontoclinicaltrials,andd)patienteducationneeds,and4)PatientEducation:discussionofthepatientandfamilyasapartnerinthetreatmentdecisionmakingprocess.

Outcomemeasures toevaluate thesuccessof thisprogramin thispopulationare:survival,diseasefreesurvival,accrualintoclinicaltri-als,hospitalizationsandlengthofstay,andqualityoflifeoutcomes.

The older patient with cancer requires specific evaluation andtreatmentstrategiestoensuregoodsymptomcontrol,qualityoflifeandclinicaloutcomes.Theoncologynurseplaysapivotal role inadvocatingfor the“bestevidencebasedcare”for theoldercancerpatient.2281IMPROVINGSKINCAREOFTHEPEDIATRICBLOODANDMARROWTRANPLANTPATIENT.MichelleSmith,RN,BSN,MichelleFrey,RN,MS, AOCN®, and Joanne Kurtzberg, MD, Duke University Hospital,Durham,NC.

Infection remains the leading cause of mortality and morbidityintheimmune-suppressedpatient.Theriskofinfectionisdramati-callyincreasedwhenthebody’sbasicdefensesarealteredandlacknormalinfectionfightingcapabilities.Theskinisthelargestorganof thebodyand themost frequentlyaffected.Patientsundergoingchemotherapy, radiation, and/or marrow ablation (bone marrow/stemcelltransplantation)areatevengreaterriskforlifethreateninginfectionasaresultofskinbreakdown.Additional insultssuchasgraft-versus-hostdisease,engraftment,respiratoryandsystemicin-fections,increasedneedforoxygenandprolongedimmobilityplacethepatientatevengreaterrisk.

ThepurposeofthisposteristodescribetheDukePediatricBloodandMarrowTransplantprogramSkinCareInitiative.Thisprogramwasdevelopedin2001inanattempttoreduceinfectionandmorbid-ityassociatedwithskinbreakdown.Thegoalsofthisprogramweretodevelopandimplementstrategiestoensureearlydetectionofpa-tientsatriskforskinbreakdownandtostandardizetheplanofcare.

Eachunitwithinthehospitaldesignatesa“unit-based”skincarechampionwho is responsible for theoversightofpatientsand theeducationofstaff.Theprogramhasdetailedguidelinesandproce-duresforthepreventionofskinbreakdownandstrategiesforearlyinterventionandtreatment.

Thepainchampionisresponsibleformonthlyauditsofallpatients.Theauditsevaluatetheeffectivenessoftheinterventionsaswellasthe documentation of skin integrity.The data is reviewed by unitandHospitalleadershipandisreportedandtrendedviatheNationalDatabaseofNursingIndictators(NDNQI).

By performing thorough skin assessments on all pediatric bonemarrowandstemcelltransplantpatients,wecandecreasetheinci-denceofskinbreakdownandlessentheseverityofpatients’suffer-ing,riskforinfections,lengthofstayandultimately,mortality.

2283RADIOPROTECTION WITH AMIFOSTINE: WHAT CAN BE DONE TOHELPPATIENTSTOCOMPLETETHERAPY?LindaCarlin,RN,MSN,OCN®,ThomasJohnsCancerCenter,Richmond,VA.

Amifostine (Ethyol) is a radioprotectant used to help prevent orlessenmucositis,xerostomia,andesophagitisreactionsfromradia-tiontherapytreatmentstotheheadandneckarea,lung,esophagusandrectalarea.Thus,treatmentwiththisagentwouldbedesirableinlesseningthesetoxicitiesassociatedwithradiation.However,thisdrugitselfhasmanysideeffectsandpatientsfrequentlyneedtostopitbecauseofthem.

Thepurposeofthisprojectwastoevaluatetheuseofpremedica-tionsusedwithAmifostineprior todaily radiation treatments, theeffectofthesepremedications,thetolerabilityofAmifostineandtheseverityofsideeffectsoftheradiationtherapy.

Aretrospectivechartreviewofpatientsundergoingexternalbeamradiationtotheheadandneckarea,lung,andrectalareaswhore-ceivedAmifostineforradioprotectionwasconducted.Assessmentoftheirpremedication,theircompliancetothepre/posthydration,reac-

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tionsnotedandtheextentofxerostomia,mucositisandesophagitiswasevaluated.

Seventy-fivepercentofpatientsevaluatedhadheadandneckcancerwhiletheremainderhadeitherlungorrectalcancer.Sixty-fourper-centwerepremedicatedwithondansetron,ranitidineandcetirizine.Despitethis,nopatientswereabletocompleteAmifostinetherapysecondarytointolerablesideeffectsofnausea,vomiting,hypoten-sion,rashorfever.Inaddition,patientswhoreceivedAmifostineex-periencedthesamegradeofxerostomia,mucositisandesophagitisasthosewhodidnotreceiveAmifostinetherapy.

Amifostine has been available for use as a radioprotectant formany years. Unfortunately, many patients cannot tolerate it. Be-cause of the improvement in long and short-term toxicities thatmayresult fromtheadministrationofAmifostine, it is importantthatwecontinue todevelopnewways tomake itmore tolerableforthepatient.

2284ANINNOVATIVEPROGRAMTOSUPPORTFAMILYCAREGIVERSOFBRAINTUMORPATIENTS.HarrietPatterson,MPH,andMaryLovely,RN,PhD,NationalBrainTumorFoundation,SanFrancisco,CA.

Family caregivers of brain tumor patients face a daunting chal-lenge,dealingwiththeacuteneedsofaterminalcancerpatientandthestressofcaringforsomeonewithimpairedneurologicalstatus.Oncologynurseshaveanimportantroleasprovidersofpatientandfamilyeducationthatcanpositivelyimpactfamiliescopingathome.Recentstudiesshowthateducationalandskill-buildinginterventionscanhavesignificantimpactoncaregiverandpatientwellbeing.Aninnovativesupportprogramforfamilycaregiversofbraintumorpa-tientshasbeendevelopedand implementedacross theUS tohelpmeetthisneed.1.Describetheneedforcaregivertrainingandeducationprograms

forbraintumorpatients2.Identifythesevenmodulesofthecaregiverprogramcurriculum3.State the essential challenges andbenefits of implementing the

program4.Presentoutcomes

Thisfamilycaregivertrainingprogramworksondevelopingpracti-calcareskillsandprovidingdetailedinformationaboutbraintumorstofamilymembers.It includesan8-hourworkshopcurriculumontopicssuchasMedicalOverviewofBrainTumors,SymptomMan-agementatHome,UnderstandingCognitiveChanges,HowtoSafelyMoveaPatient,andmore.Theprogramhasbeen implementedatmedical centers throughout theUS.This sessionwilldescribe theworkshop format, curriculum, and challenges to implementation,equippingnursestoofferthefreeworkshopattheirinstitutions.Thesessionwillconcludewithoutcomedatafromthepast3yearsandadiscussionoffutureareasforresearchandintervention.

Theprogramhasbeenevaluatedover the last3yearsusingpost-workshopparticipant evaluations.Evaluationmeasurements includeincreasesincaregiverknowledge,changestocaregivingbehaviorandconfidencelevels,andtheoverallbenefitoftheworkshopasperceivedbyparticipants.Alargerretrospectiveoutcomestudyisunderway.

Asmore familycaregiversbecomeextensionsof thehealthcareteaminthehome,theimportanceofeducationandtrainingforthisgroup iscritical.Oncologynursescanutilize thisprogramfreeofchargetohelpbuildskillsandteachfamilieshowtoprovidebettercarefortheirlovedoneswithbraintumors.

2288THE NURSE COMPLEMENTARY AND ALTERNATIVE MEDICINE IN-STRUMENT:STABILITYTESTING.M.TeresaRojas-Cooley,RN,City

ofHopeNationalMedicalCenter,Duarte,CA;DanaN.Rutledge,RN,PhD,CaliforniaStateUniversity,FullertonDepartmentofNursing,Ful-lerton,CA;andMarciaGrant,RN,DNSc,FAAN,CityofHopeNationalMedicalCenter,Duarte,CA.

Patientsreporthighinterestand/oruseofCAMtherapies,butforvariousreasons,hesitatediscussing these treatmentswithhealth-careproviders.RegisteredNurses,thelargestandmosttrustedpartofthehealthcareteam,areintheidealsituationtoquerypatientsaboutCAM.Unfortunately,due to lackofknowledge,nursesre-port great discomfort discussing CAM therapies with patients.Education,therefore,isneededtoopenCAMcommunicationbe-tweennursesandpatients.Beforeaneducationalcurriculumcanbeimplemented,avalidandreliablemeasureisneededtoassessbaselineeducationalneedsofnurses;TheNurseComplementaryandAlternativeMedicineKnowledge&Attitude(NrCAMK&A)Instrumentwasdevelopedduetolackofsuchameasure.Faceva-lidityandinternalconsistencyweredemonstratedpreviously.Thisstudyreportsreliabilityestimatesofstabilitywithspecificsurveyitems.

Todeterminere-testreliabilityestimatesofTheNrCAMK&AInstrumentinasouthwesternUSsampleofmulti-specialtyRNs.

Psychometrictheory.Design-paperandpencilsurvey.Sample/setting-nursesattend-

ingaconferenceonevidence-basedpracticeatcomprehensivecan-cer center in Southern California. Instrument- Nr CAM K &A.Procedure:Ondatacollectiondayoneandtwo,averbaldescrip-tionofthestudy,awritteninvitationtoparticipate,ademographicdatasheet,andtheCAMK&Ainstrumentwasprovided.Returnedsurveyswerematchedbytheparticipants’initialsandcoded.Dataanalysis-SpecificsurveyitemsfromNrCAMK&Aweretestedfor reliability (stability) using intraclass correlation coefficients(ICC).

Atotalof18nursescompletedsurveyson2consecutivedays.Av-erageparticipantwas43yearsold,female,andCaucasian.ResultswereoverallICCscoreof.30andindividualitemindexICC’s.45to.71.

Previously,nurseswerenotedhavingpoorknowledgeaboutCAM,buthighlyinterestedinlearningmore.Resultsfromthisstudyindi-catethatwhennurses“guess”onknowledge-typequestions,stabil-ityofresponsesmaybepoor.Surveyitemsthatevaluateknowledgewillhavea“donotknow”responseadded.

FundingSources:ProjectsupportedbytheAmericanNursesFoun-dation/DorothyReillyScholar.Fundingdates2005-2006.

2290ORGANIZINGAHEAD&NECKCANCERSCREENINGDAY:THEON-COLOGYNURSE’SROLE.JanetMcKiernan,RN,BSN,OCN®,andJillSolan,RN,MSN,ANP,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Morethan30,000Americanswillbediagnosedwithheadandneck(H&N)cancerin2006andapproximately7,000willdieofthedis-ease.The5yeardisease-freesurvivalhasnotsignificantlyimprovedsincethe1950’sandmaybelessthan50%dependingonstageofdisease. Cancer screenings have demonstrated improved mortalityratesforanumberofcancers.TheH&Nregioncanbereadilyexam-inedmakingcancerscreeningsfeasible to improveearlydetectiontherebyreducingmortality.OncologynursescanplayasignificantroleinorganizingH&Ncancerscreeningclinics.

Thispresentationwill reviewthesteps involvedforanoncologynursetoplanandimplementaH&Ncancerscreeningday.

AtthisNCI-designatedcomprehensivecancercenter,afreeH&Ncancer screeninghasbeenheld annually for8years.Experienced

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H&NoncologynursescoordinatethescreeningdaywithintheH&Nsurgicalpracticeteam.Initiallythedateforthescreeningdayisse-cured.Publicityfortheeventiscoordinatedwithpublicaffairsandgraphics.Commitmentsforassistancewithsmokingcessationandnutritionalcounselingareprearrangedastheseservicesareavailablethroughoutthescreeninghours.Preparationsalsoincludeobtainingregistrationscreeningforms,trainingtheadministrativesupportstaffabouttheregistrationprocessandflow,andmeetingwiththesurgi-calfellowstodiscussthedetailsoftheH&Nexaminationanddocu-mentation.Finally,thenursetalliesthescreeningdataandsendsafollow-uplettertoallparticipantswithanabnormalexamrequiringfurtherevaluation.

Over thepast8years,94 to173 individualshavebeenscreenedeach year within a 4 hour period. Abnormal examinations haverangedfrom18to35%withfindingsincludingoralleukoplakiale-sions,skinlesions,thyroidnodules,cervicallymphadenopathyandcomplaintsofdysphagiaandhoarsenesswitharecommendationforfurther evaluation. A supraglottic carcinoma was detected at onescreeningdaywithinstructionsprovidedforimmediatemedicalat-tention.

Thispresentationwilldiscuss theprocess involvedtocoordinateafreescreeningdayandwillalsoreviewthescreeningresults.Thisprocesscouldbeappliedtootheroncologyscreeningsandmayas-sistoncologynursesplanningacommunityscreeningday.

2291HEALTHBEHAVIORPATTERNSANDDISPARITIESOFMAMMOGRA-PHYUSE INTHEMULTI ETHNICCOHORT.Quannetta Edwards,RN,FNP-C,WHCNP-C,PhD, FAANP,City ofHopeDepartment ofClinicalCancerGenetics,Duarte,CA;ArthurLi,MS,andMalcomC.Pike,PhD,UniversityofSouthernCalifornia,KeckSchoolofMedicine,LosAnge-les,CA;LaurenceN.Kolonel,MD,PhD,CancerEtiologyProgramCan-cerResearchCenterofHawaii,UniversityofHawaii,Honolulu,HI;andBrianE.Henderson,MD,andRobertaMcKean-Cowdin,PhD,UniversityofSouthernCalifornia,KeckSchoolofMedicine,LosAngeles,CA.

Accordingto2003datafromtheNationalHealthInterviewSur-vey(NHIS)oftheNationalCenterofHealthStatistics,71%ofAf-ricanAmerican(AA)and71%ofWhitewomensurveyedreportedreceivingamammogramwithintheprevious2years,suggestingthatHealthyPeople2010objectivesfor70%ofwomenage40years&oldertoreceiveatleastabiannualmammogramhavebeenachieved.Nodatahowever,areavailableonrepeatmammographyovertime.For women 40 years & older, mammograms are recommendedyearlybytheAmericanCancerSociety(ACS)&every1-2yearsbytheNationalCancerInstitute(NCI).Womendiagnosedwithbreastcancerwhodidnotreceiveregularmammogramsoftenhavetumorcharacteristicsassociatedwithpoorprognosis.

AIMS:(a)DescriberepeatmammographyasreportedbywomenenrolledintheHawaii&LosAngelesCaliforniaMultiethnicCohort(MEC)&assess ifACSorNCImammography recommendationsweremet;(b)Exploreifracial/ethnicdisparitiesexistinmammog-raphy;&(c)assessifdemographic,medicalhistory,orbodymassindexinfluencesbehavior.

A‘HealthBehavior’modelwithsocial,demographicandculturalfociwasusedtoguidethestudy.

DESIGN: Baseline & follow-up surveys of 81,722 women ages45-75withcompletemammographyhistoryatenrollmentofapro-spectiveMEC;DATAANALYSES:oddsratiosand95%confidenceintervals (CI) were calculated using unconditional logistic regres-sion.

RESULTS: 91% of women reported ‘ever’ having a mammo-gramatbaseline;howeveronly37%reportedanannualand48%

anannualorbiannualmammogramduring the follow-upperiod.Race/ethnicitywasanimportant indicatorofregularmammogra-phy use even after controlling for age, education, family historyandestrogenuse.OddsofrepeatexamswerelowerforAA(ORadj=0.76,95%CI0.72-0.79);Hispanic(ORadj=0.80,95%CI0.76-0.84),NativeHawaiian(ORadj=0.80,95%CI0.80-0.90)andJapa-nese(ORadj=.93,95%CI0.89-0.97)womencomparedtoWhites.Whilemostwomenreportedapriormammogram,thepercentofwomenwhoreportedanannualorbiannualmammogramwaslowanddifferedbyrace/ethnicity.Culturallysensitivepatienteduca-tion by nurses to improve women’s life-long mammography be-haviorsiswarranted.

2293FACILITATING MULTIDISCIPLINARY COLLABORATION IN AN OUT-PATIENT INFUSIONSETTING. JudithKarp,RNC,BSN,OCN®, SinaiHospital,Alvin&LoisLapidusCancerInstitute,Baltimore,MD;andPatriciaWilcox,APN,MSN,AOCN®,SinaiHospital,Baltimore,MD.

Theinteractionbetweennursesandpatientsinoutpatientsettingscan be brief, but many patient treatments now extend for severalhoursormorepervisitduetoregimensthataremorecomplexandtheneedsoftheagingoncologypopulation.Becauseofthesefac-tors,multidisciplinaryinteractioncannotbeoverlookedin thispa-tientsetting.

Sinai Hospital in Baltimore, MD has a rapidly growing outpa-tientoncologypopulation.Inthepastfouryears,ithasgrownfrom400to1300patientvisitspermonth.Theinfusionareaisassoci-ated with a six-member group of oncology physicians that treatalltypesofcanceranduseallofthelatestbiologicalandchemo-therapyagents

The nurses in the infusion center decided that multidisciplinaryroundswouldprovide a forumwhere select patients’ planof carecould be discussed. The case studies that the nurses selected forroundswerethosethestafffoundmostinterestingorposedaman-agementchallenge.Nursingleadershipsupportedthisproposalandapprovedonehoureachmonthwherepatientsarenotscheduledintheinfusioncenter,toenableallstafftoattendthemeetings.Patientsareidentifiedoneweekpriortoroundsbytheinfusionstaff.

TheMedicalDirector,CRNPs,APN,unitmanager,infusionstaff,oncology pharmacist, social worker, and the oncology office RNsparticipateintheserounds.Presentationofthepatientincludespasthistory,currenttreatmentandsocialsituation.

Twocommonthemeshavebeenidentified.Thefirstistheneedtobegintransitionofthepatientandfamilytowardpalliativecare.Thesecondthemeidentifiedistheneedtoprovidesupporttopreviouslyunidentifiedpatientneeds.

Theparticipantsallagreethat thissharingof informationonpa-tientsandfamilieshashelpedtobetterarticulatepatientneeds,im-provepatientoutcomesandfacilitatesandimprovescommunicationbetweenalldisciplines.

2295EVALUATING A NEURO-ONCOLOGY INFORMATION HOTLINE AS ACOMPLEMENT TO CLINICAL CARE. Jenette Spezeski, MPH, MaryLovely,RN,PhD,andHarrietPatterson,MPH,NationalBrainTumorFoundation,SanFrancisco,CA.

Theplethoraofinformationaccompanyingacancerdiagnosiscanoverwhelmpatientsandtheircaregivers,resultinginquestionsthatarisebetweenmedicalvisits.Aneuro-oncologyinformationhotlineis intended to bridge this gap by providing information on topicsranging frombrain tumor types and treatments, caregiving issues,symptommanagement,andreferralstosupport-relatedresources.

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Thepurposeofthis initiativewastoevaluatetheusefulnessofaneuro-oncologyhotlinetoitscallers.Further,theevaluationsoughttogather informationaboutwhousestheservice,whyindividualscallthehotline,andwhichneedswerenotbeingmet.

Trained intervieweesconducteda retrospective telephone surveywithasampleofcallerswhohadusedthehotlineoverasix-weekperiod. The questionnaire was pilot-tested and contained 19 mul-tiplechoiceand4open-endedquestions.Ofthe107individualscon-tacted,75(70%)completedthesurvey.Responsesweresummarizedandopen-endedquestionswereanalyzedusingqualitativeresearchmethods.

Callerswereprimarilyfemale(79%)andCaucasian(85%).Nearly65%ofcallerswerebetween46and65yearsold,whereasonly4%ofcallerswere35yearsoryounger.Fifty-twopercentwerethefriendorfamilyofapatient,while35%self-identifiedasapatient.Call-erscontacted thehotline seeking information, support,orbecauseofcircumstancessuchasadiagnosisortreatmentoptions.Eighty-onepercentofcallersreceivededucationalmaterials,37%receivedaconsultationwithaneuro-oncologynurse,and34%ofcallerswerereferredtosupport-relatedresources.Callersexpressedsatisfactionwiththeirexperienceandfoundtheinformationtobequitehelpful.Unmetneedsincludedresourcesonlong-termsurvivorshipandthepractical impactofacancerdiagnosis.Virtuallyallofcallerssaidthey would recommend the hotline to others needing informationaboutbraintumors.

Thissurveyhighlights theimportantroleofpatienthotlinesasacomplementtooncologynursing.Neuro-oncologyisaspecializedfieldandqualityinformationcanbefoundthroughahotlinevenue.Hotlinesempowerpatients to seekquality informationabout theirdiagnosis.Referringpatientstohotlinesraisesawarenessaboutthehelpfulservicesavailable.Partnershipsbetweennursesandpatientgroups will address unmet needs and reach underserved popula-tions.

2296EXERCISE DURING ADJUVANT CANCER TREATMENT DECREASEDNAUSEAATTHEENDOFTREATMENTINBREASTCANCERPATIENTS.JiyeonLee,RN,MS,andMarylinDodd,RN,PhD,FAAN,UniversityofCaliforniaSanFrancisco,SanFrancisco,CA.

Exercisehasbeensuggestedasaneffectiveinterventionforcancerrelated symptoms suchas fatigueand sleep.However,onlya fewstudieshavebeendonethatfocusedontheeffectofexerciseinnau-seacontrol,withinconclusiveresults.

The purpose of this study was to evaluate the effect of exerciseinnauseacontrolduringandafteradjuvantchemotherapy(CTx)+Radiationtherapy(RTx).

Thetheoreticalframeworkofthisstudyisthemodelforsymptommanagement.

Thissecondarydataanalysisisbasedonrandomizedclinicaltri-al that investigated the effect of exercise on fatigue of cancer pa-tients.SubjectswerefemalebreastcancerpatientswithstageItoIII(N=112).Mostsubjectsreceivedadriamycinandcyclophosphamide(n=98) + RTx (n=59). Subjects completed baseline measurement(T1)betweenthecompletionofthefirstcycleandbeforethestartofsecondcycleofCTx.Secondmeasurementwasdoneaftercomple-tionofallcyclesofCTx+RTx(T2).ThefinalmeasurementwascompletedafterequivalentperiodoftimebetweenT1andT2(T3).Exercisestatuswasmeasuredbyintensityofexercise,timepereachsession,andthenumberdaysperweek.Ifasubjectexercisedsome-whathardinintensity,morethan21minutespersessionandmorethanthreedaysperweek,thesubjectwasconsideredasanexerciser.Patientsevaluatednauseaseverityona0-10numericratingscale.

Mann-WhitneyUtestwasusedtocomparemeannauseaseveritybetweenexercisers(n=45)andnon-exercisers(n=52).

Therewassignificantdifferenceinnauseaseveritybetweenexer-ciserandnon-exerciseratT2(z=-2.183,p=.029).Forsubjectswhowere exercisers at T1, continuation of exercise during treatmentphase(T1-T2)isemphasized,sincediscontinuingexerciseresultedin more nausea after their treatment (T2). Starting exercise withadjuvanttherapy(T1-T2)innon-exercisersatT1ishighlyrecom-mended as to achieve better control of nausea after the treatment(T2).Encouragingsubjectstoexerciseduringadjuvanttherapyisasuggestedinterventiontocontrolnauseaaftertherapy.

2298UTILIZINGASCENICCURTAINTODECREASETHEPATIENT’SANXI-ETY AND ANGER DURING INITIAL CHEMOTHERAPY TREATMENT.Kimberly Moeller, RN, BSN, OCN®, Summa Health System, Akron,OH;SherryMurvine,RN,BSN,HospiceandPalliativeCareofVisitingNurseService,Akron,OH;andChristopherBegan,RN,BSN,AultmanHospital,Canton,OH.

Thediagnosisofcancerandfearoftheunknownoftenproducesphysiologicaldistress,suchasincreasedlevelsofanxietyandanger.Anxietycanbeamajorfactorinanticipatorynauseaandvomiting,substantiallyinterferingwiththepatient’squalityoflife.Evidencebasedresearchhasrevealeddistractioninterventionhasbeeneffec-tiveinreducingthelevelsofanxietyandanger.Alleviatingpatientstress and anxiety is a significant clinical goal because anxiety isboth:animportantnegativehealthoutcome,andhasavarietyofdet-rimentalpsychological,physical,andbehavioraleffectsthatworsenotheroutcomes.

ThepurposeofthisstudywastoexploretheuseofatranquiloceanSereneViewcurtainasadistractioninterventiontoreduceangerandanxietyinpatient’sreceivinginitialchemotherapyintheout-patientsetting.

DorothyJohnson’sconceptualframeworkguidedthisstudy.Onegoalisforthepatienttoobtainfunctionattheoptimallevel.Johnsonunderstoodtheclientisstressedbyeitherinternalorexternalstimuliwhichdisruptthisequilibrium.Thegoalofnursingistoreturnthesystemtobalanceandsupporttheprocessbywhichitisobtained.TheliteraturereviewalsoshowedthatFlorenceNightingalebelievednursesneed toputpatients in thebestpossiblecondition toallowhealthtoberestoredandpreventionofcureanddisease.

The method utilized was a quantitative experimental design. 29participantswererandomizedintoeitherthecontrolorexperimentalgroup and received a two-pocket coded packet. Each packet con-tainedatwentyquestionpreandpost testsurveyalongwithapreandposttestvisualanalogscale.

Bothgroupsrevealedsignificantdecreasesinanxietyasevidencedbysurveyquestions,VASmeasures,bloodpressures,andheartrates.Thesedecreasescouldnotsolelybeattributedbythesceniccurtain.Itisimportanttonursingthatregardlessoftheintervention,initialchemotherapyproducesanxiety.

2301GENDERDIFFERENCESINQUALITYOFLIFEOFCAREGIVERSOFPA-TIENTSWITHADVANCEDCANCER.PatriciaCarter,PhD,RN,CNS,Sabrina Q. Mikan, MSN, and Cherie Simpson, MSN, University ofTexasatAustin,Austin,TX.

Nearly one out of every four households (23% or 22.4 millionhouseholds)isinvolvedincaregivingtopersonsaged50andolderwithachronicdisablingcondition.Thisnumberisestimatedtoin-crease to 39 million by the year 2007.The cumulative impact ofinformalcaregivingishasseverenegativeeffectsoncaregiversleep

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quality,depressionandqualityoflife.Maleandfemalecaregiversresponddifferentlytothestressorsofcaregivingandthusmayreportdifferentlevelsofsleep,depression,andqualityoflife.

Thepurposeofthisstudywastoexplorethesimilaritiesanddiffer-encesbetweenmaleandfemalecaregiversonthevariablesofsleepquality,depression,andqualityoflife.

Thestressandcopingframeworkwasusedtoguidethisstudy.This4-monthsleepinterventionstudyenrolledadultfamilycare-

giversofpersonswithadvancedstagecancer.Variablesofinterestaresleepquality,depression,qualityoflife.Analysisrevealedsignif-icantdifferencesbetweengendersonthevariableofqualityoflife.Thispaperwillpresentthefurtherexplorationofthesedifferences.Sixty-threecaregivershavebeenenrolledinthestudytodate(Malesn=22,Femalesn=41).

Preliminaryfindingsrevealthatthereisasignificantdifferencebe-tweenmaleandfemalequalityoflifewhilecaregivingatbothbase-line(week1)andpost-intervention(week3)qualityoflifescores;p<0.05. Infemalecaregiversqualityof lifewassignificantlycor-relatedwithcaregiverage,currenthealthstatus,relationshipquality,depression,andsleepquality.Depressionwastheonlyvariablesig-nificantlycorrelatedwithqualityoflifeinmalecaregivers.

Conclusions:Maleandfemalecaregiversresponddifferentlytothestressorsofprovidingcaretoafamilymemberwithadvancedstagecancer.Thesefindingssuggestthereisarelationshipbetweenpoorqualityofliferelatedtocurrenthealthillnessesofthefemalecare-givers.Malecaregiversexperiencedepression,howevertherewerenoothervariablesidentifiedasstrongpredictorsfordecreasedqual-ityoflife,althoughthismaybeduetosamplesize.Furtherresearchinwomen’shealthandinformalcaregiverstressisnecessaryinordertocreate interventionsforwomento improvequalityof lifewhilecaregiving.

2302WHY WAIT? THE DEVELOPMENT OF AN APN-LED, SAME-DAY,RAPIDDIAGNOSTICBREASTCLINIC.BridgetteLord,RN,MN,ACNP,PrincessMargaretHospital,Toronto,Canada.

In 2006, an estimated 22,200 Canadian women were diagnosedwithbreast cancer.Considerablevariationexists forpatients fromthe timeabreastabnormality isdetected to the timeofdiagnosis.Manypatientswaitseveralweekstoreceiveadiagnosis.Thisdelayindiagnosisleadstoprolongedpatientanxietyandadelayintreat-ment.

AtalargeCanadianCancerCentre,bothpatientsandhealthcareprovidersrecognizedtheneedtoimprovethediagnosticprocessforpatientswithbreastabnormalities.Inconsultationwithamulti-dis-ciplinary team,anAdvancedPracticeNurse(APN)-led,same-day,rapiddiagnosticbreastclinicwascreated.Thegoalsof thisclinicweretwo-fold:toexpeditethediagnosticprocessforpatientswithsuspiciousbreastabnormalities,andtoprovideacaringandsupport-iveenvironmentforpatientsthroughoutthediagnosticprocess.

TheAPNplaysapivotalroleinstreamliningthediagnosticpro-cessforpatientsallowingforaone-stop,same-day,rapiddiagnos-ticbreastclinic.Theclinicoperatestwiceweeklyforpatientswithsuspiciousphysical,mammographicorsonographicbreastfindings.TheAPNtriagesnewpatients;conductshealthhistoriesandphysi-calexaminations;andarranges further imagingandcorebiopsies,ifrequired.Forthosepatientsundergoingbiopsy,theAPNandsur-geonmeetwith thepatient todiscuss thepathology results in theafternoon.On-goingpsychosocialsupportandeducationisprovidedthroughoutthediagnosticprocess.

Todate,thepreliminarydatashowsthatthecurrenttimetodiag-nosishasbeendecreasedfromseveralweekstoseveralhours,with

89%ofpatientsreceivingasame-daydiagnosisintherapiddiagnos-ticclinic.Eightypercentofpatientsseenintherapidclinichadbiop-siesand85%ofthosepatientsrequiredsurgery.Patientsatisfactionwiththesame-day,rapiddiagnosticcliniciscurrentlybeingevalu-ated.Uptodateresultsandstatisticswillbeprovidedintheposter.

Oncologynursescanplayanimportantanduniqueroleindevelop-ingandleadingnewclinicstoamelioratethediagnosticprocessforpatientsandimproveoverallpatientcare.Otherdepartmentsand/orhospitalsmayadoptthisclinicmodeltoprovidesuperiorpatientcareandamoretimelydiagnosisforpatients.2303EVIDENCEBASED,ONCOLOGYFOCUSEDORIENTATIONEDUCATIONFORALLLEVELSOFEXPERIENCE.MarthaKershaw,RN,BSN,andChristinaMcMahon,RN,BSN,RoswellParkCancerInstitute,Buffalo,NY.

Asacomprehensivecancercenter,thechallengetorespondtothegrowingneedfornursingrecruitmentandretention,implementationofsharedgovernanceandapplicationformagnetstatushavedriventhechangeintheorientationeducationfornursingstaffatRoswellParkCancerInstitute.Recommendationsfromstaffprogramevalu-ations, inputfromincumbentstaff throughEducationcouncils,re-viewoftheliterature,includingtheONSEducationBlueprint,andbenchmarkingwithlikeinstitutionsdeterminedthestructurerecom-mended.

Thegoalwastodevelopanevidence-based,oncologyfocusedori-entationthatmettheneedsofnursingstaffcomingintoourcompre-hensivecancercenterwithalllevelsofexperience.

Toprovideclassesmeaningfultoalllevelsofexperience,thedeci-sionwasmadetohavenewnursingstaffattendclassesbasedontheirpastexperience.3levelsofnursingstaffwereidentified,Graduatenurse,ExperiencednurseandExperiencedOncologyNurse.Acom-petencyselfassessmentcompletedbythenewstaffmemberontheirfirstdayofemploymentalongwithaskilldemonstrationdrivestheclassroomorientationtheyarerequiredtoattend.

Evidenceandbenchmarkinghelpedshape theclassroomcontentincluded and the presentation methods used. Basic pieces recom-mendedbytheANCCfororientationinamagnet institutionwereincorporatedwithoncology information includedbyother like in-stitutions.InformationpreviouslyprovidedinSLMformatwasrec-ommended as lecture content. Lectures incorporating power-pointpresentationswithcasestudiestoproviderelatablereinforcementofthecontentpresented.Oncologyservicespecificclasseswere rec-ommendedtobuildontheinformationintheBasicOncologyNurs-ingOrientation.

Atoolwasdevelopedthatallowsnewstafftoevaluateclassroomorientation at the end of each class session. Information will besharedwithEducationCouncilsforon-goingdiscussiononhowtoshapefuturesessions.

By providing an orientation program that evaluates the nursingstaff’s previous experience and then provides an evidenced-basedclassroom orientation built around their oncology specific educa-tional needs, the information is relevant to the learner and thus avaluablelearningexperience.

2304APILOTSTUDYOFDECISIONMAKINGPREFERENCESINPERSONSWITHADVANCEDCANCER.AnneHughes,RN,MN,AOCN®,LagunaHondaHospital/SFDepartmentofPublicHealth,SanFrancisco,CA.

While recent literature suggests thatpatients’ abilities topartici-pate freely inmedicaldecisionswhenchronicallyor seriously ill,maynotbecompletelyautonomousgiventhegravityofwhatisat

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stakeandthepatients’knowledgebase,neverthelessintheUS,pa-tient participation is a key aspect of cancer care, and is a corner-stoneofwesternbioethicsculture.Theabilityofsocio-economicallydisadvantagedpersonslivingwithadvancedcancertoparticipateinmedicaldecisionmakingisnotwelldescribedintheliterature.

Thepurposeofthispilotstudyistodescribethedecisionmakingpreferencesofpersonswithadvancedcancerwhoarepoorandlivinginanurbanarea.

Thetheoreticalframeworkforthispilotispatientdecisionmakingtheorywhomaintainsthattherearearangeofpreferencespatients’maydemonstratewhenfacedwithamedicaldecision.

Thisanalysisispartofalargerstudy,usingmixedmethodstoex-plorethemeaningofdignity.Patientswererecruitedfromproviderscaringfortheurbanpoor.TheControlPreferenceScalewasadmin-istered to the participants by the researcher along with other studyinstruments.Dataanalysisincludedcomputingthepatient’sdecisionmakingpreferencebasedonthepairedsortoffivedecisionmakingstyles, andbyasking for theonedecisionmaking stylewhichbestreflectsthepatient’susualstyleofdecisionmaking.

Sixteen patients with advanced cancer participated in this pilot,mosthadstageIIIorstageIVsolidtumors(lung,breast,colorectal,etc.).Threeofthe16patientsalsohadAIDS.Thesampleincluded7menand9women,rangedinagefrom38-69years,andhalfofthesamplewerepersonsofcolor(6AfricanAmericansand2Hispanic/Latinos).Patientsdisplayedarangeofdecisionmakingpreferencesmostwantingshareddecisionmakingwiththeirphysician.Assev-eral patients commented during the administration of this survey,“I’mnotadoctor.”Thispilotreinforcestheneedtoassesspatients’decisionmakingpreference,regardlessofeconomicresourceswhencoping with cancer, and leaves unanswered how decision makingpreferencemaychangeovertimeastheillnessprogresses.

2306ADVANCEDIRECTIVES:DOWEPRACTICEWHATWETEACH?BarbaraBiedrzycki,RN,MSN,AOCN®,CRNP,JohnsHopkins,Baltimore,MD.

Oncologynursesaretheprofessionalsthepublictruststhemost.Witha sensitive issue, suchasadvancedirectives, thepublicmayplacevalueontheironcologynurses’personaluseof,accesstore-sourcesforandknowledgeaboutadvancedirectives.Oncologynurs-es’comfortwithadvancedirectivesmaydirectlyimpactthepublic’sperceptionanduseofadvancedirectives.

Theaimofthispilotstudywastolearnmoreaboutoncologynurs-es’useandknowledgeofadvancedirectives.Participationindeci-sionmakingabouttreatmentinadvanceddisease,thatisincludedinmanyadvanceddirectives,wasthesecondpriorityforthetotalONSmembership,basedonONS’2004survey. Indirectly, this researchrelates to facilitating the family system to make decisions whilemanaging the demands of cancer (ONS Priority Topic 2.1, ONS2005-2009ResearchAgenda).

The Health Belief Model provides the theoretical frameworkwhichguidesthispilotstudy.Thevaluethatoneplacesontherisksandbenefitsofthehealthoutcome,aswellasthecompletionofanadvancedirective,determinesifactionistaken.

Throughaneducationalproject,aposterpresentationat the31stAnnual Congress, this pilot study captured data directly onto theposter.Throughtheslashmarksofconferenceparticipants,datawascollectedon theuseofadvancedirectives.Also,participantswereaskediftheythoughtthataccesstoresourcesand/orknowledgeim-pactedtheirpersonaluseofadvancedirectives.

Thedata supports thatoncologynurses arewilling to share thatthey do not have advance directives. Knowledge of and access toresourcestocompleteadvancedirectivesdoesnotappeartoimpact

theoncologynursespersonaldecisionregardinghavinganadvancedirective.While themainpurposeof thepreviousposterpresenta-tionwas to increaseoncologynursesawarenessofadvancedirec-tives,valuablepilotdatawasgathered.Thisverypreliminarydataprovidestheimpetusforconductingamorerigorousresearchstudyexploringtheoncologynursesuseofadvancedirectives.

2308EVALUATING ALTERNATE APPROACHES FOR DELIVERING NON-PHARMACOLOGICALINTERVENTIONSFORDYSPNEAINPATIENTSWITHLUNGCANCER.PatsyYates,PhD,RN,QueenslandUniversityof Technology,KelvinGrove,Australia; ElizabethWhite,MSc,AgedCareAccreditation,Brisbane,Australia;andHelenSkerman,MSocSci,QueenslandUniversityofTechnology,KelvinGrove,Australia.

Despitethepotentialbenefitsofnon-pharmacologicalstrategiesformanagingdyspnea in lungcancer, such interventionshaveproveddifficult to implement in routineclinicalpracticebecause they re-quirespecialisedtrainingandsubstantialtime.

This study aimed to undertake preliminary evaluation of alter-nate approaches to delivering an intervention involving BreathingRetrainingandTargetedPsychosocialSupporttoimprovethenursesensitivepatientoutcome-dyspnea

Corner’sIntegratedmodelofdyspneaTwo pilot studies using experimental designs were undertaken.

Trialoneinvolvedaquasi-experimentaldesignwith30patientsas-signedtointerventionorcomparisongroups.Theinterventiongroupreceived the intervention in face-to-face sessions administeredweeklyfor4weeksathospitalorinthehome.Trialtwoinvolvedarandomisedcontrolleddesignwith57patients.Theinterventionwasalsoadministeredonaweeklybasisforfourweeks,howeverthefirstsessiononlywasdeliveredface-to-faceandfollowupsessionsweredeliveredbyphone,supportedbyprintedinformation.Inbothtrials,measuresofbreathlessness,physicalandpsychologicalsymptoms,and functional statuswereundertakenatBaseline,4weeksand8weeks

Analysisofpre-postinterventionassessmentsintrial1revealedastatisticallysignificantinterventioneffectforbreathlessnessatbestratingsonly(F[2,44]=5.30,p=.009).Nosignificantdifferenceswerefoundbetweengroupsinbreathlessnessorsymptomdistressratingsintrial2,althoughtheinterventiongroupreportednon-pharmaco-logicalstrategiestobesignificantlymoreusefulovertimethanthecontrolgroup(p<.001).

Thesepilot studiesweredeveloped to examine the effectivenessof different delivery formats and shorter time frames or doses ofnon-pharmacologicalinterventionsfordyspneathanthosereportedinpreviousstudies.Findingsprovideonlyminimalevidenceofim-provementresultingfromtheseinterventionstrategies.Furthersuf-ficientlypoweredstudiesarerequiredtoinvestigatewaystooptimisethedeliveryof non-pharmacological interventions for lung cancerandreducetheresearch-practicegapinthisfield.

2310QUALITYOFLIFEWITHTHEBREASTCANCERPATIENTSANDTHEIRSPOUSESACROSSTREATMENTPHASESINREPUBLICOFKOREA.Insook Lee, Seoul University National Hospital, Seoul Korea; andWoonheeLeeandChungminChoi,YonseiUniversityCollegeofNurs-ing,Seoul,Korea.

AmongKoreanwomen,breastcanceristhemostcommoncancer.Furthermore,theincidencecontinuestorisewiththepeakin40yearsolds.WhenawomanisdiagnosedwithbreastcancerinKorea,thereoftenisacrisisinthefamily.Cancerdoesindeedinvadetheentirefamily,andthatfamilymembers,especially,spouses,aredistressed.

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Especially,Qualityoflifeisimportanttobreastcancerpatientandtheirspouses.Nevertheless,littleresearchhasbeenconductedontheQualityofLifeofbothbreastcancerpatientsandtheirspouses.

Theaimsofthisstudyweretoassesssimilaritiesanddifferencesbetween patients with breast cancer and their spouses across thetreatmentphasesandtoinvestigatetherelationshipsbetweenthepa-tients’andspouses’qualityoflife.

The convenience sample consisted of 45 women and their hus-bands in operation phase, 13 women and their husbands in adju-vanttreatmentphase,and31womenandtheirhusbandsinrecoveryphase.Participantscompletedquestionnaireswhichcontainedade-mographicquestionnaire,andQualityoflifequestionnaire(Ferrell’sQOL-BC and QOL-Family version). Descriptive statistics, t-test,andANOVAtestswereusedtoanalyzethedata.DifferenceswerefoundacrossphasesoftreatmentonsubscalesandtotalQOLscores,includingthoserepresentingperceivedphysicalwellbeing,psycho-logicalwellbeing,socialwellbeing,spiritualwellbeing,andtotalQOL.

Results: Psychological wellbeing score of breast cancer patientswere significant differences across the treatment phases (F=3.83,p=.025).However,nosignificantdifferenceswerefoundacrossthetreatmentphases inhusbands.Therewasasignificant relationshipbetweentotalQOLandsubscalesofbreastcancerpatientsandtheirspousesacrossthetreatmentphases.

Conclusions: Health care professionals need to recognize simi-laritiesanddifferencesbetweenwomenandtheirhusbandstobettermeettheneedsofpatientsandtheirhusbandswithabreastcancerdiagnosisandtreatment.Futurestudiesneedtoconsidernursingcareinterventionforbreastpatientsandtheirspousesacrossthetreatmentphases.

2313MANAGING THE RISK OF VENOUS THROMBOEMBOLISM IN CAN-CERPATIENTSTHROUGHMULTI-DISCIPLINARYCOLLABORATION.VictoriaHawkins,DRPH,RN,DonnaL.Gerber,PhD,AOCN®,BCLS,CNS,RN,JaneM.Falk,MS,BSN,JanetK.Taubert,MSN,BSN,ACLS,BCLS, CNS, OCN®, RN, Monique E. Taylor, MSN, MBA, OCN®, RN,andDianneL.Stephens,MSN,BSN,ACLS,OCN®,RN,M.D.AndersonCancerCenter,Houston,TX.

Mortality within six months of initial hospitalization increasesthree-foldforcancerpatientswithvenousthromboembolism(VTE)whencomparedtopatientswithcanceronly.VTEispreventableandtreatableinmanycases.Howeverin2005,onlysevenpercentofpa-tientswhodiedfromthromboticcomplicationsintheU.S.wereeverdiagnosed or treated forVTE, according to a new study.AnotherrecenttrialhasdemonstratedthatasystematicprocessofVTEriskassessmentwithphysiciannotificationresultsinimprovedprophy-laxisandreducedincidenceofVTE.

ThepurposeofthisprojectistoestablishasystematicprocessofVTEriskassessmentwithphysiciannotificationthatissafe,effec-tive,andeasytouse.

Through an extensive literature review, VTE risk factors wereidentified and stratified based upon strength of the evidence. Thelistoffactorswasnarrowedtothoseforwhichtherewasconsensus,andtheRNVTERiskAssessmentToolwascreated.Concurrently,amultidisciplinaryhealthcare teamdevelopedanonlinephysicianordersetforVTEpreventionbasedonnationalguidelines.TheRNtoolandphysicianorderswereintegratedintooneonlinedocument,thuscreatingarecordfornursetophysiciancollaborationandreduc-ingtheneedforredundantdocumentation.

Apilotprojectwillbeconductedforonemonthonamedicalon-cologyunitandasurgicaloncologyunit.Thedatatobecollectedat

baselineandduringthepilotinclude:(1)numberandpercentofnewpatientswho received the riskassessmentwithphysiciannotifica-tion;(2)typesofVTEriskfactorsfoundinthesepatientpopulations;(3)physicianpracticepatternsrelatedtothromboprophylaxis.Inad-dition,asurveywillbeconductedamongparticipatingmultidisci-plinarystaff toassess theaccessibility,convenience,andutilityofthenewprocess.

Itishopedthattheprocesscanbeadaptedeasilytootherclinicalsettingshereandatotheroncologyhealthcarecenters.EducatingnursesregardingtheprevalenceofVTEintheoncologypopulationandenablingnursestoconductVTEriskassessmentwithphysiciannotificationarepowerfultoolsinthepreventionofthisdeadlycom-plication.

2315ASSESSINGMEDICALONCOLOGYOFFICEPRACTICESFORQUAL-ITYIMPROVEMENT:AFOXCHASECANCERCENTERPARTNERSINI-TIATIVE.MargaretO’Grady,MSN,RN,OCN®,ElaineSein,RN,BSN,OCN®,PatriciaKeeley,RN,MSN,APRN-BC,OCN®,BonnieMiller,RN,BSN,OCN®,andPaulEngstrom,MD,FACP,FoxChaseCancerCen-ter,Rockledge,PA;andStevenCohen,MD,FoxChaseCancerCenter,Philadelphia,PA.

As “Pay for Performance” becomes a reality, medical oncologypractices will need clinical nursing support to help quality moni-tor and audit for compliance. Fox Chase Cancer Center Partners(FCCCP)isauniquecommunityhospital/academicpartnershipthatjointlymonitorsquality improvement activities in communitypri-vatepracticemedicaloncologyoffices.

TheFCCCPClinicalOperationsTeamconsistingofMedicalOn-cologistsandOncologyCertifiedNursesconductqualityaudits in16medicaloncologyofficesforsixyearsutilizingNationalCom-prehensiveCancerNetwork(NCCN)derived indicators.Theauditprocess allows for benchmarking against quality indicators/guide-linesandprovidesaroadmapforqualityimprovementinitiativesintheoncologyclinicalofficesetting.

Reviewing 16 medical oncology practices, concordance withNCCNguidelinesisratedforeachof20chartsselectedfromindi-vidualofficepractices.TheFCCCPteamand thePartnerMedicalOncologistshavebuilt siteandstagespecific indicators foryearlyreviewlookingatbreast,colon,lung,prostate,esophagealandgas-triccancers.Measurementisbasedonathree-pointscale:1meetscriterion,2doesnot,or3isnotapplicable.ThisisbasedonalistofindicatorsanddatadictionarydevelopedyearlybyFCCCPOpera-tionsstaff.

A report is generated for the medical oncology practice on ar-eassuchasdocumentation,screeningrecommendations,newdrugutilizationandresearch trends inaparticulardiseasesite.Statis-ticsaregeneratedlookingatindicatorsmet,numberofnewcasesseenperyear,numberofdiseasesitecasesbasedontumorregis-try information, and clinical trial accrual total and site specific.Educationanddocumentationtoolsareprovidedtophysiciansandoncology office nursing staff to maintain quality and streamlineprocesses. Valuable education and documentation tools are pro-videdtoambulatorycareandoncologynursestomaintainqualityandstreamlineprocesses.

BenchmarkingagainstNCCNguidelinesandeachother,FCCCPprivatepracticemedicaloncologistshaveenhanceddocumentationdevelopmentandresearchstudyinformationexchangehasoccurredto better capture information and support the provision of qual-itycare.UtilizingtheexpertiseofoncologynursesandtheNCCNguidelines,thisqualityreviewprocessisamodelforuseinanyon-cologypractice.

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2316NURSINGROLE INAPILOTSTUDYONTHEADMINISTRATIONOFEXERCISE IN ACUTE LEUKEMIA PATIENTS DURING INDUCTIONCHEMOTHERAPY. Reynaldo Garcia, RN, BSN, OCN®, University ofNorthCarolinaLinebergerCancerCenter,ChapelHill,NC;CristaCree-dle,RN,BSN,OCN®,UniversityofNorthCarolinaHospitals,ChapelHill,NC;ClaudioBattaglini,PhD,UniversityofNorthCarolinaatCha-pelHill,ChapelHill,NC;InpatientAdultOncologyNursingStaffRN,UniversityofNorthCarolinaHospitals,ChapelHill,NC.

Inductiontreatmentforanacuteleukemiausuallyrequiresan-in-patienthospitalizationfor3–4weeks.Besideschemotherapy,pa-tientwillreceivebloodproductsupport,antibioticsandintravenoushydration.Patientsareusuallyencouragedtostayactiveduringthishospitalization,however,chemotherapyside-effects,diagnostictestsandfluidtrafficmanagementhindersthissituation.

Apilotstudyconductedexaminedthefeasibilityofadministeringanexerciseregimenduringtheinductionandthe2-weeksafterin-ductionofthesubjects.Secondly,thestudyexaminedtheeffectsofexerciseondepressionandfatiguesymptomsutilizingtheRevisedPiperFatigueScaleandDepressionquestionnaire(CES-D).

AnarticlefromSportsMedicineVol.10showedthatexercisecanbe considered as a complimentary therapy in the management ofchemotherapyrelatedsymptoms.

The study accrued 6 male and 3 female subjects (target of 10)withagerangingfrom18–60.Under thesupervisionofanexer-cisephysiologist,subjectsunderwentaninitialbatteryoffitnessandpsychologicalassessmentsdonewithinthefirst3daysofinductionfollowedbyanexerciseintervention3–4timesperweekandre-as-sessmentofthefitnessandpsychologicalparametersduringspeci-fied timesandat theendof the study (daybeforeor thefirstdayofconsolidationtherapy).Itwasadministeredforapproximately6weeks(averageof4weeksasanin-patientsupervisedindividualizedexerciseprescriptionand2weeksasfollowupathomethroughpre-prescribedself-administeredexerciseprescription)andwasmodi-fiedweeklydependingonsubject’stolerance.Thiswasdividedintotwodailysessions.

Asystemhasbeenutilizedtoinformeveryoneinvolvedinthepa-tientcareaboutsubject’sparticipationinthestudy.Variousnursinginterventionswereimplementedandgoodcommunicationbetweenthenursingstaffandtheexercisephysiologistwasnecessarytoplanthe subject’s daily activities. Patients reported a decrease in theiroverallfatigueof62.5%usingtheRevisedPiperFatiguescaleanda35.3%decreaseindepressionsymptomsbyusingtheCES-Dassess-ment.Insummary,nursesplayapivotalroleinthesuccessfulexecu-tionofthispilotstudyandthereisevidencetosupportthepositiveeffectsondepressionandfatigue.

2317ETHICSINNURSINGCARE,ADDRESSINGTHEISSUESFROMTHEBEDSIDE. Anne Delengowski, RN, MSN, AOCN®, Mia Burgis, BSN,andChristineMuldoon,BSN,ThomasJeffersonUniversityHospital,Philadelphia,PA.

Ethicsinclinicalcarehasbeenanongoingchallengeforstaffnurs-es.Withtheincreaseintechnologyandlife-sustainingtherapy,thesechallengeshavebecomemorepronounced.Evenmorechallenginghasbeentheabilitytoeducateandsupportthenursesatthebedsidewhenethicalissuesarise.

Tomeetthischallenge,aworkinggroupwasestablishedconsist-ingofastaffnurserepresentativefromeachnursingunitinamajorurbanhospital.Thenurseswerechallengetobecome“nursecham-pions” forethicson their respectiveunits.The initialgoalsof thegroupweretoeducatethestaffontheapplicationoftheANACode

ofEthicsandprinciplesofethics.Theintentwasthatthesememberswouldbringtheinformationbacktothebedsidebytheuseofbi-di-rectionalcommunicationpresenting.

Thegroup,establishedinOctober2004,hasmetmonthly.Theini-tialsgoalswereachievedbydiscussionandlecturesbyaninterdisci-plinaryteamincludingnursesandthechairmanofthehospitalethicscommittee.Oncetheinitialgoalswereaccomplished,moresensitiveissues were addressed, such as futility, truth telling, communicat-ingbadnewsandresearchonnursingethicaldilemmas.Inthepastyear, the group has matured with the staff now presenting ethicalcase studies and leading discussion on the ethical principles.Thegroupintendsonsponsoringacontinuingeducationprograminthefall,withmembers.Thegroupassessesaccomplishmentofthegoalsfromthepreviousyearandtopicsfortheupcomingyearcompletesayearlyneedsassessment.

Ethicalissuesfacenurses,especiallyincancercare,onadailyba-sis.Lackofeducationandsupportcompoundthestressimposedbytheseissues.Theethic’snursechampionshavefoundmuchcommongroundacrosslifespansandspecialtiesinreferencetodealingwiththesestresses.Sharedexperiencesandeducationhavemadeanim-pactontheirabilitytodealwiththesechallenges.Withtheirexperi-encewithmanyethicalsituations,theOncologyCNS,wholeadsthegroup,andoncologynursechampion,emergedasleadersandmen-torsofthegroup.Thissessionwilldescribetheplanning,processesanddevelopmentofthegroup.

2318BLOODTRANSFUSIONORNOT:ALITERATUREREVIEWOFBLOOD-LESSINTERVENTIONSTOTREATCANCERRELATEDANEMIA.JuneEilers,PhD,RN,BC,CS,NebraskaMedicalCenter,Omaha,NE;andLuisaRounds,BSN,RN,UniversityofNebraskaMedicalCenterCol-legeofNursing,Omaha,NE.

Bloodtransfusionshavebeenemployedsince1492.Incancertheyhavebecomestandardtreatmentforanemiasecondarytocytotoxictherapy,bloodloss,andbleedingdisorders.

Risingbloodcosts,bloodsafetyconcerns,healthbeliefs,andcon-tinuingbloodshortagesencouragesthehealthcarecommunitytoad-dressbloodconservationandrestricteduseofbloodproducts.Thelifesavingpotentialofbloodtransfusionsmustbeweighedagainstthese factors. Inaddition, legalandethicalconsiderationscompli-catetheiruseasstandardtreatmentforJehovah’sWitnesses.Theuseofevidencebasedbloodconservationpracticesandthepotentialoftransfusionfreecaretocorrectanemiawillallowtheoncologynursetosupporthighquality,costeffective,safe,culturallysensitivecareforthetreatmentofsuppressedbloodcountssecondarytocancerandcancertreatment.

Thepurposesofthisintegratedliteraturereviewweretoidentifybloodconservationandbloodlessinterventionstonormalizehemo-globin foroncologypatientsandproposeevidencebasedprotocolforbloodconservationinthetreatmentofcancerrelatedanemia.

Data frommore than100articleswerecompiled inanevidencebased table to articulate the bloodless intervention, author/year,sample,limitations,findings,andlevelofevidenceforeachcitation.The common interventions identified were cell salvage, aprotinin,colloids, growth factors, tranexamic acid, and overlay autogenoustissue(OAT)patch.Theinterventionsidentifythenursingandmedi-cal staff expertise in transfusion-free medicine, careful planning,intensive teamwork, patient-specific customization, and integrateduseofmultimodalbloodconservationstrategies,includingbloodlessbonemarrowtransplantation.

Thebloodlessinterventionsweredescriptivelyoutlinedtoevaluatebasedonmeasuresofeffectiveness,cost,safety,andqualityoflife

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relatedtobloodtransfusions.Thereviewallowsthenursetoevaluatetheinterventionsforpatientcenteredtreatment.

Overfivehundredyearssincethefirstbloodtransfusion,evidencesupportstheuseofbloodconservationandbloodlessinterventions.Valuable lessonsand intriguingquestionschallenge thehealthcarecommunity about the necessity of routine blood transfusions andtheir transfusion trigger threshold.This leads to a discussion of aproposedevidencebasedprotocol.Through the integrationof thisevidence-based literature nurses can evaluate, support, teach, andadvocate forbloodconservation techniques to treat cancer relatedcomplications.

2319CASE MANAGEMENT OF THE NEWLY DIAGNOSED LEUKEMIA PA-TIENT. Kathy Rogala-Scherer, RN, and Michele Durusky, RN, BSN,RoswellParkCancerInstitute,Buffalo,NY.

Forthebestpatientoutcomes,mostcosteffectivemanagementofpatientcareandutilizationofresources,theCaseManagementDe-partmentattheRoswellParkCanerInstitutedevelopedandimple-mented a paradigm of activities that occur each week the patientremainsinpatientduringtheirinductionchemotherapytreatment.

Thepurposeofourabstractistopresenttheuniquechallengesandsolutionsfor:

Communicationwiththepatient’sinsurancepayerWorkingwiththepatientandthepatient’sfamily/supportsystem

onarealisticandsafedischargeplan.Obtainingvital informationneededtoplanforoptimalposthos-

pitalcare.Wehavebeenabletodemonstratethateducationtotheinsurance

payersaboutAcuteLeukemiaanditssubcategories,thevarietyoftreatmentoptionsavailableandtheexpectedlengthofstayhasde-creasedthedenialofreimbursementofinpatientstaydaysfromtheinsurancepayers.WehavealsodemonstratedthatwithCaseMan-agementinterventiononweeks2-3,initiatingthediscussionofdis-chargeplanning,RPCIinconjunctionwithpatients/familiesareabletoplanforamorerealistic,timelyandsafedischargeplan.Lastly,becausetheNurseCaseManagercompletesacomprehensiveinsur-ancecheckofthepatient’sinsurancebenefits,weareabletomaxi-mizethebenefitsthatareavailabletothepatient.

TheRPCICaseManagementDepartmentevaluatesthesuccessofourprogramusingthefollowingcriteria:• Allinpatienthospitaldaysarereimbursedbytheinsurancepayor• Thepatientisdischargedtothenextlevelofcarethatissafeand

mostbeneficialformaximalrecovery.• TheNurseCaseManagerandthepatient/familyareawareofthe

coverageandco-pays.Informedchoicesaremadewherecoveragemaybelacking.Alternatesourcesofcoverageareappliedfor.

In conclusion, we believe this process meets the needs for bestpracticeandoutcomesforinsurancepayors,resourceutilizationandmost importantly, the needs of the newly diagnosed leukemia pa-tient.2321NURSING EDUCATION AND VENOUS THROMBOEMBOLISM (VTE):VTE—IT’S NOT JUST FOR SURGICAL PATIENTS ANYMORE! KarinSwiencki,RN,MSN,AOCN®,andJoanKaiser,RN,MA,AOCN®,NewYork-Presbyterian/Columbia,NewYork,NY.

VenousThromboembolism(VTE)isasignificantproblemnation-ally;approximately600,000AmericanssufferfromVTEannually,andupto200,000willdie.ThefocusofVTEhasbeenontheriskforsurgicalpatients;however,multipleriskfactorsexistthatputthema-jorityofhospitalizedpatientsatrisk.AlthoughVTEriskcanbede-

creasedbyuptotwo-thirdsbytheuseofprophylaxis,manypatientsneverreceiveprophylaxis.TheInstitutionstartedaPilotProjecttodecreasetherateofhospital-acquiredDeepVeinThrombosis(DVT)on theOncologyUnit, itwasevident thataneducationalprogramshouldbedevelopedfortheOncologyNursingStaffregardingtheproblemofVTEinOncologypatients.BecauseRegisteredNursesplayakeyroleinpatienteducationregardingmedicationsandprac-ticestomaintainpatienthealthandsafety,patienteducationwasanimportantfocus.

Oncology Nurses must be aware that the presence of a malig-nancyisamajorriskfactorforthedevelopmentofVTEandofthemorbidity and mortality associated withVTE. The primary pur-poseoftheVTENursingEducationProgramwastoincreaseRNawarenessoftheproblemofVTEinOncologyPatients,andaware-nessofnursingimplications.TheprogramprovidesanoverviewoftheproblemofVTE;riskassessmentandappropriateprophylaxis;andnursing implications regardingVTE,witha focusonpatienteducation.

A45-minutePowerPointpresentationwasprovided to100%ofthe Registered Nurses on the Medical Oncology Unit.An educa-tionalposterwithkeypointsfromthepresentationwasdisplayedontheunit.TheprogramwaspresentedatNursingGrandRounds.TheVTEprogramisprovidedtoallnewhiresontheMedicalOncologyUnit.

Because documentation in the medical record reflects care ren-dered, the Patient Care Director audits the charts for compliancewithdocumentationofpatient education regardingVTEandVTEprophylaxis according to Institutional guidelines. If there is a de-crease incompliancewitheducation,RNStaff isprovidedwitharefresherinservice.

VTEisasignificantproblemfortheOncologyPatient.TheOncol-ogyRegisteredNursewhoiseducatedaboutVTEcanhaveamajorimpactonpatientsafety.VTEeducationshouldbeacomponentofNursingOrientationonallOncologyUnits.

2323“BRIDGE TO ONCOLOGY”: AN INNOVATIVE PROGRAM DESIGNEDTOBRIDGETHEGAPFORNEWGRADUATESANDONCOLOGYNA-IVE NURSES PRACTICING IN AN AMBULATORY CHEMOTHERAPYTREATMENT SETTING. Altagracia Mota, RN, MSN, OCN®, StacieCorcoran,RN,MSN,AOCNS,andJaniceReid,RN,MA,OCN®,Memo-rialSloan-KetteringCancerCenter,NewYork,NY.

Historicallytheneedforhighlyskilled,criticallythinkingnursesinambulatorycarehasprecludedhiringnewgraduatesoroncologynaïvenursesintotheambulatorychemotherapytreatmentsetting.Inthefaceofanursingshortage,newrecruitmentandretentionstrate-gieswereneededatthisNCI-designatedcancercenter.

Through collaboration with nursing leadership, nurse educatorsandclinicalnursespecialists,the“BridgetoOncology”orientationprogramwasdevelopedtoenableoncologynaïvenursestopracticesafelyandcompetentlyinthissetting.Thispresentationwilldescribeprogramdevelopmentandobjectives.

Anorientationpathwaywasdevelopedwithclearlystatedobjec-tiveswhichguidedinstructionandskilldevelopmentoverasixteenweekperiod.Contentprogressedfromabasic foundation tomorecomplex concepts in oncology and chemotherapy administration.Teaching methods included clinical experiences in developing in-travenousskills,patientassessment,symptommanagement,patienteducation, and chemotherapy administration. Online programs,readings,evidence-basedlecturesbyexpertnursesandoff-unitob-servationalexperiencesenabledtheindividualtogainadeeperun-derstandingofoncologyandthecarecontinuum.

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Characteristics of these nurses and the challenges faced whentransitioning to a newenvironment, ledus to examine theories ofmarginalization,realityshockandadultlearning.Tofurtherpromoteasuccessfultransitionandtocloselymonitorprogress,weeklyin-dividual meetings were scheduled with orientees, their preceptor,nurseeducator,nurseleaderandclinicalnursespecialist.Regularlyscheduled meetings with the Director of Nursing Education alsoservedasaforumforopendiscussionandpeersupport.

Atoolwasdevelopedfororienteestoevaluatetheprogramatsix-teenweeks,sixmonthsandoneyear.Resultswilldeterminetheneedforprogrammodificationandidentifyorientees’shortandlong-termretentionstatus.

Asmoreorienteecohortscompletethe“BridgetoOncology”ori-entationprogram,assessmentofseveralkeyfactorssuchaslevelofcompetency,autonomy,confidenceandprofessionalsatisfactionwillhelptodeterminetheprogram’smeritanddesign.Thisprogrammayhaveadditionalimplicationsforotheroutpatientsettingsandhasthepotentialtoenhancerecruitmentandretentionefforts.

2330GENETIC VARIANTS & OSTEOPOROSIS IN POSTMENOPAUSALWOMENWITHEARLYSTAGEBREASTCANCER.PatriciaKelly,RN,MS,AOCN®,TexasHealthResources,Dallas,TX.

Bonehealthandriskforosteoporosisaresignificantsurvivorshipissuesforpostmenopausalwomenwithbreastcancer.Breastcancertreatmentsspecificallyaromataseinhibitor(A.I.)medicationsaccel-eratebone lossbyreducingcirculating levelsofestrogen.Aroma-taseinhibitorinducedhypoestrogenemiaincreasesthepotentialforosteoporosis inapostmenopausalpopulationalreadyat riskbaseduponage.Womenwithbreastcancermaybeat increasedrisk forosteoporosisbasedupontheirdiagnosisalone,aphenomenonthatmayberelatedtogeneticfactorscommontobothdiseases.Thevita-minDreceptor(VDR)andtheestrogenreceptoralpha(Era)genesarewell-studiedgenesassociatedwithbonegrowth in thegeneralpopulation;however,thesegeneshavenotbeenstudiedinthebreastcancerpopulation.Bonemineral density (BMD) isheld tobe thegold standard for evaluating osteoporosis risk. In general popula-tionstudies,BMDvariationshavebeenshowntobeassociatedwithpolymorphismsintheVDRandERagenes.

Thepurposeof thispilot study is to identifygenetic factorsandassociatedmodifiers that relate tobonemineraldensity (BMD) inpostmenopausalwomenwithadiagnosisofearlystagebreastcan-cer(ONSTalkingPoints,LateTreatmentEffectsandSurvivorship).Aims:(1) Measure BMD and identify associated modifiers in thepostmenopausal breast cancer population.(2) Describe polymor-phismsfortheestrogenreceptorgene,Era,andthevitaminDrecep-torgene,VDR,inthepostmenopausalbreastcancerpopulation.(3)Determine whether there are differences in BMD and associatedmodifiersover3yearsamongstudysubsets.

Genomics is the conceptual framework,gene-geneandgene-en-vironment interactionsand the relationshipofgenes tohealthanddisease.

Thislongitudinalcomparativedescriptivestudywillinvolvethreegroups (N=45) of postmenopausal women. At study enrollment,women will have genotyping for polymorphisms in theVDR andEra genes.ParticipantswillhaveaBMDatbaselineandyearlyfortwoyears.Descriptivestatisticsandrepeatedmeasuresofvariancewillbeusedfordataanalysis.

Genetic pathways may help explain osteoporosis variability inpostmenopausalwomenwithearlystagebreastcancer.Baselineevi-denceisneededtoestablishosteoporosisscreening,prevention,andtreatmentguidelinesinthispopulation.

2333ESTABLISHING A CENTRALIZED EDUCATION SERVICE FOR CLINI-CALRESEARCHPERSONNEL.ReginaCunningham,PhD,RN,AOCN®,DeenaCentofanti,MSN,RN,AOCN®,DianaVamos,PharmD,SunitaChaudhary,PhD,andKristenFessele,MSN,RN,AOCN®,CancerInsti-tuteofNewJersey,NewBrunswick,NJ.

The conduct of quality clinical cancer research requires highlycompetentclinicalresearchnurses(CRNs)whoareknowledgeableaboutresearchmethods,regulatoryandcomplianceissues,biostatis-tics,andclinicaltrialsmanagement.Historically,educationofCRNshasoftenbeen limited to “on-the-job” experiences.The increasedcomplexityoftrialdesign,exponentialincreaseindemandsrelativetoregulatoryissues,advancesininformatics,andtheneedforpatientprotection,makeacompellingcaseforamoreformalandsystematicapproachtoeducationandskillmaintenance.

TheoverallpurposeoftheCentralizedEducationServices(CES)istoenhancethequalityofcancerresearchthrougheducation.Thisservice designs, develops, and implements educational programstomeettheinitialandongoinglearningneedsofCRNs,tosupplyregulatoryandcomplianceupdates,andtoprovideprotocol-specificinformation.

CESstaffincludesprofessionalswithdiversebackgroundsinclini-calresearch,researchpharmacy,andregulatoryaffairs; theseindi-viduals are actively engaged in research in their daily work. CESstaffdevelopscurriculaandprovideeducationdesignedtofacilitatedevelopmentandmaintenanceofknowledgeandskillsthatenabledeliveryofhighqualityservicestoclinicaltrialsparticipants.Pro-gramcontent reflectsGoodClinicalPracticequality standards fordesigning, conducting, recording, and reporting trials that involveparticipation of human subjects. Content is also derived from theCodeofFederalRegulations,expertresearchfacultyexperience,andrelevantliterature.Bothbasicandadvancedprogramsareofferedus-inginnovativemethodstodelivercontent.

Programsareevaluatedusingavarietyofmethods.Outcomesin-cludethenumberofprogramsoffered,thenumberofCRNsattend-ingprograms,scoresonstandardcontinuingeducationevaluations,contentevaluations(pre-andpost-tests),anddemonstratedresearch-specificcompetencies.MembersoftheCESarecollaboratingwitheducational methods experts to develop and test innovative deliv-erystrategiesbasedonprinciplesofadultlearningandcomplexitytheorytodeterminetheireffectonchangingpractice.

Effective clinical research relies on highly knowledgeable andcompetent CRNs.The CES provides ongoing education based onevolving needs and changing trends in the research environment.ThisprogramhasbeenwellreceivedbyinvestigatorsandCRNsandhasservedtoimprovetheoverallefficiencyoftheclinicalresearchenterprise.

2334ARGININE DEPRIVATION THERAPY (ADI-PEG 20) AND THE INCI-DENCE OF FATIGUE IN ADVANCED HCC PATIENTS: A CHALLENGEFORNURSES.MariannaConnola,RN,MargheritaFoggia,LauraGale-ani,JaneBryce,MarziaFalanga,MauroPiccirillo,MD,andFrancescoIzzo,MD,NCI–Naples,Naples,Italy.

Pegylatedargininedeiaminase(ADI-PEG20)isanovelanti-can-cerenzymetherapycurrentlybeingtestedinphaseIIItrials,whoseefficacyisbasedonblockingtheproductionofarginine,anaminoacid required for growth of certain tumors such as hepatocellularcarcinoma(HCC).ItisadministeredweeklybyIMinjectionforatleast6months,andisassociatedwithmoderatetosevereandpersis-tentfatigue,believedtobelargelyduetotheinhibitionofarginineproduction.

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The purpose of this study is to describe the incidence and levelof fatigue in patients with HCC undergoing experimental weeklytherapywithADIPEG20,andtoevaluate the impactof the imple-mentationofevidencebasednursing(EBN)interventionsonfatigueincidenceandgrade.

WeusedtheOrem’sConceptualModel,tohelppatientrecognize,referandmanagesymptomswhentheyoccur,becauseitisconsis-tentwithourinstitute’sphilosophy.

120patientswereenrolledinourcenterfromNovember2003toDecember2006.Fatigueisevaluatedatbaselineandweeklyusingselfreport(0-10scale)andCTCcriteria(grade1-4)fatiguescales,andKarnofskyperformancestatus.Clinicalexamandinterviewareconductedateachpatientvisit,andfatiguecofactorsaredocument-ed. IndividualizedEBNinterventions,adaptedfromtheONSPEPresourcesandNCCNguidelines,aredesignedforeachpatientafterclinicalexamandinterview.Allpatientsreceiveeducationabouten-ergyconservation,activitymanagement,measurestooptimizesleepquality,dietaryindicationsincludingtheavoidanceofarginine.

Wealsocreatedabrochureprovidingpatientsinformationtouseathometohelpthemrecognizeandcorrectlyrefersymptomstothemedicalteam.

Nearly80%ofallpatientsexperiencedgrade2or3fatigueearlyinthetreatmentcourse.Datarevealareductioninpatientreportedfatigueby3pointsandinclinicianassessedfatiguelevelby1gradein60%ofpatientswhoreceivednursinginterventionsandemotionalsupport.Wereporteddataonfatigueexperienceoverthecourseoftreatmentaswellasthedifferenceinfatigueexperienceinpatientshelpedwithpsychologicalsupport.

FindingssupporttheuseofEBNinterventionsforfatiguemanage-mentinHCCpatientsreceivingexperimentaltherapy.

2335PREPARING ONCOLOGY NURSES FOR CONTEMPORARY SURVI-VORSHIPCARE.MarciaGrant,RN,DNSc,FAAN,BettyFerrell,PhD,FAAN, Smita Bhatia, MD, and Denice Economou, RN, MN, City ofHope,BeckmanResearchInstitute,Duarte,CA.

Cancersurvivorsfacemultiplelifetimerisksrelatedtocanceranditstreatment.In2006theInstituteofMedicinereportidentifiedlackofknowledgeofcancerlateeffectsasonemajorbarrierhealthcareprovidersfaceinprovidingfollow-upcaretothe10millioncancersurvivors.

ThepurposeofthisNCI-fundedstudyistodevelopahealthprofes-sionalcurriculum,recruitparticipants,conductaneducationalpro-gramandevaluate and followparticipants’goal achievementovertime.

Theframeworkiscomposedofthreeconcepts:institutionalchange,adulteducationprinciples,andtheCityofHopeQualityLifeModel(COH-QOL).Multipleteachingstrategiesinclude:competitiveap-plicationprocess,administrativesupport,goal-basededucation,par-ticipativelearning,post-coursenetworkingandfollow-up.

Fourannualcoursesincludepre-courseandpost-course(6,12,&18month)evaluationdata.Two-personinterdisciplinaryteamsfromcancercentersapplywithatleastonememberbeinganurse,physi-cian,oradministrator.Coursecontent,organizedaroundtheCOH-QOLdomains:Physical,Psychological,SocialandSpiritual,isde-livered by expert faculty.Team selection includes stated interests,threeprojectedgoalsandlettersofcommitmentfromadministrators.Participants’goalsareevaluatedat6,12,&18monthsforinstitu-tionalchangesinsurvivorshipactivities.

ThefirstprogramwasheldJuly13-15,2006for53teams(106par-ticipants);75%of the teamshadoneormoreoncologynurses.Theinstitutional barriers identified pre-course were lack of survivorship

knowledge (94%), financial constraints (61%), staff philosophy thatexcludedsurvivorship(15%)andlackofadministrativesupport(6%).

Courseevaluationsrevealedaratingofqualityofcontentat4.6onascaleof1-5(5=best)

The 159 institutional goals used in following participants’ postprogram progress were divided into major categories: educationalendeavors;changesinorganizationalstructure;developmentofnewclinicalprocesses; specificsurvivorshipactivities;andresearchonsurvivorship.First6monthfollowupdatawillbepresentedandin-cludethecharacteristicsofinstitutionalbarriersandtheexperienceofgoalimplementation.

Funding Sources: National Cancer Institute. 1-R25-CA 107109-01-A1-SurvivorshipforQualityCancerCare.

2337DEVELOPING ELECTRONIC CASE REPORT FORMS WHILE ESTAB-LISHINGSTANDARDS.ElizabethNess,RN,MS,NationalCancerIn-stitute,Bethesda,MD;andDianneReeves,RN,MSN,NationalCancerInstitute,Rockville,MD.

Asaresultofshrinkingresourcesfortheinitiationandconductofclinicaltrials,establishingstrategiestomaximizereuseofdatacol-lectiontoolsbecomesvital.

Creatingadatacollectiontool[i.e.:casereportforms(CRFs)]thatcanbequicklyandsystematicallycreatedandclonedisparamount.The eCRF ideally captures protocol-specific data in a manner tosupport theneedsof thePI, institution,sponsor,andother regula-tory/reportinggroups.Theuseofcontrolledvocabulariestocreatemetadatathatdefinesthedatacollectedneedstobeavailable.

In2002,theCenterforCancerResearch(CCR)initiatedapartner-ship with the National Cancer Institute Center for Bioinformatics(NCICB) to develop a single research database built according tobestpracticesthatcouldalsomaintaindatafrommultipledisparatelegacydatabases.ThedatabaseiscalledC3D-CancerClinicalCen-tralizedDatabase.Centraltothesuccessfuldevelopmentofthenewdatabaseisthedevelopmentofstandardtemplateelectroniccasere-portforms(e-CRF).EachfieldwithintheeCRFisidentifiedagainstcommondataelements(CDEs).IfnoCDEexists,curationofnewCDEswithinCancerDataStandardsRepository (caDSR) is com-pleted. Finally, eCRFs, related instructions, and validation/deriva-tionrulesaredeveloped.TherearevariousstakeholdersinvolvedintheprocessandoversightisdonebytheCCRConfigurationControlManagementGroup(CCMG).

C3Dhasover125clinicaltrialsbuiltwith90%ofthesehavingac-tivedatacollectionandreportingtovarioussponsorsincludingbothindustryandgovernment.caBIGadoptersoftheC3DtemplatesincaDSRhavebeenabletouseuptomorethan90%ofexistingcon-tent.Therehavebeenanumberoflessonslearnedincludingtheneedtoeducateallstakeholdersaboutclinicaltrialsandinformatics.

The implications for the future include applying these processes,standardsandinfrastructuretothecaBIGcommunityandothergroupsincludingONS.ONScanapplytheseresultsfortheirownresearchsuchasevidence-basedpracticeresearchlookingatsymptomcontrol/amelioration/measurement.ExtensionofCCRCCMGmodel to thecaBIGcommunity,withmembershipofCCRCCMGin thecaBIGstructuretoharmonizebusinessrules,workflow,strategies.

2338PROMOTING OPTIMAL PATIENT OUTCOMES: MANAGING MORETHANHIVES.KimberlyCamp,RN,BSN,OCN®,DukeUniversityHos-pital,Durham,NC.

Outpatientchemotherapyhasprogressedtoacombinationoftar-geted and cytoxic therapies. Increased reactions with monoclonal

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antibodiessuchasErbituxhavebeenseen.Accordingtothepackageinsert,3%ofpatientswhoreceiveErbituxwillhaveananaphylactic/anaphylactoidreaction.RuralareasoftheUnitedStateshaveexpe-riencedthemajorityofreactionsincludingNorthCarolina.Ourrateofseverehypersensitivityreactionshasbeen3timeshigherthanthedocumentedpercentageinthepackageinsert.

Thepurposeofthispresentationistoreviewtheprocessweunder-tookindevelopingourstandinghypersensitivityordersandhowwehaveimplementedthemintopractice.

InterventionsHypersensitivity orders were developed in collaboration with

oncology nurses, pharmacists, and physicians. Benchmarking wasdonewithotherfacilitiesandareviewoftheliteraturewasconduct-ed.ArepresentativefromourinstitutionparticipatedontheErbituxAdvisoryBoardwhichmettoinvestigateanddiscussthehighrateofreactionsexperienced.TheJournalofAllergyandImmunologyoffered recommendations for treating patients who had developedreactionstoavarietyofsubstancesaswell.Withrecommendationsandareviewoftheliterature,standinghypersensitivityordersweredevelopedaccordingtothesymptomandlevelofseverityandap-provedbythemedicaldirectorandpharmacy.Theorderswerere-viewedwithnursingstaffatastaffmeetingandindividuallytrainingwasdoneforelectronicinitiationanddocumentation.

Thehypersensitivityordershavedecreasedthetimefromreactiontointerventiontoalmostzero.Nursesandphysicianshaveprovidedpositivefeedbackabouttheordersandareinterestedindevelopingadditionalorderstosupportpatientcare.Educationregardinghyper-sensitivityreactionsandtargetedtherapiesisongoing.Wearecur-rentlyevaluatingthe“orders”andtheimpactonpatientoutcomes.

Standing hypersensitivity orders allow oncology nurses to inter-vene immediatelywhile thepatient isatgreatest risk.Ambulatorynursinghasprogressedtomultiplemodalitieswithahigherpropen-sityforreactions. Infusionnursesarefrontlinehealthcareprovid-erswhomustbeequippedwiththetoolstorescuethepatientwhenneeded.

2340SLEEPPATTERNSINTHEINITIALDAYSFOLLOWINGCHEMOTHER-APY.SusanBeck,PhD,AOCN®,APRN,FAAN,andBobWong,PhD,University of Utah, College of Nursing, Salt Lake City, UT; AndreaBarsevick,DNSc,RN,AOCN®,andKatieStewart,MSPH,FoxChaseCancer Center, Cheltenham, PA; and Jacquee Williamson, MS, andWilliamDudley,PhD,EmmaEcclesJonesNursingResearchCenter,UniversityofUtah,CollegeofNursing,SaltLakeCity,UT.

Sleep/wake disturbances during cancer treatment commonly oc-curaloneandaspartofsymptomclusters.ResearchonsymptomsincludingsleepdisturbancesremainsanONSpriority.

The purpose of this study was to determine the extent to whichsleepproblemsexistafterinitialchemotherapyandexaminediffer-encesinsleepparametersbasedonpre-chemotherapyreportsofbe-ingagoodorpoorsleeper.

Thisanalysisexaminedbaselinedatafromarandomizedclinicaltrialofaninterventiontoimprovefatigueandsleepduringchemo-therapy.This trial is guided by the Common Sense Model of Ill-ness.

Participantscompletedbaselinequestionnairesattheinitiationofchemotherapy including the Pittsburgh Sleep Quality Index, a 19item reliable and valid measure of self-reported sleep parametersoverthepastmonth.Patientsalsoworeawristactigraphfor3daysbeginningonDay1ofchemotherapyandcompletedadailysleepdi-aryuponarising.Action4softwarewasusedtoanalyzetheactigraphdata using accepted algorithms. Sleep parameters were averaged

over3nights. IntegratedanalyseswereconductedwithSPSSandincludeddescriptivestatistics,t-testsandRM-ANOVA.

Participants(N=177)were83.6%female,meanage53.27(S.D.=12.09).Numerousdiagnosesandtreatmentregimenswereincluded.Thetotalsleeptimeaveraged458.69minutes(S.D.=91.31);sleepefficiencyaveraged86.87%.28%oftheparticipantshadsleepeffi-ciencylessthantherecommended85%.Thenumberofawakeningsrangedfrom0to30withameanof9.97.Subject’stimeawakeaftersleep onset averaged 74.94 minutes (S.D. = 59.12). RM-ANOVAindicatednosignificantdifferencesover the3nights.PSQIglobalscoresrangedfrom1 to20,meanof8.20.ThePSQIglobalscore>8 indicated 68 (40%) poor sleepers during the previous month.Poorsleepershadsignificantlymoreawakenings,timeawakeaftersleeponset,lesstotalsleeptime,andlowersleepefficiency.Thesefindings indicate disrupted sleep patterns following chemotherapyfor a substantial percentage of patients, primarily related to sleepmaintenance.Baselinesleepassessmentofpoorsleepmayindicateapatientisatgreaterriskforproblems.

FundingSources:NINR,R01NR004573

2341FEASIBILITYFORTESTINGTHETHERAPEUTICADMINISTRATIONOFANORANGETORELIEVETASTEANDSMELLSENSATIONSASSO-CIATEDWITHDIMETHYLSULFOXIDE(DMSO)DURINGSTEMCELLREINFUSION.PamelaPotter,APRN,BCDNSc,UniversityofWash-ington School of Nursing, Seattle, WA; Seth Eisenberg, RN, OCN®,SeattleCancerCareAlliance,Seattle,WA;andDonnaBerry,RN,PhD,AOCN®,FAAN,UniversityofWashingtonSchoolofNursing,Seattle,WA.

Autologous peripheral blood stem cell transplantation (SCT) isused to treatanumberofmalignancies.Collectedcellsare storedand frozen in liquidnitrogenusingDMSOas a cellularpreserva-tive.DMSOhasanoxioustasteandodorthatfrequentlyproducesunpleasantthroatsensations,coughing,nausea,retchingandvomit-ing(NRV).Anuntestedandinformalpracticeatadesignatedcancercenterinvolveduseofanorangetoalleviatethesesymptoms.

Thisstudypurposeandspecificaimwastotestthefeasibilityforstudying efficacy of sliced orange, orange aromatherapy, or deepbreathingfor reliefofcoughing, throat irritation,andNRVduringreinfusionofstemcellscryopreservedinDMSO.

The Human Response Framework, incorporating individual vul-nerability and environmental risk and the interplay of biological,psychologicalandsocialhumanresponsesthatinfluenceillnessout-comes,providedthestudy’sconceptualfoundation.

Arandomized,PhaseIIpilotwasconductedwith60patientsre-ceivingatleasttwobagsofcryopreservedstemcells.Forty-fourmenand16womenwererandomizedtooneofthreegroups:Orange(OG)(n=19),OrangeAroma(AG)(n=23),andControl(CG)(n=18).ThestudyemployedatimeseriesdesignwithanearlyversuslateinterventionformatwhereCGparticipantswerere-randomizedafterthreecellbags toOGorAG.Dataanalysiscontrolled forweight,genderandinfusionrate.Thosereportingminimalsymptomswho“didnotuse”theinterventionweretreatedasmissinginthe“relief”analysis.

Thegroupswereequivalentondemographicsandbaselineinten-sitysymptoms.Dataanalysisdemonstratednosignificantdifferenceintickle/coughintensity,nauseaorretchingintensity,orincidenceofvomitingamongthegroups.Onaten-pointscalefrom0(none)to10(mostrelief),forthesecondbagofinfusedcells,theOGreportedsignificantly (p=0.041)moresymptomrelief thandid theAGorCG.TheOGdemonstratedatrend(p=0.059)towardmoresymp-tomreliefoverthefirstthreebagsthandidtheAGorCG.Findings

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fromthispilotsuggestpotentialefficacyaswellasclinicalbenefitforpatientsreceivingautologousSCT.Adefinitive,multi-site,ran-domizedtrialisrecommended.2342TIMELY COLORECTAL CANCER SCREENING IN AFRICAN AMERI-CANS.KathleenGriffith,PhD,CRNP,AOCN®,JohnsHopkinsUniver-sitySchoolofNursing,Baltimore,MD;KeithPlowden,PhD,RN,andDeborahMcGuire,PhD,RN,FAAN,UniversityofMarylandSchoolofNursing,Baltimore,MD;ReneeRoyak-Schaler,PhD,MEd,andEileenSteinberger,MD,MS,UniversityofMarylandSchoolofPublicHealth,Baltimore,MD;andLouiseJenkins,PhD,RN,UniversityofMaryland,Baltimore,MD.

African Americans have low rates of colorectal cancer (CRC)screening, and little is known about factors influencing their par-ticipation.

Thisstudysoughttoidentifybiological,psychosocial/behavioral,andsocialfactorsthatpredictedtimelyCRCscreening(i.e.comple-tionofrisk-appropriatetestswithinarecommendedtimeframe)inAfricanAmerican (AA)menandwomenaged>40 inMaryland.Cancerscreeningandpreventionhavebeenrankedwithinthetop10researchprioritiesforONSinboth2000and2004.

TheBiopsychosocialBPS)Modelwasusedtoguidethisstudy.Datafrom580AAparticipantsinthe2002MarylandCancerSurvey

(MCS)wereexaminedinasecondaryanalysistodeterminewhetherbiological (age,gender,CRCfamilyhistory),psychosocial/behav-ioral (mammogram and prostate specific antigen [PSA] screeninghistory,bodymassindex,activitylevel,fruit/vegetableconsumption,alcohol,smoking,cancerconcern,cancerperceivedrisk,perceptionof familialcancer),andsocial (education,employment, insurance,accesstohealthcareprovider[HCP],andHCPrecommendationoffecaloccultblood testand/or sigmoidoscopy/colonoscopy) factorspredictedtimelyCRCscreening.Simultaneous,hierarchicalblock,and stepwise entry logistic regression analyses of individual andgroupedvariableswereconducted.

For individuals without a family history of CRC (n=473), HCPrecommendationoffecaloccultbloodtest(OR11.90,95%CI:6.84,20.71) and sigmoidoscopy/colonscopy (OR 7.06, 95% CI 4.11,12.14),moderate/vigorousactivity(OR1.70,95%CI:1.02,2.82),and history of PSA screening (OR 2.81, 95% CI 1.01, 7.81) pre-dictedtimelyCRCscreening.ForindividualswithafamilyhistoryofCRC(N=86)recommendationofsigmoidoscopy/colonscopy(OR24.3,95%CI5.30,111.34)andvigorousactivity(OR5.21,95%CI:1.09,24.88)predicted timelyCRCscreening.CRCfamilyhistorydidnotpredictscreeningwhenage,education,andinsurancewerecontrolled.

HCPrecommendationwasthemostimportantpredictoroftimelyCRCscreening,regardlessoffamilyhistoryofCRC.InvestigationofotherpotentialpredictorsofscreeningnotavailableintheMCSdatasetandsocioeconomicandothervariables that limitaccess toHCPsiswarranted.

2343“WECANDOITBETTER!”ANINNOVATIVESTUDYBYDIRECTCAREONCOLOGYNURSESTOOPTIMIZETHECHEMOTHERAPYVALIDA-TIONPROCESS.BrandiSwisher,RN,BSN,DeidreKutzler,RN,BSN,MelissaKratz,RN,MSN,AOCN®,DebraPeter,RN,BC,MSN,MaryannRosenthal,RN,MSN,ChristinaGogal,BS,andJoannaBokovoy,RN,DrPH,LehighValleyHospital&HealthNetwork,Allentown,PA.

Oncologytherapyhasbroadenedconsiderablyoverthepastdecade.Topromotesafetyandprovideoptimalup-to-dateoncologycare,itisessentialfornursestocompetentlyadministerantineoplasticdrugs.

Staffnursesonaninpatientoncologynursingunitatan820-bedtertiarycareMagnetcommunityhospitalinitiatedastudytoidentifynoviceandexperiencednurseperceptionsofthecurrentchemother-apyvalidationprocessandtoobtainrecommendationsforimprove-mentsinthisprocess.

ThisstudyascribestoBenner’sPhilosophyinNursingPracticetodefineskillsandtraitsrelatedtothechemotherapyvalidationprocesswhichareassociatedwithnoviceorexpertnurses.

Thesearethebaselineresultsofaprospective,pre/postinterven-tionstudy.Twouniquesurveysweredesigned,andfaceandcontentvaliditywasestablished.Theentirepopulationofnurses(N=31)ontheoncologyunitofinterestwasselectedandgivenoneoftwosur-veys:1)Surveytargetingexperiencedoncologynurses(preceptorforthechemovalidationprocessandhadatleast1.5yearsexperienceontheoncologyunit),and2)Surveytargetingnursesnewlyhiredon theunit (notachemotherapyvalidationpreceptorandhad twoyearsorlessexperienceontheoncologyunit).A5-pointLikertscalewasusedtoidentifyleveloffamiliarityandexperiencewithvariouschemotherapyadministrationprocedures,andopen-endedquestionswereincludedformoreinformationandrecommendationsonche-motherapyvalidationprocessimprovement.QuantitativedatawereanalyzedusingtheSPSSstatisticalprogram.Open-endedquestionswereanalyzedusingqualitativemethods.

Asexpected,novicenurses(N=15)wereyoungerandhadlesson-cologynursingexperiencethanexperiencednurses(N=16).Sixty-twopercentofnewnurses listedhavingeitherapreceptororvalidationprocessasmosthelpfulinthevalidationprocess.Sixty-threepercentofexperiencednursesfeltthatavalidationchecklist,anidentifiedpre-ceptorandapreceptorcoursewerecrucial fornewnurses.Staffingwaslistedbybothexperiencedandnovicenursesasabarriertowardseffectivechemotherapypreceptoring.Resultsfromthisbaselinesur-veyarebeingusedtocreateabetterchemotherapyvalidationprocesstoimprovesafetyandcareonthisoncologyunit,providingatemplatetobeusedonotheroncologyunitsnationwide.

2344PRE-BONE MARROW TRANSPLANT WORKUP. Rose Kumpf, RN,OCN®,andLisaPrivitere,RN,OCN®,RoswellParkCancerInstitute,Buffalo,NY.

Ithasbeendemonstratedthatpre-admissionwork-upsontheBoneMarrowTransplant(BMT)patientsprovideathoroughcontinuityofcarethatisbeneficialtothePatient’ssafety,emotionalandfinancialstate.

ThepurposeoftheBMTworkupistoensurethatthepatientmeetsallofthenecessarycriteriaandiswellpreparedtoundergoaBMT.Theworkupprocessisatimewhenallthedisciplinesperformevalu-ationsandconductamultidisciplinaryreview.TheinclusioncriteriaareevaluatedforappropriatenessandsafetyofthepatienttoundergoaBMT.

Interventions:This preadmission process facilitates nursing carebyensuring:1.Patientsunderstandthephysical,emotionalandfinancialaspects

ofthetreatment2.Allpre-admissiondiagnostictestsandproceduresareperformed3.Allprescriptionshavebeencheckedandverifiedbynursingand

pharmacyinadvance4.Patientprocessandflowatadmissionareimproved5.Allinvestigationalprotocolrequirementshavebeenmet6.Noreversedadmissionsondayofadmit

The majority for this work up is the responsibility of the BMTnurses.TheeducationprocessstartswiththeFamilyMeeting.Thepatientandcaregiversarepresentedwiththefinaltreatmentregimes

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andadetailtimeframeofthesequenceofeventswithpotentialout-comes.At this timefor thepatient/familycanexpressconcernsoraskquestionsofallthedifferentdisciplines.

Asaresultofthepre-admissionprocess,potentialproblems/issuesaredetectedandresolved.Withthecriterialistandthepre-BMTad-missionpacketachecklistiscompletedTheabilitytocompletethetestsonthecriterialistasanoutpatientiscosteffectiveandmoresat-isfyingtothepatientwithonelessdayasaninpatient.Thepatient’sanxietyondayofadmissionisdecreasedduetotheknowledgethatthetestsandproceduresarecompletewithresults.ThisisimportantforanOncologyNursebecausethisprocessallowsanenvironmentforadetailededucationalprocessspecifictotheexactneedsofeachpatientpreduringandposttreatmentofaBMT.Concernsthatwerediscussedduringthepreadmissionaremonitored,andaplanofac-tionplacedpriortoanemergencysituation.

2347ARSENIC—IT’S NOT JUST FOR KILLING RATS ANYMORE! JaniceCarsello, RN, BSN, Lynda Peoples, RN, BSN, Martha Michael, RN,BSN,TeresaMoore,RN,KarenTrumbo,PharmD,andJenniferHauer,PharmD,JeffersonHomeInfusionService,Philadelphia,PA.

Approximately 10% of leukemias are diagnosed as Acute Pro-myelocyticLeukemia(APL).APLcausesa rapidaccumulationofabnormalwhitebloodcellsinbonemarrowandblood,causingane-mia, bleeding and susceptibility to infection.Arsenic compoundshavebeenusedmedicinally for thousandsofyears. In the1980’s,Chineseresearchersfirstusedarsenictotreatleukemia,afterfindingthatarsenicwasaningredientinseveralChinesemedicines.Jeffer-sonHomeInfusionService(JHIS)hasdevelopedaplanofcaretodeliverthiscuttingedgetherapytopatientsintheirhomes.

Thepurposeofdevelopingthiscareplanforarsenic(Trisenox®)administrationwastwofold.First,itenablesournursestoadminis-terthispotentiallytoxicmedicationtopatientsintheirhomessafely.Second, itallows thepatient to receive theconsolidationphaseoftheirchemotherapyintheprivacyoftheirownhome.

Inductiontherapyisadministeredinahospitalsettingandshouldnotexceed60doses.Patientsareexposedtopathogensjustbybeinghospitalizedduringthisphaseoftreatment.Therearealsopsychoso-cialissuesrelatedtothelengthyhospitalstaynecessaryforcomple-tionoftheinductiontherapy.

Consolidationtherapyisstarted3to6weeksafterinductionther-apyiscompleted.

JHISprovidespatientswithasafealternativetobeingconfinedtothehospitaloranoutpatientinfusioncenterduringtheconsolidationphaseofTrisenox®therapy

ThepatientcontinuestotolerateTrisenox®athome,andhasexpe-riencednosignificantadversereactions.Ourexperienceinundertak-ingthisinnovativehomeinfusiontherapybodeswellforexpandeduse,suggeststhat,withjudiciousplanning,Trisenox®canbeasafeandbeneficialtreatmentathome

New, innovative treatment strategiesarealwaysbeingdevelopedtobattlecancer.Nursesmustbecognizantofthemanyissuessur-roundingtheirpatients,notjustwhichpatientgetswhatdrug.Thereare financial, psychosocial and quality of life issues that must beconsideredwhenapatientstartsadrugtreatmentprotocol.JHIShasenabledapatientpopulationthatwould,justafewyearsago,havebeen hospitalized for several months, to receive this cutting edgetreatmentwhileathome

2348THEROLEOFTHECLINICALTRIALNURSE.DonnaCatamero,RN,CCRC,OCN®,MargaretCoursen,RN,OCN®,LouiseLynch,RN,Sara

Parise,RN,BSN,ZeononaLesko,RN,BSN,SueMoore,APRN-BC,AOCNP,andKathleenMullaly,MSN,NYUCancerInstitute,NewYork,NY.

The role of a clinical trial nurse (CTN) in an NCI designatedacademic cancer institute provides the opportunity to participateincuttingedgeresearch.Abetterunderstandingofthehighlyspe-cializedskills requiredof theCTNisneeded.Standardizationoftheroleischallengingduetonumerousdiseasespecificprotocolsimplemented at multiple sites, with varied levels of complexity.LackofroledelineationandstandardizationofprocessesresultsindecreaseutilizationofexpertCTNresourcesandleadstoduplica-tionofeffort.

Thepurposeofthisprojectistodefineanddescribetheroleoftheclinicaltrialsnurse.

ComponentsoftheBennerModelwereusedtodefinethelevelofCTnursingknowledgeandskill.Thenovicelevelbuildsonknowl-edgebasethroughpracticeandparticipationintheCTprocess.ThecompetentlevelworksautonomouslyandactsasaresourceforthenoviceCTN.Theexpertlevelhasanintuitiveunderstandingofallaspects of clinical trials and acts as a resource for themultidisci-plinaryteam.

While defining and describing the role of a CTN the followingweredeveloped:1)ACTcompetencyevaluationtoolthatincludesskillsandknowledgerequiredtoa)Reviewandcritiqueaprotocolb)Screenpatientforeligibilityc)Participateintheinformedcon-sent process, clinical activities, regulatory/economic componentsand quality improvement. 2) An educational program for CTN’sincludinga)Orientationb)Ongoingeducationc)Corecompeten-cies.DefiningtheroleandeducationalneedsoftheCTNallowsforidentificationofexpertspeakersandmentors.

Thefollowingwillbeevaluated:1.Preandpost testsforallCEapprovededucationprograms2.CTN job satisfactionand3.Peerevaluationsusingthecompetencytool.

TheCTNplaysapivotal role inmaintaining the integrityof theprotocol.Defining theCTNroleprovidesanopportunity tobetterutilizetheirexpertise.

2349NURSINGCOUNCILMODELOFSHAREDGOVERNANCESPANNINGTHREEACADEMICMEDICALCENTERS.AnneGross,RN,MS,CNAA,Dana-FarberCancer Institute,Boston,MA;PatriciaBranowicki,MS,RN, CNAA, Childrens Hospital, Boston, MA; Sheila Rozanski, RN,Dana-FarberCancerInstitute,Boston,MA;andColleenNixon,BSN,CPON®,ChildrensHospital,Boston,MA.

Collaborationacrossacontinuumenablesoncologynursestoworktogethertotacklecommonproblemstoensuresafeandcomprehen-sivepatientcare.Nursesfromour threeacademicmedicalcentersformedtheNursingCouncil toaddresspracticeissuescommontothesingleCancerCenterthatspannedourseparateinstitutions.TheCouncilmergedexistingpracticecommitteestocreateasingleentitywhere nurses from all areas could participate and contribute theiruniqueexpertisewithinaSharedGovernancemodel.

Thepurposeof theCouncilwas to identify sharedpriorities forclinicalpracticeandpolicy,integratenursingcommitteework,assureasinglestandardofcare,monitorprojectsandprovideavehicleforshareddecisionmaking, informationsharingandquality improve-ment.Goalshavebeensetandachieved throughthedelegationofworkwithinthevariouscommitteesoftheCouncil.OurframeworkisbasedontheSharedGovernanceconceptualmodel.

Nowinitsthirdyearofoperation,theCouncil,usesthefollowingstructureandprocessestoaccomplishitsgoals:• MembershipisopentoallnursesintheCancerCenter.

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• RNs from leadership andclinical staff are co-chairsofCouncilcommitteesthatarecomprisedofrepresentativesfromtheAdult&PediatricCancerPrograms.

• Priorities,outcomemeasuresandtimelinesforachievinggoalsaresetannually.

• Bi-annualreportsfromallcommitteesarereviewedanddiscussedatCouncilmeetingsandcommunicatedtoallnursingstaffelec-tronically.

• Councilco-chairsserveasliaisonstotheNurseExecutiveBoard.The Council is evaluated bi-annually using a survey instrument

thatisdistributedtoallCouncilmembers.Findingsfromthelatestsurveyshowthat81%ofthemembersratetheOverallPerformanceof theCouncil asgood/excellent; areas still needing improvementare:InvolvementofNursingStaffatAllLevelsandCommunicationtoFrontLineStaff.Aplanhasbeenactivatedtoaddresstheareasofconcern.

Oncology nursing practice can be enhanced when nurses cometogether via shared governance to identify and resolve commonpractice issues and concerns. Information about how our NursingCouncil functionscouldassistoncologynurses’efforts todevelopgovernancestructuresthathelpfosterco-operationandshareddeci-sion-makingacrosspracticesorinstitutions.

2350IMPLEMENTATIONOFANINTERDISCIPLINARYTEAMTOIMPROVEMEDICATION SAFETY. Katie Mullaly, Joan Scagliola, MSN, AOCN®,Thomas DelCorral, RPh, MS, Vera Sziklai, RN, James Speyer, MD,ElizabethDuthie,RN,PhD,andKevinKirchen,MHA,NYUHospitalsCenter,NewYork,NY.

Medicationdeliveryinanambulatorycancercenterisacomplexprocessthat includesprescribing,processing,dispensing,adminis-teringandsideeffectmonitoring.Areviewoferrorsintheinfusionarea of the Clinical Cancer Center revealed that volume was lowcomparedtothenumberofdrugsadministereddaily;howevereachpotentialerrorcarriedahighpatientsafetyrisk.

AnInterdisciplinaryMedicationSafetyCommitteewasorganizedconsistent with the ONS position statement on medication safety.Membership included nursing, pharmacy, patient safety officer,medicaldirector,andadministration.Thegoalofthecommitteewastodevelopandimplementasystemthatwouldimprovecommunica-tion and to facilitate the detection and correction of errors beforetheyreachapatientandcauseharm.

Arootcauseanalysisofnearmiss/medicationerrorswasconduct-edwhichrevealedmultiplesystemissues.Anactionplanwasdevel-opedandimplementedthat includedthefollowing:ananonymousmedication safety hotline, pharmacy system redesign, mandatorytreatmentplan,specificchemotherapyagentsmixedpriortopatientappointment, centralized nursing model changed to primary nurs-ing,electronicorderingsystem,nursing/physicianteamsdevelopedtoimprovecommunication.

Weeklymeetingswereorganizedto identifyandaddress issuesrelatedtotheongoingchanges.Frequentcommunicationwithallstakeholderswascrucialtothesuccessofthisinitiative.Achievedoutcomes included appropriate utilization of hotline, decreasednumberofnearmisserrors,andimplementationofelectronicor-ders.The electronicorders resulted in the eliminationof incom-pleteandillegibleorders,increasedaccessibilitytoorderentry/re-viewforclinicians,decreasedpatientwaittimeandimprovedstaffsatisfaction.

ConsistentwiththeONSpositionstatementonmedicationsafety,themedication safety committee’s aimofpreventing future errorsand potential patient harm was realized. Nursing, physician and

pharmacy staff report improved communication, staff satisfaction,easeofworkflowand increasedproductivity.Patientsarepleasedwiththedecreasedwaittime.

2353INCORPORATINGRESEARCHINTOEVERYDAYPRACTICEFORON-COLOGY NURSES. Mary Ann Long, BSN, RN, OCN®, Joyce Yasko,PhD,andMaureenKelly,MSN,RoswellParkCancerInstitute,Buffalo,NY.

ResearchisamajorcomponentofaNationalCancerInstitutedes-ignatedcomprehensivecancercenter.Oncologynursesmakesignifi-cantcontributionstoclinicalresearchstudyinitiation,implementa-tion anddata collection.Althoughoncologynurses are frequentlyimmersedinprovidingcareforpatientsenrolledonresearchstudies,the information about study outcomes and future applications of-tendoesnotreachtheindividualsthatimplementtheresearchstud-iesanddocumentthestudydatapoints.Providingthisinformationwillencouragethenursestobecomeadvocatesforresearchstudiesaswellasexpertsinprovidingcaretopatientsenrolledinresearchstudies.

Amultidisciplinarygroupwasformedtoprovidemonthlypresen-tations thatwill includeanoverviewof researchstudies thatwereimplemented on site including the study results.A single page ofstudyhighlightswasgiventothenursestotakebacktotheirrespec-tiveareastosharewiththeirpeers.

Anincreaseintheknowledgebaseofnursesthathaveattendedtheprogramshasbeenrealized.Thereisalsoanelementofpridethatthenursesnowhaveknowingthattheyplayedanintegralpartinachiev-ingthestudyoutcomes.

Implementingaplanforsharingresearchstudyinformationwiththestakeholdersallowedthenursestobecomemoreknowledgeableabouttheoutcomesofthestudiestheyhaveimplementedandtoun-derstand the important role thatclinical researchplays increatingevidencebasedcancer treatmentandcare for the future.Aformalevaluationofnursingsatisfactionwiththisprocesshasnotbeenun-dertakenbutwillbeavailableatthetimeofthepresentation.

2357THEIMPORTANCEOFPROVIDINGEDUCATIONTOINPATIENTMEDI-CAL ONCOLOGY NURSES CARING FOR PATIENTS WITH SEALEDAND UNSEALED RADIATION SOURCES. Jennifer Graff, RN, BSN,OCN®,CHPN,ThomasJohnsCancerCenter,Richmond,VA.

Approximately50%ofoncologypatientswill receive radiationas a component in their treatment. This includes either externalbeamorbrachytherapywithasealedorunsealedradiationsource.Knowledge of radiation safety precautions are of utmost impor-tancefortheoncologynursecaringforapatientwithaninternalsource.

Thepurposeofthisprogramwastoincreaseawarenessofradia-tion,radiationsources,typesofcancertreatedwithinternalradioac-tivesources,andsafetyprecautionsforthenursingstaffcaringforthispatientpopulation.

Educationonradiationsafetywasprovidedtotheinpatientmedi-cal oncology nurses, with a pre and post test method utilized toevaluateknowledge,aswellasanemotionalassessmentutilizingaLikert-typescale.Thecognitivecomponentofthetestincludedmul-tiplechoicequestions,anumberofwhichweretakenfromtheONSRadiationOncologyManual.Theemotionalcomponentassessedtheparticipant’s feelingson their ability tocare forpatients receivinginternalradiationsources,theabilitytoexplainradiationsafetypre-cautions,andmaintainingsafetyfromexposure.Thisprogramwastaughtbyaninterdisciplinaryteam,includingadosemetrist,aradi-

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ologytechnologist,oncologyclinicalnursespecialist,andoncologycertifiednurse.

Inthecognitivetest,themeanscorefromthepre-testtothepost-test(aftertheeducationalintervention)rosealmost20%.Equallyasimportant,nursesratedtheircomfortlevelwithcaringforthesepatientsmuchhigheraswellastheirabilitytoprovideeducationtopatientsandotherstaffmembersaswell.Theemotionalcom-ponentalsoshowedanimprovementinthelevelofsafetystafffeltregarding the risk of radiation exposure following the educationprogram.

Radiationsafetyisofparamountsignificancetonursescaringforpatients receiving internal radioactive sources. Ensuring that thenursingstaffiswelleducatedandverycomfortablewiththispatientpopulation is vital.Therefore, just as recertification for all nurseswho administer chemotherapy occurs yearly as most institutions,renewalofradiationsafetyknowledgeshouldalsooccur.Thiswillservetonotonlyupdatethestaff’sknowledge,butalsotoincreasetheircomfortlevelwithradiationsafetymeasures.

2361PATTERNSOFFATIGUEANDEFFECTOFEXERCISEINBREASTCAN-CER PATIENTS RECEIVING CHEMOTHERAPY. Horng-Shiuann Wu,PhD,RN,MarylinDodd,PhD,RN,FAAN,andMariaCho,PhD,RN,UniversityofCaliforniaSanFrancisco,SanFrancisco,CA.

Cancer-relatedfatigue(CRF)islonglastingandthemostimpair-ingcancer-related symptom. Itsmechanismshavenotbeenestab-lished;itsfluctuatingnaturemakesCRFdifficulttomanage.Thereisaneedforsystematicevaluationofdifferenttherapies,includingexerciseonCRF.

ToexaminethedailypatternofCRFduringthethirdcycleofche-motherapy in women with breast cancer; to predict whether CRFtrajectoriesdifferbyexercisebehaviors.

Piper’sIntegratedFatigueModel.Thedatawerecollectedaspartofarandomizedclinicaltrialto

test theeffectivenessofasystematicexercise interventiononfa-tigue.Atotalof98femalebreastcanceroutpatients,ages28to72(M=49.5,SD=9.3),majority(79%)receivingstandarddoxorubi-cin/cyclophosphamide(AC)chemotherapy, infivecancercenterswere included in this report. Exercise behaviors, defined by theSurgeonGeneral’sGuidelineforPhysicalActivity,wereclassifiedas exercisers (n=40) or non-exercisers (n=52). Fatigue intensitywasmeasureddailyatbedtimefortheentire21-daycycle,begin-ningonthefirstdayofthethirdchemotherapycycle.Averageandworstfatiguelevelsinthelast24hoursweremeasuredonan11-pointnumericratingscalerangingfrom0,nofatigue/tiredness,to10,overwhelmingfatigue/tiredness.Multilevelmodelingwasusedtoestimatehowfatiguechangedover timeandwithexercisebe-haviors.

Thepredictedaverageandworstfatigueonthefirstdayofchemo-therapyfornon-exerciserswas4.7and6.2.Non-exercisersexperi-enced1.1(P<0.01)higheraveragefatigueand1.2(P<0.01)higherworstfatiguethanexercisersonthefirstdayofchemotherapy.Av-erageandworstfatiguedeclinedsignificantlyovertime(P<0.001)andthedecreaseswerenotsignificantlydifferentinexercisersandnon-exercisers. Results also demonstrated a cubic change trajec-toryofdaily fatigueduring the third cycleof chemotherapy,withapeakrightafterchemotherapyanda troughfewdaysbefore thenextcycle.

Informationonthepatternoffatigueiscrucialinpreparingcancerpatientsforchemotherapyanddeterminingthetimingofinterven-tionsandmeasurementofoutcomes.Thisreportfurtherstheunder-standingofthepatternoffatigueandtheeffectofexercise.

2362MEETING THE NEEDS OF NURSES NEW TO ONCOLOGY. ElizabethGlemser,RN,BSN,OCN®,SusanLindsey,BSN,RNBC,OCN®, andMelissaAndres,BSN,RN,ClarianHealth,Indianapolis,IN.

Attheendof2001therewereovertenmillionpeopleintheUSliv-ingwithcancer.Lastyearitwaspredictedthat1.4millionnewcaseswouldbediagnosed,yetmostschoolsofnursingdonotprovideafocusinoncology.

Transitioningfromnursingschoolorfromanotherareaofnurs-ing into oncology causes stress, frustration and anxiety for thenurse, his/her peers, and most importantly the patient and fam-ily.Eithersituationcatapultsthenurseintoanadvancedbeginnerstage.Therearegenericprogramsthathavebeendesignedtoeasethistransitionsuchasinternshipsandresidencies.Theyaregearedtoward the task relatedneedsof thenewnurse.Theseprograms,howeverdonotaddresstheneedsofthe“seasoned”nursenewtooncology.

Wehavesuccessfullyaddressedtheseissuesbydevelopingapro-gramcalledOnCollege.Theoverallgoaloftheprogramis:Expandbasicnursingknowledgetoincorporatetheuniqueneedsoftheadultoncology population. This provides a foundation from which theoncology nurse can promote and participate in safe, high quality,holisticoncologycare.

OnCollegeconsistsofsixsessionsthatareeighthourslong,oversixconsecutiveweeks.Thecontentincludesavarietyoftopicsde-signedtodifferentiatebetweenthenursingcare(assess,plan,imple-ment,evaluate)ofamedical/surgicalpatientandnursingcareoftheoncology patient. Focus topics include pathophysiology and epi-demiologyofcancers, treatmentoptions,qualityoflife,oncologicemergenciesandstemcelltransplant.Incorporatedwithinthetopicsarecriticalthinking,collaborationandterminology.

ABasicKnowledgeAssessmentTest (BKAT),specific tooncol-ogy,wasdeveloped.Thistestisadministeredpriortothecourseandattheend.Additionaldatawasgatheredpriortothefirstofferingofthecourseandcontinuestobecollected.Thisdataincludespatientsatisfactionscores,safetyandriskmanagementdataandalsonurs-ingsatisfactionsurveys.

Thispresentationwillsharewithyouhowwedevelopedthiscourseandthelessonswelearned.Discussionwillincludecurriculum,ob-jectives,content,teachingstrategiesandevaluationmethods.

2363FROMCHEMO-CAUTIOUSTOCHEMOQUEENS—DEVELOPINGCON-FIDENCE AND COMPETENCE IN A NEW CHEMOTHERAPY ADMIN-ISTRATION SERVICE. Elaine Griffin, MSc(A), RN, AOCN®, JasmineMatawaran, RN, BSN, Donna Vasichko, RN, CMSN, Rosa Strahan,RN,BSN,AkramMirhamadiha,RN,CMSN,andTinaCutrer,RPh,MS,PresbyterianHospitalofPlano,Plano,TX.

Withthegrowthinoncologyprogramsoverthepastseveralyears,manysmall-to-mediumsizedsuburbanandruralhospitalsnowofferoncologyservices.Theinitiationofchemotherapyadministrationischallenging to staff nurses. It frequently occurs on non-dedicatedoncologyunits,providedbynursesinexperiencedwithoncologypa-tients.The experienced preceptors found on established oncologyunits are absent as are many human and informational resources.Thiscreateshighanxietyforpracticingthesenewskillsinasafeandcompetentmannerandincreasestheriskforerror.

Thisabstractdescribes the initiationofasuccessfulprogramforprogressivechemotherapycompetenceandclinicalsupportinanewoncologyprogram.

Interventionsincludeeducation,informationalresources,andclin-icalandadministrativesupport.InadditiontotheChemotherapyand

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BiotherapyCourse,nursesalso receiveeducation related to safetyandoncologypatientcare. Informational resourcesare rapidlyac-quiredordevelopedinresponsetostaffneeds.Beginningwithinfor-malunitleaders,nurseswerepreceptedbytheCNSandgraduallydevelopedintothepreceptorrole.Chemotherapyadministrationini-tiallywasrestrictedtotimeswhenadequatelycompetentstaffwereavailable;availabilityofserviceincreasedwithstaffconfidenceandcompetence. Nurses have the option of continuing to work infor-mallywithapreceptoraftercompletingrequirededucationandskillvalidation;theendpointofthepreceptingexperienceisconfidence,notjustcompetence.

After1year,75%ofeligiblenursingstaffisadministeringchemo-therapywithoutCNSsupervision.Performanceonallnursing-sen-sitivequality indicatorsforchemotherapymeetorexceednationalbenchmarks.Staffnursesexpressconfidencewiththeirchemothera-pyadministrationskillsandareenthusiasticinpromotingtheirnewspecialtytoothers.Patientandphysiciansatisfactionisgoodandtheoncologyprogramhasgrownaheadofinitialprojections.

Thesuccessfulimplementationofanewservicerequiresthestafftobeconfidentintheirowncompetence.Criticaltoourprogramisresponsivenesstotheneedsofthestaff.Supportandflexibilityfromadministratorsandoncologistshasbeenessentialtomakethiswork.Ourprogramhasbeenverysuccessfulindevelopingnurseswhofeelconfidentaswellascompetent.

2365NURSINGEDUCATIONFORNEPHRONSPARINGSURGICALINTER-VENTIONFORRENALMASSES.ColleenHughes,RN,andAnnaGial-lo-UvinoBSN,OCN®,MemorialSloan-KetteringCancerCenter,NewYork,NY.

TheAmericanCancerSocietyestimates38,890newcasesofkid-neycancer thisyear,70%ofwhichare4.5cmor smaller.Radicalnephrectomy surgery,historically theprimary treatmentofkidneymasses,involvesremovingthewholekidney,adrenalgland,andfat-tytissue.Partialnephrectomy,ornephronsparingsurgery,isthere-movalofonlythecancerousportionofthekidney.Smalltumorsareamenable to nephron sparing surgery. Previously, partial nephrec-tomywasonlyindicatedinpatientswithonekidney,orwithbilateralrenalmasses.Partialnephrectomyisnowbecomingthetreatmentofchoiceforsmallkidneytumorswithhealthycontralateralkidneys.

Research indicates thatpartialnephrectomyhasanadvantage inmaintaining optimal renal function, avoiding the development ofchronickidneydisease.Tenyearsofdatahasshowncomparableon-cologicaloutcomesbetweenpartialandradicalnephrectomies.Thispresentationdescribesthenursingmanagementforpatientswithre-nal masses who have elected to undergo partial nephrectomy.Anoverviewofthesurgeryandthepatienteducationplantoguidethepatientthroughthisinterventionwillbediscussed.

Partial nephrectomy is a challenging procedure, associated withhighershortterm,surgicalrisks.Nursinginterventioninvolvespre-operative teaching and postoperative care. The surgical care plancontainsanoverviewandinstructionsoncoughinganddeepbreath-ing,progressiveambulation,andpainmanagementbutparticularlyfocuses on the complication of partial nephrectomy including he-matomas, hemorrhage, and urinary fistulas requiring prolongedpercutaneous drainage and its management.The model of patienteducationisacollaborativeeffortbetweenoutpatientandinpatientnursesprovidingpatientswithuniforminstructionsthroughouttheirsurgicalprocess.

At this comprehensive cancer center, the number of partial ne-phrectomies surpasses that of radical nephrectomies proving thesurgeryisasafe,effectivetreatmentwithlongtermrenalfunctional

advantages.Nationally,partialnephrectomyremainsunderutilized,limitedtotertiarycarecenters.Theimplementationoftheinpatient/outpatient nurse liaison enhances the patient educational programensuringcontinuityofcare.

Theprogressiveuseofpartialnephrectomyrequiresahighlevelofnursingawareness,andpreparednesswithanaccurateknowledgebase.Patientseducatedonthesurgicalcareplanwillparticipateinpreventativemeasures to limit complications, seeking interventionwhenneeded.

2366THE PROVISION OF PALLIATIVE CHEMOTHERAPY IN HOSPICE: ANATIONALCOHORTSTUDYOFHOSPICESANDHOSPICEPATIENTS.TerriL.Maxwell,PhD,APRN,BC-PCM,andKevinT.Bain,PharmD,BCPS,CBP,FASCP,excelleRxInc.,Philadelphia,PA;andJulieA.So-chalski,PhD,RN,FAAN,UniversityofPennsylvaniaSchoolofNurs-ing,Philadelphia,PA.

ThedesignoftheHospiceBenefitin1982reflectedtherealityofcancertreatmentatthattime;treatmentswereusuallyverytoxicandfewpalliative therapieswereavailable.Recently,abroadrangeofpalliativechemotherapyagentshavebecomeavailable,challenginghospice requirements related to discontinuation of therapies priortoenrollment.Somehospicesarenowadmittingpatientsreceivingchemotherapytoimproveaccessandincreasehospicelengthofstay(LOS)forthesepatients.

Purpose: To identify hospice organizational factors associatedwith theprovisionoforalpalliativechemotherapy, tocharacterizepatientswhoreceivedoralchemotherapyinhospice,andtoexaminedifferencesinhospiceLOSamongpatientsthatdidanddidnotre-ceivethesetherapies.ThisstudyprovidesinsightsintoONSresearchpriorities such as decision-making in advanced disease, palliative,andhospicecare.

Exploratory,descriptivecorrelationaldesignusingsecondaryanal-ysisofdatafromanationalpharmacyproviderofpatientsadmittedtohospicewithadiagnosisofbrain,breastorlungcancersbetween1/01/03anddischargedorexpiredasof6/30/05.

Sample was comprised of 58,154 patients enrolled in 544 hos-pices.43.6%ofhospicesprovidedchemotherapyto1,140patients.Hospicesize,profitstatusandgeographicalregionwerestatisticallyassociated with providing chemotherapy, but after including thesefactors in a logistic regressionmodelonlyhospice size andprofitstatusweresignificant,withlarge-sizedandnot-forprofithospicesmost likely to provide chemotherapy. Non-profit hospices were 5timesmorelikelytoprovidechemotherapy,independentofhospicesize.Chemotherapypatientswere4yearsyoungercomparedtonon-chemotherapypatients.Receivingchemotherapywasnotassociatedwithgender,race,diagnosis,ordischargestatus.Chemotherapypa-tientswere inhospiceapproximately2weeks longercompared tonon-chemotherapypatients (p<.001)andhadonaverage,a9-dayincreaseinmedianlengthofstay,withbothbreastandbraincancerpatientsincreasingtheirmedianlengthofstayby2weeks.AchangeinMedicare’spayment system thatexplicitly recognizespalliativechemotherapymayincreaseaccesstohospiceservices.However,theremoval offinancial barriersmay increase access at theorganiza-tional level,but thedemand frompatientsmaybe lacking.Futureresearch should focus on outcomes of providing chemotherapy inhospice.

2370USINGKARNOFSKYPERFORMANCESTATUS(KPS)OFBONEMAR-ROWTRANSPLANT(BMT)PATIENTSATTIMEOFTRANSPLANTASAPREDICTOROFOVERALLSURVIVALOFPATIENTSWITHACUTE

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MYELOID LEUKEMIA (AML) OR MYELODYSPLASTIC SYNDROME(MDS).LisaPrivitere,RN,OCN®,andMargaretSyta,RN,NP,RoswellParkCancerInstitute,Buffalo,NY.

RefractoryAMLandMDSaredifficultdiseasestomanageduetorecurrentdisease.

We retrospectively reviewed 47 consecutive patients withAML(n=36)orMDS(n=11)whoreceivedafirstrelated(n=23)orun-related(n=24)AllogeneicBMTbetween4/1/2003and3/31/2006atRoswellParkCancerInstitute(RPCI)tocompareoutcomesbypre-BMTdiseasestatus.

16patientshadaKPSof100%to90%and31hadaKPSof80%orless.

ExamplesofadditionalpatientfactorsanalyzedinadditiontoKPSrelativetooutcomewerediagnosis,diseasestatusconditioningregi-men,HLAmatching,graftversushostdisease(GVHD)prophylaxis,viralinfection,fungalinfection,age,ejectionfraction,selectpulmo-naryfunctiontests(PFTs).KPSwastheonlysignificantpredictorofoverallsurvival.

Thegoodofthisprojectistoidentifywhatfactorsotherthancy-toreducing the patient before hematopoetic stem cell transplant(HSCT)suchasKPS,ageandhumanleukocyteantigen(HLA)sta-tusaffectoutcome.PatientswithaKPS<90%havebeenidentifiedashighriskforpooroutcomeandaremonitoredmorecloselywithastringentassessment.Communicationsamongtheinterdisciplinaryteamareprioritizedforimmediateresponse.

Weparticipatedinaretrospectivecohortstudyof116consecutiveAMLandMDSpatientsbetween1/1/2003and7/1/2006.Ofthispa-tientpopulation47(41%)actuallyreceivedanalloHSCTatourcen-ter.AsaresultofourfindingsourstandardnursingordershavebeenrevisedtoaddressthepotentialacuityofapatientwithalowKPStoensureearlydetectionofstatuschanges.Wehavealsoreducedtheintensityoftheconditioningregimens,usingre-inductionstrategiesthatdonotcompromiseKPS.

ThatlowKPSisastrongpredictorofpoorlong-termdiseasefreesurvival(LFS)andoverallsurvival(OS).

2371DEVELOPMENT OF A CLINICAL TRIAL TRACKING TOOL. ZenonaLesko,RN,LisaGaynes,BS,JoanScagliola,MSN,MinervaUtate,RN,BSN,OCN®,DonnaCatamero,RN,BSN,OCN®,CCRC,AlexiMorillo,BS,andJulietEscalon,RN,OCN®,ANP,CCRC,NYUCancerInstitute,NewYork,NY.

A specialized research team is integral to the successful imple-mentation of a clinical trial (CT) program.A cancer institute thatispartneredwithhospitalandambulatoryclinicalcareprovidestheopportunity to offer innovative scientific and disease focused re-searchprograms.TheincreasingnumberofcomplexCTspresentschallengesthatarecoupledwithincreasingregulatoryrequirementsandeconomicconstraints.Collaboratingwithallmembersofthein-terdisciplinaryteamiskeytoachievingasuccessfulCTprogram.

AtaskforcewasorganizedtodevelopaCTtrackingtoolthatde-scribesallelementsofaclinicaltrial,andidentifythemembersoftheinterdisciplinaryteamwhoareaccountableforeachelement.Thepurposeofthetoolwastoclarifyeachmember’sroleandpromoteutilizationofessentialteammember’sskillsandknowledgeinordertodecreaseduplicationofeffortandincreasecommunicationamongtheinterdisciplinaryteam.

ACTtrackingtoolthatincludeselementsofaclinicaltrialinclud-ingprotocolpre-activation,screening,eligibility,informedconsent,active treatment, regulatory/ economic components, quality im-provement,patienttrackingandreportingwasdeveloped.Includedinthistoolisacolumnindicatingresponsibleindividual(principal

investigator, researchRN, infusionRN,datamanagement, regula-tory,pharmacy,lab,andclinicaltrialsoffice).Nursetoclinicaltrialratiobasedoncomplexityandnursingtimewasdefined.AweeklyCTinterdisciplinaryfeasibilitymeetingwasorganizedtoensurethatresourcesneededtoaddresstheabovelistedCTelementswereavail-ablepriortoatrailgoingtotheIRB.

TheCTteamhasastreamlinedsystemthatfacilitatestheflowofthetrialsdemonstratedbylesstimespentintroubleshootingafteratrailhasbeenapproved.Transparencyregardingworkloadandneedforcrosscoveragewasestablished.Regulatoryandfinancialdocu-mentationhaveimprovedwhileenrollmenttoclinicaltrialscontin-uestosteadilyincrease.

IncludingstakeholdersinthedevelopmentandimplementationoftheCTtrackingtoolsuccessfullyfosteredpartnershipsamongmem-bersoftheresearchprogram.

2374ONCOLOGYNURSINGEDUCATIONANDOBSERVATIONPROGRAMFORHIGHSCHOOLSTUDENTS.TeresaCampbell,RN,BSN,OCN®,MemorialSloan-KetteringCancerCenter,NewYork,NY.

In lightof thesignificantnursingshortage,andwaning interestinOncology,theneedtorecruitstudentsat thehighschoollevelanddevelopaninterestinOncologyisbothrelevantandimportant.Theliteraturedescribesindetailtheneedfornovelapproachestoaddresstheshortage,providinganamplebackgroundforthispro-gram.

Thepurposeandrationale,supportedbyevidenceintheliterature,isclearlydefinedanddescribed.Theconceptualmodelused isaneducational model, steeped in hands-on experience and acute ob-servation.

Theinterventionalprogramdoesaccomplishthepurposeofopen-ingthedoorofnursingingeneral,andoncologyinparticular,tothehighschoolstudentpopulation.Thevariedexperiencesinthispilotprogramwereexcitingandappropriate, andallowed the studentamonitored,butindependenthands-on,experience.

Theprojectgoalsareevaluatedasanindividualcasestudy,asthepilothasjustbeeninitiated.TheoutcomesareapplicabletoOncol-ogynursingandhavebeenverypositive.

The implications for Oncology nursing practice, particularly ineducatingthehighschoolpopulation,havebeenenormousandtheiruseinthefutureiswideopen.Suggestionsareincludedforspecificsitechangesandexperiences,asaresuggestionsforgrowthof theprogram.

2375EARLYDETECTIONANDMANAGEMENTOFADVERSEEVENTSAS-SOCIATEDWITHIPILIMUMAB:HOWTHERESEARCHNURSEPLAYSAVITALROLE.CatherineLevy,MS,BSN,RN,andTamikaAllen,RN,BSN,NationalInstitutesofHealth,Bethesda,MD.

Ipilimumabisamonoclonalantibodycurrentlybeingusedinclini-caltrialsinavarietyofdiseasesincludingmelanoma,renalcellcar-cinoma,andadenocarcinomaofthepancreas.AsIpilimumabbeginsthefasttrackprocessforFDAapproval,itisessentialthatoncologynurses understand the importance of early detection and manage-mentofpotentialadverseevents.

TheprimaryactionofIpilimumabistoinhibittheCTLA4mole-culefoundonthesurfaceofTcellsandpotentiallyenhancesimmuneresponsesagainstcancer.However,Ipilimumabcanresultinautoim-muneeventssuchascolitis,hypophysitis,uveitis,dermatitis,hepati-tis,and/ornephritis.Autoimmuneeventscorrelatewithahigherrateoftumorregression.Theresearchnurseplaysanimportantroleintheassessmentandreportingofadverseevents.Nursingresponsibil-

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itiesincludeprovidingcomprehensivepatienteducation,collectionandanalysisofpatientsymptoms,andmonitoringlaboratoryvalues.Constantsurveillanceofadverseeventsfacilitatesprompttreatmenttopreventlongtermorpotentiallyfatalcomplications.

Theresearchnurse’sroleineducatingstudysubjectsonpotentialadverseeventsispartoftheinformedconsentprocess.Thisprocessisongoingasstudyparticipantsremainenrolledontheclinicaltrial.StudysubjectsareprovidedwithaSymptomManagementLog todocument anynewsymptoms.Examplesof symptoms from Ipili-mumabincludediarrhea,abdominalcramping, fatigue,headaches,arthralgias,anyvisualchanges,andanyskinchangessuchasrash,itching, or discoloration. These symptoms appear anywhere fromoneweektoafewmonthsafterreceivingtherapy.

Eachsituation isevaluated individuallyandmaywarrant furtherwork-up.Pendingevaluation,steroidtherapymayormaynotbeini-tiated.Steroidsarenotutilizedasafrontlinetherapyinmildformsofautoimmuneeventsastheymayinhibitimmuneresponse,how-eversteroidsmaybeindicatedforsevereautoimmuneeventssuchcolitisorhypophysitis.

As more clinical trials use Ipilimumab, unknown autoimmuneeventsmaysurface.Itisimperativethattheresearchnursemaintainsongoing communication and close surveillance with participantswhoreceiveIpilimumab.

2376PROMOTION OF LEADERSHIP WITHIN A SHARED GOVERNANCEMODEL.GabrielleArauz,RN,BS,OCN®,andMaryEllenSchwarzbek,RN, BS, MA, OCN®, Memorial Sloan-Kettering Cancer Center, NewYork,NY.

At this (NCI) designated cancer center, a shared governancemodelhasbeenimplementedtoallownursingtoparticipateinthedecisionmakingprocessthatdirectlyaffectstheirpractice.Sharedgovernanceisfacilitatedviaaformalcouncilstructurecomprisedofambulatorynurses.Recentlyitbecameincreasinglydifficulttofindstaff tochair thesecouncils.Chairmanship isvoluntary,andposes additional challenges and responsibilities beyond the as-signednursingrole.Pastchairsreportedfeelingoverwhelmed,un-der supported,andunprepared tohandle theircouncil leadershipresponsibilities.

Ataskforcewasformedandconsensuswasreached,thatnewlyelected chairs and chair elects would benefit from an educationaloverview toprepare themfor theirnewroles.Thepurposeof thispresentationistodescribetheleadershipdevelopmentprogramde-velopedfortheseinexperiencedleaders.

The program is multifaceted and addresses the complex needsofthecouncilleadership.Anintroductorysessionisheldforchairelectstointroducethemtotheirrolesandresponsibilities.Addition-ally,threetrainingclassesarehighlyrecommendedtohelppreparethesenewleadersforobstaclestheymayface.Classesincludedin-formationonrunningmeetingsandsuggestionsonhowtointeractwithdifferentpersonalitieswithin thecouncil.Eachclass isa fullday, and is offered through the human resources department.TheclassesareNatureofTeams,UnderstandingBehavorialStyles,andFacilitationSkills.Lastly,therearetwoinformalsupportsessionsinwhichcasescenariosarepresentedanddiscussed.

Feedbackfromtheseprogramshasbeenpositive.Thenursesreportincreasedcamaraderie,supportandpreparednessfortheirrole.Theprogramhasbeenevaluatedthroughverbalfeedbackfromprogramparticipants.Evaluationwillbeperformedonacontinualbasiswitheachnewgroupofcouncilchairsandchairelects.

Duringthisnationalnursingshortageitisessentialweoffereduca-tionandtrainingprogramswithinourinstitutionstofosterprofes-

sional growth and development.Through a variety of educationalstrategies, continued follow-up and open communication, we areable torecognize thesuccessandstrugglesof thecouncil leaders.Thisapproachencouragesstaff toparticipate,promotes leadershipandoffersnursesagreatersenseofempowerment.

2377EXPANDINGTHEROLEOFRESEARCHNURSESINANITALIANGY-NECOLOGIC ONCOLOGY COOPERATIVE GROUP. Marzia Falanga,BSN,AziendaOspedalieraSanGuiseppeMoscati,Avellino,Italy;andMariannaConnola,BSN,andJaneBryce,RN,MSN,NationalCancerInstitute,Naples,Italy.

CooperativeoncologygroupshavealonghistoryinItalywhilere-searchnursingisrelativelynew.Theoncologynursingliteraturepro-motesanexpandedrolefornursesincooperativeresearchgroups.Thepurposeof thisprojectwas to establish anetworkof clinicalresearchnurses(CRN)withinanItalianoncologygroupandtoiden-tifystrategiesformaximizingtheirpotentialcontribution.

A group of CRNs began collaborating in May 2006 after beingidentified through a survey sent to all Investigators of the Multi-centerItalianTrialsinOvariancancerandgynaecologicmalignan-cies(MITO)cooperativegroup.Throughbrainstorming,aliteraturereview,discussionswiththeMITOleadership,andcontactswithin-ternationalgynaecologiconcologygroupsthenursinggroupidenti-fied4initialobjectivesforimprovingpatientcareandresearchnurs-ingpractices: toestablishtheuseofnursingsummariesforMITOconductedtrials, toidentifypotentialcompanionstudiesandothernursingresearchprojectsinthispatientpopulation,toestablishfor-malcontactswithinternationalgynaecologiconcologynursingor-ganizations,andtoincreaserolevisibilitythroughpresentationsandpublications.

ThepilotnursingsummarywaswritteninOctober2006andes-tablishesminimalprotocolcontentforMITOconductedtrials.Twonursing research projects are in development: a companion studywithinafutureMITOtrialwithIntraperitonealchemotherapy,andanindependentnursingresearchstudyofthevalidationoftheItalianversionof a symptomassessment tool.MITO is amemberof theGynecologicCancerIntergroup(GCIG),andtheMITOnurseshaveestablishedcontactswithGCIGnurses,andparticipatedinthefirststudycoordinatorsmeeting.Further,achapteronItalyintheONSManual for ClinicalTrial Nursing is in press, authored by MITOnurses.MITOcourseshavenow includednursepresentersandanIPchemotherapynursingprotocolwaspublishedwithintheMITOgroupinDecember2006.

Thoughthecollaborationisinitsearlystages,theseearlysuccess-esoftheMITOnurseshasstimulatedinterestincontinuingtoworktowardachievementoftheinitialobjectives,andtousethismodelforexpandingtheroleofresearchnursesinotherItaliancooperativeoncologygroups.

2380MAINTENANCEOFTHEIMPLANTEDCENTRALVENOUSPORT:US-INGEVIDENCE-BASEDPRACTICETOREDEFINETHENURSINGPOL-ICY. Annemarie Flaherty, RN, MS, AOCNS, CNSC, Nancy Houlihan,RN,MA,AOCN®,KimMertens,RN,MSN,AOCNS,SuzanneSweeneyGornell,RN,BSN,OCN®,JoanneTaylor,RN,MA,AOCN®,andNicoleLeonhart, RN, MS, ANP, Memorial Sloan-Kettering Cancer Center,NewYork,NY.

Implantedcentralvenouscatheters(I-CVCs)playamajorroleinoncologycarebutareassociatedwithlongtermrisksofinfection,thrombosis,andcathetermalfunction.Despiteroutineflushing,41%of I-CVCs result in thrombosisof thevessel,which increases the

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riskofinfection.Withthegrowinguseoforalagentsandsuccessivechemotherapy regimens, I-CVCs are increasingly unused for ex-tendedintervals.Patientvisitsforflushingmaycreatenuisanceandnon-reimbursableexpense,andcompliancecanbeproblematic.Yet,complicationsmaybegreaterbeyonda4-6weekflushingschedule.Reviewofnursingpolicyat this institutionrevealeda lackofevi-dence-based(EB)guidelinesforlongtermI-CVCmaintenance.

TheEvidenceBasedPracticesubcommitteeidentifiedthislackofclear practice standards as a dilemma in caring for long term pa-tients.WeappliedanEBapproachtoinvestigateaspecifictimein-tervalforflushinganI-CVCwhennotinroutineuse.

Acomprehensivereviewof theevidenceincluded:reviewof thepublishedliterature,guidelines,andmanufacturerrecommendationsand consultation with identified experts. In analyzing institutionalcomplications,weperformedaretrospectivechartreviewofpatientstreatedwithAlteplase®.Datawascollectedaboutcomplicationsandriskfactors.

WefoundlimitedinformationinourreviewtosupportaspecifictimeframeforflushingunusedI-CVCsandvalidationfromexpertopinion of the universal need to set practice standards. Our chartreview was inconclusive because of inconsistent documentation.Outcomevariablesincludedtypeofinfusion,efficacyofflush,andoverall catheter functioning. Based on this review current nursingpolicyisunderrevisiontoclarifylongtermI-CVCmaintenanceandrelateddocumentation,withaplanforre-educationofstaff.

Applicationofanevidencebasedmethodologytosolveaclinicalquestionguidesqualitycare initiatives.We learned that long termI-CVCmaintenanceisanunder-studiedpracticeissue.Lackofran-domizedclinical trials creates adilemma forbestpractice recom-mendations.Thispresentation,whichwilldescribeourEBprocessand the results of the evidence and complication data, can guideothernursesinaddressingclinicalquestionsaswellasraiseclinicalimplicationsforfurtherstudy.

2381ANEWTECHNIQUEFORTREATINGVOCALCORDPARALYSIS:WHATONCOLOGYNURSESSHOULDKNOW.RebeccaZeuren,RN,BSN,andJanineKasparian,RN,BSN,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Vocalcordsarecriticalforclearphonation,protectionofthetra-cheafromaspiration,andeffectivecoughproduction.Whenavocalcord is paralyzed it is unable to abduct and adduct and thereforecreatesasmallgap.Thismaycausehoarseness,inabilitytocommu-nicate,shortnessofbreathe,andaspiration.Therearemanyknowncausesofvocalcordparalysis.Thetwomostcommonarelungma-lignancyandsurgically-inducedinjury.Vocalcordinjectionmayal-leviatetheseproblemsassociatedwithparalysis.Itisimportantfornursestobeawareofthistreatmentoptionfortheirpatients.

Thispresentationwill educatenurses aboutvocal cordparalysisandthevocalcordinjectiontechnique.Therisksandbenefits,proce-duredetails,andnursingimplicationswillbedescribed.

Afterthepatient’sthroatislocallyanesthetized,onephysicianin-sertsafiberopticscopeforvisualizationofthevocalcords.Asecondphysicianpalpatesexternallandmarks,prepstheskin,andinsertsaneedle into the thyroarytenoid/vocalismuscle.Ahuman tissueorsyntheticproductisinjectedintothetissuepushingthevocalcordmedially.Thenurseobserves thepatientforadversereactionsandprovidespost-procedureinstructions.

Vocalcordinjectionsaregenerallyeffectiveforfourtosixmonthswithalowriskofsideeffects.Improvementmaybeobservedim-mediately,withprogressiveimprovementoverthenextfewdays.Itisminimallyinvasive,lesscostlythanopensurgicaltechniques,

andcanbeespeciallyeffectiveinimprovingthequalityoflifeforpatientswith advanceddiseasewho areunable to undergo anes-thesia.

Anyoncologypatientmaybeaffectedbyvocalcordparalysisasaresultoftheirdiseaseortreatment.It isimperativeforoncologynursestobeeducatedaboutthisproblemandthepotentialbenefitsofvocalcordinjection.Thiswillallowthepractitioner to identifypatientswhomaybenefitfromthisprocedure.

2384THEUSEOFCLINICALNARRATIVESASADEVELOPMENTALTOOLFOR GRADUATE NURSES. Mary Louise Kanaskie, RN, MS, RNC,AOCN®,PennStateMiltonS.HersheyMedicalCenter,Hershey,PA.

Graduatenurses in oncology are facedwithmany challenges astheylearntheroleofprofessionalnursewhileworkinginafieldthatrequiresspecializedknowledgeandskill.Graduatenurseinternshipsprovidethestructurefortheacquisitionofknowledgeandbasicskillcompetency.

Thepurposeof thisproject is todevelopa framework fornursemanagersandnurseeducatorsutilizingtheclinicalnarrativeasatoolforevaluationanddevelopmentofgraduatenurses.

Aclinicalnarrativeisanurse’swrittenstatementoftheirnursingpracticeandcanbeeffectivelyusedtoevaluatepracticebecauseitde-scribesthepracticewithinacontext.AccordingtoBenner,graduatenursesfunctioninitiallyas“novices,”gainingknowledgeandexperi-encethrougheachclinicalexperience.Theclinicalnarrativeprovidesatooltodialoguewiththegraduatenurseaboutaclinicalsituationandtoprovideanopportunityforthemtoreflectonthesituationfromanewperspective.Thenarrative identifies importantnursing inter-ventions, makes visible the stages of knowledge development andenhancesindividualizedlearningplans.Graduatenursesinanintern-shipprogramonanoncologyunitwereaskedtowritenarrativesatsetintervals.Meetingswiththeclinicalnurseeducatorandnurseman-agerwereheldtodiscusstheiroverallgrowthanddevelopmentandprogresswithorientationoutcomes.Utilizingthenarrative,dialogueoccurredwhichidentifiedindividuallearningneeds.

Graduatenursesevaluated theexperienceofwritingandsharingtheirnarrativesasvaluable,allowingthemtoreflectontheirpracticeandtoidentifyareasforgrowth.Managersandeducatorsidentifiedthatthenarrativemadethenurse’spracticevisibleandenabledthemtoevaluatecriticalthinkingskillsandmoreeffectivelydevelopindi-vidualizedlearningplans.

Thesuccessofthisprojectrequirestheongoingeducationofnursesinleadershiprolesabouttheeffectivewaytoutilizetheclinicalnar-rative.Examplesofclinicalnarrativeswillbesharedhighlightingthephrasesandsegmentsthataremostrevealingandhowtoconstructquestionsandstatementsinthedialogueaboutthem.TheimpactofthisprojectisfarreachingandcanalsobeeffectivelyutilizedinthedevelopmentofexperiencedRNstaff.

2388EDUCATE STUDY (EDUCATING CLINICIANS TO ACHIEVE TREAT-MENT GUIDELINE EFFECTIVENESS): DEVELOPMENT AND IMPLE-MENTATION. Lyssa Friedman, RN, BSN, MPA, McKesson SpecialtyOncology Services, San Rafael, CA; Constance Engelking, RN, MS,OCN,TheCHEGroup,Mt.Kisco,NY;CatherineD.Harvey,DrPH,RN,AOCN®,TheOncologyGroup,Raleigh,NC;RitaWickham,PhD,RN,AOCN®,CHPN,RushUniversity,Chicago,IL;KimberlyL.Miller,PhD,OvationResearchGroup,SanFrancisco,CA;andJoelD.Kallich,PhD,Amgen,ThousandOaks,CA.

Febrile neutropenia is a dose-limiting toxicity of chemotherapy;fatigueduetochemotherapy-inducedanemiaisalsocommon.These

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side effects can lead to life-threatening infections, increase costs,and may reduce patients’ quality of life. National OncologyAlli-ance(NOA)offerspeer-reviewedanemiaandneutropeniaguidelinesconsistentwithnationally-recognizedguidelinesyetcustomizedtooffice-basedoncologypractice.

Researchshowsthatdistributionof treatmentguidelinesaloneisinsufficienttochangeknowledgeorclinicalpractice.Aneducationalprogramtargetedtohealthcareproviders(HCPs)toimproveguide-lineadherencemayimproveadherenceandleadtoimprovedpatientoutcomes.

TheEDUCATEstudy(EDUcatingClinicians toAchieveTreat-mentguidelineEffectiveness) isdesigned toevaluatewhetheraneducational interventionprogramtargeted toHCPsonadherencetoanemiaandneutropeniatreatmentguidelinesimprovesguidelineadherence in thecommunity-basedsetting.The12-montheduca-tional program, based on NOA’s anemia and neutropenia guide-lines, is tailored to the office-based setting, where nurses havecollaborativerolesandcanfacilitateguidelineadherence.Commu-nity-basedoncologypracticesinfiveUSregionswererandomizedtotheintervention(education)orcontrol(noeducation)group(2:1ratio).Atotalof1568practiceswereapproachedforparticipation,122practicesresponded,49practiceswereineligibleand26prac-ticesdeclinedparticipation.TheunitofanalysisinthestudyistheHCP;82HCPsin47randomizedcommunity-basedpracticeswereenrolled.

Thesameeducationalprogramwasofferedtoallcliniciansintheinterventionsites(registerednurses,physicians,nursepractitioners,physician assistants, pharmacists, licensed practical nurses). Theeducationalprogramemploysseverallearningformatstoreinforceriskassessmentforneutropeniaandanemia,appropriategrowthfac-toruseanddosingandpatientmonitoring.Theeducationalprogramintroducesanewtopicmonthlyandvariesthepresentationweeklytoincludeoneofthefollowing:emailcasevignettewithquiz,edu-cational mailer with peer-reviewed article, educational giveaway,patienteducationresourceand/orstudynewsletter.

Oncologynurse educatorsplay akey role in educationdelivery,providing three educational in-service trainings and implementingcustomized standing orders for neutropenia risk assessment, ane-miaassessmentandappropriategrowthfactoruse.Comparisonofeducationversusnoeducationonguidelineadherenceandpatientoutcomeswillbereportedatstudycompletion.2389ONCOLOGY PROFESSIONAL NURSING DEVELOPMENT COUNCIL.Katie Mullaly, MSN, RN, Patricia Eklund, RN, Maureen Hickey, RN,MargaretKasper,APRN-BC,SarahMendez,RN,MA,CherylLee,RN,MA,PCNP-C,andFrancesCartwright,PhD,RN,AOCN®,NYUHospi-talsCenter,NewYork,NY.

Theoncologynursingprofessionischallengedtostaycurrentwithongoingscientificadvances.Asystemtoaddressthevariousneedsofnursesacrosstheoncologyserviceline,utilizingthediverseclini-calandleadershipexpertiseinanNCIdesignatedacademicclinicalcancercenterwasidentified.

AnOncologyProfessionalNursingDevelopmentCouncilwasor-ganizedwithmembershipfrominpatient,infusiontherapy,radiationoncology,homecare,hospice,painmanagement, community, andeducation.ConsistentwiththeONSactionplanfor2006,theaimsofthiscouncilare:1)identifytheneedsofnursingacrosstheoncologyserviceline,2)implementevidencebasededucationalprograms,3)increaseutilizationofexpertiseinalargeacademicuniversitymedi-cal center,4)developand implement criteria for attendingeduca-tionalofferings.

1)Aneducationneedsassessmentsurveywasdistributedtoallon-cologyservicelinenurses.Thesurveywascomposedof50items.Eachitemwasratedbypriorityofneedwith1(leastimportant)to10(mostimportant).2)Councilmembersnetworkedtoidentifypro-grampresenters.3)Responses from theeducationalneedsassess-ment survey and a literature reviewprovided thedata to organizeongoingCEapprovedprogramsforendof2006–2007.4)Abinderthatincludesthenewlydevelopedoncologyservicelineeducationcalendar,ONSeducationalblueprint,andsitesforonlineCEcreditsisupdatedquarterlyandavailableacrossservicelines.

Thesurveywascompletedby30oncologynurses.Highestpriorityneedsamongallsitesinclude:evidencebasedpracticeprojects,re-search,pain,oralchemotherapies,stressmanagement,andgyneco-logicalcancers.Theeducationalprogramshavebeenwellattendedandincludeadultandpediatricnursesfrominpatientandambulatorysites.Theresultsrevealedimprovedcollaborationbetweenoncologysites,asindicatedbyjointprojectsnowbeingdeveloped.Tofurtherthe above stated aims and to address the education needs survey,a mentor subcommittee, consistent with ONS was recently devel-oped.

Thecouncilhasimprovedthesystemtopromoteaseamless,inte-gratedprocessofevaluatingnurse’sneedsandimplementingacces-sibleeducationprogramstoelevatetheoncologynursingprofessionasawhole.

2392MONITORING PATIENTS THAT HAVE RECEIVED ALL-TRANS RETI-NOICACID(ATRA)TREATMENTDIAGNOSEDWITHRETINOICACIDSYNDROME.LisaPrivitere,RN,OCN®,andMerimaNokic,RN,Ro-swellParkCancerInstitute,Buffalo,NY.

Current data has shown a distinct complex of symptoms thathas been reported among patients receiving all-trans retinoic acid(ATRA)therapyforacutepromyelocyticleukemia.Amongpatientswithappropriatecytogenicprofile,ATRAhasdemonstratedefficacyasanalternativetocytoxicchemotherapy,byinducingthedifferen-tiationofmalignantcellsintophenotypicallymaturemyeloidcells.ATRAhasproducedcompleteremissioninalargeproportionofpa-tientstreatedreaching90%.

WithconsistentuseofATRAandongoinggrowthofpatientsontreatment-retinoicacidsyndromehasbeenidentified.Thesyndromeconsistsoffever,dyspnea,weightgain,pulmonaryinfiltrates,pleu-ralorpericardialeffusions,episodichypotension,renaldysfunctionand leukocytosis. Less likely but always associated with a highermortalityrateispulmonaryhemorrhage.

To reduce potential length of stay, mechanical ventilation, andothercomplications,preventingretinoicacidsyndromeiscriticaltodecreasedmortality,improvedqualityoflifeandcostefficiency.

Toimproveourpotentialoutcomesweidentifiedthefollowingin-terventions:1) Implementingin-servicesonRAsyndromeondirectcaregivers

andpatients(earlysideeffects)2) Monitoringcloselyinputandoutput,vitalsigns,weights,short-

nessofbreath,bloodresults(completebloodcount,comprehen-sivemetabolicpanel)

3) Evaluatingpatientstatusclosely,checkingrenalfunction,pulmo-naryinfiltrates,includingdiagnosticsuchasX-ray,ECHO(rul-ingoutpossiblecardiactamponade)

4) CessationofATRAformoderateorsevereretinoicacidsyndrome5) Rigorousexclusionofsuperimposedinfection6) Diuresingpatientastoleratedbyhemodynamicandrenalstatus

Retinoic acid syndrome is associated with substantial morbidityandareportedmortalityrateashighasninepercent.

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However,themajorityofpatientshavemadeacompleterecoveryifthissyndromeisrecognizedandtreatedearlyandATRAiswith-drawn.

TheOncologynurseisabletomanageapatientreceivingATRAifknowledgeable aboutpotential complications.This syndrome isalmost completely reversible if thenurse at thebedside is able torecognize,reportclinicalfindingsandunderstandtheactionsneededtoprevent furtherharm.Thispresentationwillprovide theOncol-ogyNursewiththeinformationtoimprovenursingcareofpatientsreceivingATRA.

2394MUCINOUSADENOCARCINOMAOFTHEAPPENDIXPRESENTINGASANOVARIANMASS.RobinCianos,RN,OCN®,TriciaRoesch,ACNP,andJesusEsquivel,MD,FACS,SaintAgnesHospital,Baltimore,MD.

Peritonealsurfacemalignanciesofappendicealoriginarecharac-terizedbytheruptureofaprimarymucinoustumorwithextravasa-tion of tumor cells and large quantities of mucin throughout theabdominalcavity.Theaccumulationof thismucinousmaterialatspecific anatomic sites contributes to their clinical presentation.Depositsinaherniasacwillpresentasanewonsethernia,depositsintheomentumwillpresentasincreasingabdominalgirthandinwomen,depositsinarupturedovarianfolliclewillcontributetotheclinicalpresentationasanovarianmass.Frequently, thisovarianmassismisdiagnosedandtreatedasanovariancancerwithserialdebulkingsand intravenouschemotherapy.Thecurrent treatmentforappendixcancerwithperitonealdisseminationconsistsofcyto-reductivesurgeryandhyperthermicintraperitonealchemotherapy(HIPEC).

Ananalysisofclinicalcharacteristicsleadingtotheirmodeofpre-sentation,treatmentandoutcomeconstitutesthebasisofthisstudy.

Weconductedaretrospectivereviewofallfemalepatientsunder-goingcytoreductivesurgeryandHIPECforappendixcancer fromJanuary2005toJanuary2006atourinstitution.

Thirty female patients were identified. Mean age was 54 years.Ninepatients(30%)hadthediagnosisofanovarianmass.All9pa-tientsweretakentotheoperatingroomelsewhereforanexploratorylaparotomyanddebulking.Chemotherapyregimensforovariancan-cer were given to two of the nine women prior to their definitivetreatmentwithcytoreductivesurgeryandHIPEC.Averagetimebe-tweeninitialdiagnosisandcytoreductivesurgerywas34.3months(2-120).Finalpathologiesatthetimeoftheircytoreductivesurgeryshowedlowgrademucinousadenocarcinomaofappendicealoriginin8patientsandhighgrademucinousadenocarcinomaofappendi-cealoriginin1patient.Soatameanfollowupof12months(2-22),all patients were alive, 5 with no evidence of disease and 4 withdisease.

Thischartreviewvalidatestheneedforhealthcareprofessionalsincludingnurses,medical and surgical oncologists tobe awareoftheassociationbetweenappendixcancerandovarianmasses.Thisawarenessisvitalinordertoprovideappropriatesurgicalmanage-mentinatimelymannertothisgroupofpatients.

2395CREATIVECARING—ENHANCINGSURVIVORSHIPCARETHROUGHSHARING.CindyWaddington,RN,MSN,AOCN®,NancySteward,RN,MSN,OCN®,CRNI,MaryRedman,RN,OCN®,NancyLambert,RN,MSN,OCN®,andJeffKendall,PsyD,HelenF.GrahamCancerCenter,Newark,DE.

Cancersurvivorshipisadistinctphaseofcancercare.Duringthetransitionfromactivetreatmenttoposttreatment,survivorsoftenstrugglewithanemotionalupheavalwhichmayalter theirviews

ofthemselvesandtheworld.Storytellinghasshowntofacilitatepersonal growth for both story tellers and listeners. Oncologynurses,adeptattherapeuticcommunication,havehadlimitedop-portunitiestobecomemorefamiliarwiththeexperienceofcancersurvivorsandfacilitatethispersonalgrowth.Nursesarenowmorefrequentlyinteractingwiththe10millioncancersurvivorsintheUnitedStates.

Acancersurvivorscrapbookingandstorytellingprogramwasde-velopedtofacilitatetheprocessofworkingthroughsurvivors’per-ceptionofpastandpresentevents.Italsoprovidedanopportunityforoncologynursestoworkcloselywithsurvivors.

Scrapbooking volunteers and Cancer Care Management (CCM)staffassistedparticipants in thecreationofa storycardusing5-6personalphotographs.Oncecompleted,theparticipantssharedtheircreationandpersonalstorydepictedonthecard.

Survivors responded overwhelmingly that the program was apositive,inspirationalexperience,whichprovidedenhancedlearn-ingaboutthemselves.CCMstaffreportedtheeventwasanexcep-tionalexperienceinprofessionalgrowth.CCMstaffcompletedafivequestionevaluationscoredonanominalscale(stronglyagree,agree,disagree,stronglydisagree.Allstronglyagreedtheprogramgave them inspiration about cancer survivorship. Eighty percentstronglyagreedand20%agreedtheprograma)wasapositiveex-perience, b) helped them learn about cancer survivors and theirexperiences,andc)gaveinsightthatwillhelpincaringforcancersurvivors.

These results demonstrated the beneficial contributions a scrap-bookingandstorytellingprogramhastooffersurvivorsandstaff.Based on these results, future directions include incorporating anoutcomeorientedstorytellingfocus.Thiswillincludereflectionandmindfulidentificationofthemeaningorvalueofphotographtopicsfollowed by a self assessment of the change in meaning or valuesincecompletingtreatment.Thisprogramcanbeadaptedforusebyanypatient/supportpersonpopulationwithachronicorlifethreaten-ingillness.

2396LIGHTS, CAMERA, ACTION! ENHANCING EDUCATION THROUGHVIDEO. Diedra Frantz, RN, BSN, OCN®, and Josephine Visser, RN,BSN,OCN®,H.LeeMoffittCancerCenter,Tampa,FL.

Beginning chemotherapy can be overwhelming for patients andfamilies.Adequateknowledgeempowerspatientsduringthisdiffi-culttime.OurInfusionCenter,partofalargeNCIComprehensiveCancerCenter,providessuchtreatmentformorethan3900patientsannually.Aprocessimprovementprojectrevealedthatonly73%ofourpatientsreceiveddetailedinformationabouttheirchemotherapytreatmentprior to their initial InfusionCentervisits.Furthermore,just52%could identifynamesof theagents theywere to receive.Our existing process for educating our patients included writtenmaterialsandverbalinstructions.Recognizingthatadultslearnbet-terwhenexposedtoavarietyof teachingstrategiesandhopingtoimproveour educationprocess,wedecided to add a video to ourarsenaloftools.

Findingtimetoofferqualityeducationcanbechallenginginafast-paced,high-volumesetting.ThepurposeofthisabstractistopresentapatienteducationstrategydevelopedandutilizedbyourInfusionCenternursestoimprovepatient’sknowledgeoftheirtreatments.

Twonursescommittedtoimprovingthepatienteducationprocessdeveloped content for a chemotherapy video. The group workedwiththeaudiovisualteamtodevelopaproductconsistentwiththewritteninformationprovidedtopatients.Thevideocontainsgeneralinformationaboutchemotherapy,potentialsideeffects,andsymp-

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tommanagementstrategies.Presently,thevideoisinDVDformatandviewedintheInfusionCenteruponthepatient’sfirsttreatment.AfterviewingtheDVD,anursereviewsspecificinformationaboutprescribedagentsandanswersquestions.

Includingthisteachingstrategyallowsournursestofocusonspe-cific sideeffects related toan individual’schemotherapy regimen.Also,offeringavideoprovidesanotheravenueforlearningthatcanbeviewedrepeatedlybythepatient.Bothpatientsandnurseshavereportedsatisfactionutilizingthisapproach.

Ourultimategoalistoexpandthevideoprojecttoallofouroutpa-tientclinics.GivingthisinformationpriortotheinitialInfusionCen-tervisitcouldfurtherenhancetheeducationprocessforourpatients.Incorporatingavideointoinitialchemotherapyeducationservesasasuccessfulstrategytostandardizetheeducationprovidedaswellasmaximizestheeffectivenessoftimespentwiththenurse.2398EXAMINING THE RELATIONSHIPS BETWEEN CLINICAL VARIABLES,QUALITYOFLIFEANDFATIGUE INPATIENTSWITHMULTIPLEMY-ELOMA.ReanneBooker,RN,BScN,TomBakerCancerCenter/AlbertaCancerBoard,Calgary,Canada;KarinOlson,RN,PhD,FacultyofNurs-ing,UniversityofAlberta,Edmonton,Canada;andDarleneWhyte,RN,BN,TomBakerCancerCenter/AlbertaCancerBoard,Calgary,Canada.

Fatigue isoneof themost commonly reported symptoms inpa-tientswithcancerandisalmostcertaintooccuratsomepointalongtheillnesstrajectoryinpatientswithmultiplemyeloma(MM).Fa-tigueremainsamultifacetedsymptom.Althoughmostresearchhasfocusedontheroleofanemia,thereisgrowingevidencethatotherprocesses,suchasinflammation,maycontributetothedevelopmentoffatigue.Agreaterunderstandingofthepathophysiologyoffatigueinmultiplemyelomamayprovideimportantinformationaboutindi-vidualexperienceandleadtoimprovedsymptommanagementandqualityoflifeintheseindividuals.

Thepurposeof thisstudywas tobeginanexplorationoffactorsrelatedtodiseaseandtreatmentinMMthatcontributetothedevel-opmentoffatigueintheseindividuals.

Theobjectiveofthisstudywas:1)Toexamine the relationshipsbetweenclinicalvariables (hemo-

globin,serumalbumin,C-reactiveprotein),fatigueandqualityoflifeinindividualswithmultiplemyeloma.

Thereisincreasingevidencetosupportaneuroimmunologicalroleinthedevelopmentofcancerrelatedsymptoms.Forexample,over/aberrantexpressionofproinflammatorycytokineshasbeen identi-fiedasanessentialcomponentoftumorprogression/proliferation.It ishypothesized that thesesamecytokinesalsocontribute to thedevelopmentofcancerrelatedsymptomsincludingleantissueloss,poorperformancestatus,fatigueandanemia.

Furtherevaluationofthepathologyoffatiguemayleadtogreaterunderstandingofhowpatientsrespondtotherapyandcontributetothedevelopmentofnewapproachestofatiguemanagement.

Thisstudyemployedadescriptiveexploratorydesign.Fortythreepa-tientswereaccrued.InstrumentsusedtoassessqualityoflifeincludedtheEORTC-QLQ-C30andMY24(amyelomaspecificQOLmodule).FatiguewasassessedusingtheFACT-F.Dataanalysisincludedbasicdescriptivestatistics,simplelinearregressionandmultipleregression.

Preliminarydataanalysisrevealsnegativecorrelationsbetweenhe-moglobinandCRP,albuminandCRPandQOLandCRP.Thissug-gestsapossibleroleforinflammationinthedevelopmentofcancerrelatedfatigueandQOL.Thesefindingssupporttheneedforfurtherresearchintothemechanismsunderlyingcancerrelatedfatiguewiththe greater goal of improving symptom management and patientqualityoflife.

2400THE“VIPPROGRAMOFHUNTERDONCOUNTY”:ANEDUCATIONALPROGRAMFORWOMENAGE65ANDOLDERAIMEDAT IMPROV-ING THE RATES OF ANNUAL SCREENING MAMMOGRAMS. MaryVecchio,RN,MSN,ANP-C,OCN®,JacquelineAllen,RN,MSN,CNS,AOCN®,PamelaVlahakis,RN,AudreyVitolins,LCSW,andMaryRiley,HunterdonMedicalCenterFoundation,Flemington,AL;andSuzanneHornbeck,CentralandSouthJerseyAffiliateoftheSusanG.KomenBreastCancerFoundation,Lawrenceville,NJ.

InHunterdonCounty,46%ofwomenonMedicare reportednothavingascreeningmammogramduringthepast12months.Recom-mendationsfromtherecentNewJerseyNeedsAssessmentReportinclude“expandedoutreacheffortsforcancereducation,screening,andtreatmentservicesinadditiontoformingpartnershipswithorga-nizationscapableofprovidingeducationontheimportanceofcan-cerpreventionandscreening”.Oncologynursesserveasavaluableresourcetoprovideeducationtothistargetpopulation.

Thepurposeofthisprogramistoeducatewomenontheincreasingvalueofascreeningmammogramastheygetolderandtoidentifybarriers that may be prohibiting women from obtaining a screen-ingmammogram.IncorporationoftheaspectsoftheHealthBeliefModelsupportstheframeworkofthisprogram.

Thisprogramwillbeintroducedtoorganizationswhosemember-shipsreflectthetargetpopulation.Surveyswillbeissuedtoattend-eestoidentifybarriersforobtainingmammograms.Individualswhohavenotobtainedamammograminthepast12monthswillbecoun-seledontheprocedureandlocationstoreceiveone.Apre-addressedpostcardwillbeusedtotrackscreeningcompletion.Apeersupport“ambassador”within theorganizationwill assist theparticipant ifnecessary.

The goal of this program is to build upon the strong reputationofpersonalizedcarethatisfirmlyestablishedwithinthecultureoftheHunterdonRegionalCancerCenter.Measurableobjectives in-clude theestablishmentofcommunitypartnershipsand increasingthe number of women 65 and older who receive screening mam-mograms.

Designersofthisprogramhopetoidentifybarriersthatanolderwoman must overcome in order to obtain a screening mammo-gram.Validationof the importanceof this identification and tar-geted education may encourage nurses (as educators) to expandbeyond breast health to improve population screening behaviorsforotherhealthconditions.Auniqueaspectofthisprogramistheutilizationofapeersupport“ambassador”toassisttheparticipantsinfollowingthroughwithobtainingamammogramoncetheedu-cationalprogramiscompleted.Theresultsoftheon-goingsurveymayidentifyunknownbarriers.Thetrackingsystemmayprovidedatatomammographysitesthatmayinfluenceachangeinorgani-zationalpolicy.

2401CLINICAL RESEARCH NURSES CLIMBING TO NEW HEIGHTS: DE-VELOPMENTOFANADVANCEMENTLADDER.ElizabethVaughn,RN,MS,OCN®,SheilaFerrall,RN,MS,AOCN®,CatieWiernasz,MSN,FNP,LuzDiez,RN,BSN,ChristineSimonelli,RN,BS,OCN®, andLeticiaTetteh,RN,BSN,H.LeeMoffittCancerCenter&ResearchInstitute,Tampa,FL.

Clinical researchnurses (CRN’s) possess comprehensiveknowl-edgeof diseaseprocesses aswell as protocol requirements.Serv-ingasliaisonsbetweeninvestigators,careproviders,regulatorystaffandsponsors,theycoordinateallaspectsofcarerelatedtothepro-tocol.CRN’satourinstitution,whilefacedwithchallengingroles,expressedfrustrationattheirinabilitytogrowprofessionally.Other

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nurses are recognized for developing expertise in their specialtiesthrough Clinical Ladder advancement which was not availabletoCRN’s.Lackofopportunity for advancement, coupledwithnoformalmeansof recognition for thespecialtyof researchnursing,contributedtothelossofhighly-skilledresearchstaffanddifficultyattractingnewnurses.

Theliteratureestimatesthecostofnurseturnovertobe0.75to2.0timesthedepartingnurse’ssalary.ThelossofCRN’s,eveniftheytransferwithin the institution, results infinancialandproductivitylosses, requiring significant investment to orient new nurses. ThepurposeofthisprojectwastoimproveretentionofCRN’sthroughdevelopmentofaformalizedprogramforadvancement.

With support of research management, a team of CRN’s met todiscussandformulatethenecessaryelementsoftheproposedlad-der.TwoCRN’sbecamemembersof the existingClinicalLadderCommitteeandpresentedtheproposal.Researchmanagementcol-laboratedwithHumanResourcestoevaluate,redefine,andupdatetheResearchNursingJobdescriptions,expandingCRNrolesfromonetofivetomirrortheClinicalLadder.Finally,researchmanage-mentworkedwiththecompensationdepartmenttoplaceeachCRNintotheappropriatenewlevelandaddresspayequity.

TheCRNcomponentwasintegratedintotheexistingClinicalLad-derPrograminMay2006.AllCRN’sreceivedsalaryadjustmentscommensurate to their experience.Approximately 20% of CRN’shaveadvancedsinceintegrationandothersaremakingapplication.Ourrecruiterdiscussesthisexcitingprospectwithpotentialcandi-dates. Experienced CRN’s report feeling “re-energized” and “in-spired”bytheopportunitythispresents.

ThisprocessservestorecognizeandrewardCRN’swhodemon-strateexcellenceinnursingpractice,leadership,andachievementintheclinicalresearchoncologysettingthroughpromotionandsalaryadvancement.We anticipate turnover statistics to demonstrate im-provedretentionamongCRN’swithimplementationofthisexcitingprogram.

2402DEVELOPMENTOFANURSINGALGORITHMFORPALLIATIVESEDA-TIONUSINGEVIDENCEBASEDPRACTICE.PatriciaEwert-Flannagan,MSN,BA,ARNP,BC,CNS,andJulietaFajardo,RN,BSN,UniversityofTexasM.D.AndersonCancerCenter,Houston,TX.

Palliativesedationisaneffectivesymptomcontrolstrategyforpa-tientswhosufferfromintractablesymptomsattheendoflife.Stud-iesfocusingonnursingcareduringpalliativesedationarelimited.Inordertominimizepracticevariationinpalliativesedationwithinthepalliativecareunit,anursingalgorithmwasdevelopedusingevi-dencebasedpracticeprinciples.

Theaimofthisprojectwastoverifyaclinicallyusefultooltoassessthelevelofconsciousnessandagitationinpatients.Thetoolcouldassistinthedeterminationofsedationtherapy,improvecommunica-tionamonghealthcareprovidersandprovidenursingautonomyinmedicationtitrationasthepatient’ssedationlevelneedschange.

Usingavailableevidencefromliterature,TheRichmondAgitationSedationScale(RASS)whichhasapositivetonegativenumericalscalewasassessedforapplicabilityfordevelopmentofthenursingalgorithm.AliteraturesearchwasconductedtoattaininformationonwhichpopulationswerevalidandspecifictotheRASS.Literaturesynthesisrevealedthepopulationsweresimilartopalliativepatientspriortostartingsedation.Toimprovedocumentationofassessmentandmedicationtitrationapalliativesedationflowsheetwascreatedandpilotedontheunit.

TheproposedalgorithmwaspresentedtotheinstitutionsEvidenceBasedRegisteredNurseProgram.TheAlgorithmwaspresentedat

a unit interdisciplinary meeting and was reviewed by the medicaldirector.FeedbackfromthePhysiciansandnurseshelpeddevelopthe final algorithm.The process of developing this algorithm andoutcomeswillbepresentedattheONSCongress.

Developing best practice in palliative sedation also built a com-monbondand languagebetweenphysicians andnurses regardingthepracticeofpalliativesedation.2405THE SOCIAL COGNITIVE TRANSITION MODEL (SCTM): A FRAME-WORK FOR UNDERSTANDING THE RELATIONSHIP OF LOCUS OFCONTROL,DISPOSITIONALOPTIMISM,ANDMEANINGINLIFETOSPIRITUAL/RELIGIOUSOUTCOMES.JudySchreiber,RN,MSN,Uni-versityofKentucky,Lexington,KY.

Manytheoriesandmodelshaveattemptedtoexplainthemecha-nismsofpsychologicaladjustmenttostress.Brennanhasproposedanewmodel, theSCTMintegrating theStressandCopingModel(SCM)byLazarus andFolkmanand theSocialCognitiveTheory(SCT)tocomprehensivelyexplainpsychologicaladjustmentwithinanindividual’sworldview.TheSCTMhasbeendevelopedtoincor-poratetheconceptsofthereciprocalinteractionofthepersonwiththeir environment, thepsychosocialdeterminantsofbehavior, andcopingbehaviorasproposedbytheSCTandtheSCM.

The2005ONSResearchAgendafocusesonpsychosocialandbe-havioral issues of the individual and family during treatment andsurvivorship.Thepurposeoftheproposedstudyistoexaminethedirectionalityoftherelationshipsoflocusofcontrol,dispositionaloptimism,meaning in life,andspiritual/religiousoutcomeswithintheSCTMframework.Understanding thisdirectionalitymaywellpresentthemeanstodevelopuseful,tailorededucationalmaterialsand interventions thatworkwithingeneral categoriesof cognitivemaps.Materialspresentedinaformatcompatiblewithaparticularcognitivemapcategorywouldtheoreticallybemoreeffectiveasitwouldfitwithcorrespondwithcoreassumptions.Theappraisaloftheexperienceoreventasconfirmingordisconfirmingtheindivid-ual’sexpectationsandtheresultantstrengtheningoradjustingofas-sumptionsmayprovetobeastrongerinfluenceonadjustmentthantheparticularcopingstyleemployed.

Theconceptsoflocusofcontrolanddispositionaloptimismbothincludetheideaofexpectation,theprimarypremiseoftheSCTM.Assisting someone to adjust to adjust to new circumstances isgroundedinunderstandingkeyfactorsthat influencethedevelop-ment of assumptions that form their mental model of the world.Fundamental beliefs that underlie core assumptions are often in-fluencedbypersonalitytraitsthatformthelensthroughwhichoneviewstheworld.Attributionofpowertointernalorexternalsourcesthatinfluencelifeeventsorbehaviorsisastrongbasisforassump-tionsandexpectations.Therefore,locusofcontrolispositedastheprimarycausalfactorinspiritual/religiousoutcomes.Dispositionaloptimismandmeaning in lifehavebeencorrelatedwith locusofcontrol but rarely is examined as a mediator or moderator in therelationship.

2407ONS/NBNAHPVANDCERVICALCANCERINITIATIVE.JacquelinHol-land,RNC,CRNP,andIleneComeras,RN,OCN®,OhioStateUniver-sityMedicalCenter,Columbus,OH;BertieFord,RN,MS,AOCN®,No-vartis,Columbus,OH;andDeborahDawson,RN,MS,TeresaRoblee,RN, and Mercy Ovuworie, RN, MBA, Ohio State University MedicalCenter,Columbus,OH.

Cervicalcancer is the11thmostcommoncanceramongwomenin theUnitedStates.TheAmericanCancerSocietyestimated that

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in2005therewere10,370newcasesofcervicalcancerdiagnosedintheUnitedStatesand3,710womendiedfromthedisease.Vac-cinesforthisdiseasearenowavailable.Thedistributionandadmin-istration of this vaccine before sexual activity occurs will preventthousandsofinfectionsanddeaths.Allhealthcareproviders,policymakers,thepublic,patients,andthepressshouldbeinvolvedinthedisseminationofthisinformation.

Thegoalofthisprogramwastoeducatethestaffofahospitalre-sponsiblefortheeducationandcareofchildrenandtheirparentsinanefforttoraiseawarenessanddiscussionoftheHPVvaccineandits’implications.Location:PatientCareServicesEducationGrandRounds-Children’sHospital,Columbus,Ohio.

TheuseofGrandRoundsforthisprogramwasinitiatedbytheDi-rectorofPatientCareServicesEducation.Theaudienceconsistedofhealthcareprovidersforvariousdisciplines.ThepresentationteamconsistedoffourmembersoftheNationalBlackNursesAssociationandsixmembersoftheOncologyNursingSociety.Threemembersoftheteamservewithbothorganizations.

Followingapowerpointpresentationawrittenevaluationwaspro-vided to the participants.The three objectives identified were de-scribedasmetbyallparticipantscompletingtheform.Participantswereabletodiscusssigns,symptoms,riskfactorsforcervicalcan-cer;identifyroleofHPVincervicalcancerandtoidentifyavailablevaccines.Animportantquestionontheevaluationaskedwhethertheeducationalactivity influencedyourattitude-allparticipantsgaveanaffirmativeanswer.SupportiveliteraturewasprovidedbyMerckandCompany,Inc.,theAmericanCancerSociety,ETRAssociatesandtheNationalCancerInstitute

Thisprogramresultedin increasedknowledgeonthepartof theoncologynursespresentingtheprogramastheylearnedtheprotocolforvaccineuseatthehospital.Thehospitalstaffreceivedvaluableinformationregardingprovisionofmedicalcareandvaccinationforuninsured along with available resources.This program would beapplicableasaprofessionalpresentationtoanyaudienceinvolvedinthehealthofchildrenaswellascancerprevention.

2408PSYCHOLOGICALSYMPTOMSINWOMENWITHBREASTCANCER.NicoleVaughan-Adams,RN,MSN,OCN®,M.D.AndersonCancerCen-ter,Houston,TX.

Breastcanceristhemostfrequentlydiagnosedcancerinwomenandremainsthe2ndleadingcauseofdeathamongwomen.Thedi-agnosisofbreastcancercanleadtosignificantemotionaldistress,whichmaydevelopintoorexacerbatesymptomsofdepressionandothermooddisorders.Significantdistresscanimpactanindividual’sdecisiontoseekmedicaltreatmentandfollowthroughvarioustreat-mentmodalities.Literatureidentifiesriskfactorstothedevelopmentofanxietyanddepressionafterreceivingthediagnosisofbreastcan-cer.

Thepurposeistoexaminetherelationshipofbreastcancer,psy-chologicalsymptomsandage.

The grounded theory was used to compare data and to find if asignificantrelationshipexisted.

Thestudyanalyzeddataretrievedfromthe2003NationalHealthInterviewSurveyAdultDataset.Womenwho responded, “yes” to“haveyoueverbeentoldyouhavecancer?”n=1313,werecomparedtoindividualswhomentioned,“breastcancer”asthekindofcancer,n=408.Psychologicalsymptomswerethemeasurementoffeelingsexperiencedover30days.Thesefeelingsweresadness,restlessness,hopelessness,worthlessness, fatigue,andpresenceof feelings thatinterferedwithlife.Twoagegroupsweredefined,18–49and50–85.StatisticalanalysisutilizedtheMann-WhitneyUtesttoidentifythe

significant differencesbetween individualswithbreast cancer andbetweenagegroups

Women with breast cancer experienced a significant amount ofrestlessness,worthlessness,fatigue,sadness,hopelessness,andner-vousness (p<.05).A significant difference exists when comparingyoungerandolderwomen.Youngerwomenexperiencesignificantamountsofhopelessness,worthlessness,nervousness,andrestless-ness(p<.05).Womenwithbreastcancerexperiencesymptomsthatserve as risk factors for developing depression and anxiety. Theanalysisdeterminedagreaterdifferencebetweenbreastcancer,rest-lessness,worthlessness,andfatiguewhencomparedtoallcancers.Theresultsaresupportedbytheliterature.Youngerwomentendtoexperiencemorenervousness,hopelessness,andworthlessness.Thisfinding is significant, although limited by the number of youngerwomeninterviewedinthesurvey(ages18-49,n=41,ages50–85,n=367).Furtherresearchincludingalargersamplesizeofwomenoverage50isneededtodiscusstherelationshipofageandpsycho-logicalsymptoms.

2410ENHANCING PATIENT ASSESSMENT, CARE AND DOCUMENTA-TION THROUGH TECHNOLOGY. Alexandra Stolfi, RN, MBA, OCN®,AdvancedMedicalSpecialties,Miami, FL;GretaDudley,RN,OCN®,CentralGeorgiaCancerCare,PC,Macon,GA;andKelleyMoore,RN,andGinaJohnson,MSN,ARNP,BC,SupportiveOncologyServices,Inc.,Memphis,TN.

Thereisanationaleffortinboththeprivateandpublicsectorstodefinequalitycancercare.Inaddition,medicalcarecontinuestobeimpactedbyadvancesintechnology.Nursesneedtostayabreastinthese areas as the implications derived from defining quality careandanytechnologyimplementedwillinevitablyimpactthenursingrole.

Thepurposeof this abstract is three-fold.First,keyelementsofqualitypatientcareinoncologywillbedefined.Second,theneedsandchallengesthatcommunityoncologypracticesfaceinattempt-ingtodeliveryefficientqualitycarewillbediscussedandspecificexamples from our clinical experience will be shared. Lastly, anexampleof technologysolutionusedinclinicalpracticetodeliveroptimal,efficient,well-documentedcareandeducationwillbepro-vided.

Wewilldescribethekeyelementsthatencompassqualitycareandoutcomesforoncologypatients,withaparticularfocusonneedsandchallengesinoncologypracticetoachievetheseoutcomes.Specialattentionwillbepaid toassessmentandeducationofpatients, theneedfordocumentation,pertinentclinicaldata,practiceefficiencyand how technology solutions may contribute to achieving thesegoals. Patient-reported symptom assessment and the exchange ofinformationfrompatienttonurseandproviderwillbehighlighted.Arevolutionarytechnologysystemcurrentlybeingutilizedinclini-calpracticetoaddressthesecomponentswillbedescribedanddis-cussedindetail.Enhancednursingstrategiesforuseoftechnologytoachieveoptimalpatientoutcomesandeducationwithsupportingdocumentationwillbediscussed.

Nursesarebetterabletoidentifyandattendtosymptommanage-mentwiththeuseofatechnologybasedpatientself-assessmenttool.Inaddition,technologymaymakeeducationalinterventionsandap-propriatemanagementdecisionsmoreefficientandeffective.

Nursesneedtobeawarethattheimplicationsfordefiningqualitycarewillaffectthem.Nursesneedtoactivelyparticipateindefiningthequalitycareconceptandtheirroleinit.Asclinicians,nurseswilllikelybeend-usersofclinicaltechnologiesandcanusethemtoim-provepracticeefficiencyandstrivetowardbetterpatientoutcomes.

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2411ADESCRIPTIONOFNAUSEAANDVOMITINGDURINGTHEPERI-HE-MATOPOETICTRANSPLANTPERIODUSINGARESEARCHASSESS-MENT TOOL MODIFIED FOR CLINICAL USE. Tracy Douglas, MSN,RN, OCN®, Sidney Kimmel Comprehensive Cancer Center at JohnsHopkins,Baltimore,MD.

Patients undergoing hematopoetic stem cell transplant (HSCT)haveacuteanddelayedchemotherapyinducednauseaandvomiting;nauseaandvomitingrelatedtoothermedications,graftversushostdisease,andinfectionsthroughouttheperi-HSCTperiod.Healthcareprovidersunderestimatenauseaandvomitingandevenlowamountsareassociatedwithadecreasedqualityoflifeinpatientswithcancer.The amount of emesis can be documented however that does notaccountfornauseaanddistressfromthesesymptoms.Overthelastfiveyearsnauseaandvomitingatourcomprehensivecancercenterhasbeenaccessedusingaresearchtoolcalled,“TheIndexofNauseaandVomiting, andRetching” (INV-2) scaledeveloped in1999byVernaRhodes.Thecategoryofretchingwasremovedfromthetool,leavinga16pointmaximumscale;accessingnausea,vomiting,anda patient’s distress to both of theses symptoms on a zero to four,scale.Wehaveusedthisscaleclinicallytodeterminetheneedforachangeinclinicalmanagementifthepatienthasascoreoffourorgreater.

ThepurposeofthisprojectistoanalyzequantifiableandobjectivenursingassessmentdatafromamodifiedINV-2scale.ThemodifiedINV-2scoredatawasminedfordailyscoresfrom13patientsunder-goingallogeneicHSCT.

Nurseshadbetter than80%complianceusing this toolCINViscontrolled,with0percentofpatientswithanINV-2>4.However,fromthedayoftransplanttoday22,30%-70%ofpatientshadanINV-2score>4.Thedatashowthatnauseaandvomitingrelatedtothedelayedeffectsofchemotherapy,othermedications, infectionsandunknownfactorsremainalargeproblemintheperi-HSCTpe-riod.

Oneobstacletoconductingperformanceimprovementorresearchinaclinicalareaisobtainmentofconsistentandquantifiabledata.ThemodifiedINV-2hasbeenusedforfiveyearswithgoodcompli-ance.Ourexperienceswiththisscalewillhelpusbetterunderstandnausea and vomiting in our population, improve clinical care andpartnerwithmedicalandpharmacycolleaguesforperformanceim-provementorpotentiallyresearch.

2413IMPLEMENTING RELATIONSHIP-BASED CARE IN A COMPREHEN-SIVECANCERCENTER.JoAnnMaklebust,MSN,APRN-BC,AOCN®,FAAN,andSusanneSuchy,MSN,RN,AOCNS,KarmanosCancerCen-ter,Detroit,MI.

In2005,aComprehensiveCancerCenter’sChiefNursingOfficerchargedtheOncologyNursePracticeCommitteewithidentifyinganursingcaredeliverymodel.After leadershipmembersattendedaconferenceonNursingCareDeliveryModels,theywereinspiredtodeliverprofessionalnursingcare.Inapresentationtonursingleader-ship conference attendees suggested thatRelationship-BasedCare(RBC)beadopted.

RBC promotes organizational health resulting in positive out-comesinallcriticalarenasthatmeasuresuccess.RBCiscomprisedofthreecriticalrelationships:thecareprovider’srelationshipwithpatients and families, self and colleagues.When compassion andcare are conveyed through touch, a kind act, through competentclinicalinterventions,throughlisteningandseekingtounderstandtheother’sexperience,ahealingrelationshipiscreated.ThisistheheartofRBC.

Thefocusofthe2006nursepracticeretreatwasRBC.Eachnurs-ingunitwasaskedtocreateateamofregisterednurses(RNs)rep-resenting all three shifts. Each team was assigned a chapter fromRelationship-BasedCare:AModelforTransformingPractice.Theteams read, discussed and developed a power point presentationhighlightingmajorthemes.Theychosemomentsofexcellencefromtheendoftheirchaptertoengagetheaudience.

Nursing staff job descriptions were re-written to reflect caringbehaviors.Whiteboardswereplacedat thebedsidewith theday’sassigned RN and support staff listed. Nurses sat with patients toestablish mutual patient daily goals which were recorded on thewhiteboards.Shiftreportwasredesignedtoincludecommunicationofpatient’sgoalsandpatientpreferences.PostersdepictingmajorconceptsofRBCwere illustratedwithphotographsof thenursingstaff. Formal continuing education presentations of the RBC con-ceptsweregivenweeklyforstaffdevelopment.

Evidenceofsuccesstodateisreflectedby:mutualpatientgoalsonthewhiteboards,nursingroundswithpatientinterviews,nursessit-tingwithpatientsatthebedsideaftershiftreport,shiftreportfocusedonnursingratherthanmedicalcareonly,andimprovedsatisfactionwithnursingcareaccordingtoPressGaneyscores.

Future implementation of RBC will include Primary Nursing.Implementinganursingcaredeliverymodelwithachangeininsti-tutionalculturerequiresenergyandtime.

2414UP-AND-COMINGLEADERSHIP:THEROLEOFTHECLINICALCARECOORDINATOR. Regina Smith, RN, BSN, OCN®, and Oguna Taylor,RN,BSN,OCN®,M.D.AndersonCancerCenter,Houston,TX.

Ambulatory nurses have been assigned various roles within theclinicalsetting.Thetraditionalroleforstaffnurseshasincludeddi-rectpatientcareproviders,diseaseprocessexperts,andtheabilitytofunctionindependentlywithintheclinicalsetting.Anadditionalrolehasbeendevelopedwithintheambulatoryclinics—ClinicalCareCoordinator.This roleprovidesamodel todisplay leadershipandfurtherstaffdevelopmentwithintheambulatorysetting.

Accordingtoarecentliteraturereview,primarycarenursingshouldallownursestoleadbyexampleinordertoutilizethecurrentworkforcemoreeffectively.TheClinicalCareCoordinatorwilldemon-strateleadershipwithintheclinicalsetting.

TheroleoftheClinicalCareCoordinatorhasbeenutilizedwithinoneambulatorysettingwithaprimaryfocusoneducation.Theman-agementteamworkedwiththenursinginstructortoprovidenurse-led in-services,monthlyquizzesand liaison forpatienteducation.Additionaleducationalsupportwasprovidedbythenursinginstruc-torforcontinuingeducationcredits.Thisprocessprovidesforeffec-tiveteachingstrategiesandinterdepartmentalfeedback.

One of challenges in nursing is limitation for advancement andthisrolemayaddressthislimitation.Overasixmonthperiod,theroleofClinicalCareCoordinatorhasgreatlyimpactededucationaladvancement.This has been demonstrated through the orientationofnewnurses,in-servicesandclinicalcompetencies.Thisrolecon-tributestoadvancedleadershipwithintheclinicandpromotesadualrole,forclinicalleadershipandmanagementsupport.

Ongoing feedback will evaluate this role and provide continuedsupportforthisrolewithintheclinicalsetting.Thefindingsfromthisleadershipinitiativewillinspireotherambulatoryclinicstocarveoutthisroleandbetterutilizationwithintheworkforce.

2417EVIDENCE-BASEDPRACTICE:ISITWORTHTHEEXTRATWODOL-LARS?CherylHuang,RN,MS,AOCN®,KimberlyCatania,RN,MSN,

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AOCN®,CNS,HeidiBasinger,RN,BSN,andMichelinaBensman,RN,MS, Ohio State University Medical Center–James Cancer Hospital,Columbus,OH.

Multiplebloodproductsaretransfusedonadailybasisininpatientandoutpatientareasofthehospital.Nursesexpressedconcernwithincompleteordifficulttransfusionsbygravityadministrationwhichresultedinincreasednursingtimeandexpenseaswellasdecreasedanecdotalpatientsatisfactionwithlongstaysintheoutpatientareastocompletetransfusions.

The goal of nursing staff was to change practice to decrease oreliminate theseproblemsbychanging theadministrationofbloodproductsfromgravitydriptotransfusionbyinfusionpump.

Aliteraturereviewindicatedverylittlecurrentresearchwithmoststudies completed in the 1980’s. Results of the studies found noclinicallysignificanteffectsonbloodcellswhentransfusedbyin-fusionpump.Theadvantagesof infusionpumptransfusionscitedintheliteraturewerecontrolledflowanddecreasedproductwaste.Thecurrentvendor for the infusionpumpsutilized in the institu-tionprovidedresearchresultsthatsupportedtheuseofthepumps.Newtubingwastheonlyequipmentrequirementtoimplementingthe change.Benchmarkingwith similar institutions revealedbothmethodsoftransfusionwereutilized.Approvalforpracticechangewas sought and received from three major practice committees.Oncenewtubingwasobtainedthechangecouldbeimplemented;however,thetubingcosttwodollarsmorethancurrenttubingused,translating to a large increase in cost for the health system.Ap-provalforsuchanincreasewasrequiredfromanothercommittee,butwasnotgrantedas theevidenceprovideddidnot support thecostincrease.

The focus of the study needed to change to why pumps shouldbe used. New data was collected over the ensuing three monthswhichexaminedcostsrelatedtomissedorincompletetransfusionsand nursing time invested in difficult transfusions.The cost, over$60,000supportedthechangewhichresultedinanecdotalincreasesinpatientandstaffsatisfactionandnofurtherindicationofincom-pleteorwastedtransfusions.

Allimpactsofpracticechangeneedtobeevaluatedintheprocessofgainingevidencesothatglitchestoimplementingchangedonotoccur.

2420BABY BOOMERS AND GENERATION X: NURSING EDUCATION BE-YONDTHECOMPUTER.ReginaSmith,RN,BSN,andBettyHunter,RN,MA,BSN,OCN®,M.D.AndersonCancerCenter,Houston,TX.

The emerging nursing workforce has different values, learningstyles,andanticipatedoutcomes.Technologyhasmovedustoman-datory coexistence.Thiswill challenge current teaching strategiesandtheireffectiveness.Designatedcurriculumcommitteesarebeingutilizedtoformallyintegratelecturesandcomputerbasedtraining.

RecenteducationalstudieshaveexaminedthelearningstylesoftheBabyBoomerversusGenerationXagegroupswithinclinicalnurs-ing.Duringnursingorientationallnewnursesare trained throughdidacticlecturesandcomputerbasedtraining.BabyBoomershavealove-haterelationshipwithtechnologyandgenerallydowhattheyaretold.GenerationXgrewupwithcomputersandviewtechnologyasatimesavingtool.

Theaim is tocompare theeffectivenessof re-trainingstaffwithlimited computer skills and staff accustomed to didactic lectures.Thisprocesswasevaluatedbycomputeronanongoingbasis.

During a six month evaluation, learning styles between the twogenerations, effective teaching and learning strategies were intro-ducedthroughtechnologybasededucation.Feedbackwasreceived

fromtheneworienteerthroughanonlinesurveytool.Thecomputerprovidedastepbystepprocedureandselfpacedprogram.

Lecturestylesareprimarilypowerpointandindividualspeakers.Thisallowsforpersonalinteraction—manyneedmorethansome-onereadingaparticularslidepresentation.

Tomeasure theoverall effectivenessof theprogram,weofferedonlineevaluationsinordertoprovidefeedback.Evaluationthere-sponsesbasedondifferentgeneration,learningstylesandpriorcom-puter training.Additional trainingandongoing teaching strategieswillrequireadditionalstaffwithtechnologybackgrounds.

Inconclusionwenotedaneed tocontinueacombinationof thetwo lecture styles, while further evaluation of generational differ-encewillneedtobeevaluated.Thisdevelopmentandeffectivenessof teaching alone does not integrated computer technology as theprimaryteachingsource.

Furtheradvancementintechnologywillcausecurriculumstoin-creasecollaboration,criticalthinkingandproblemsolvingthroughtheuseofthecomputer.

2425DASHBOARDS: A TOOL TO DEMONSTRATE THE IMPACT OF THEADVANCED PRACTICE NURSE IN THE HOSPITAL SETTING. ElaineGriffin,MSc(A),RN,AOCN®,SuzanneStaebler,RN,MSN,RNC,NNP,KarenMuery,RN,MSN,CNS,PhyllisMcCorstin,RN,MSN,CCRN,CNS,andLindaHarrington,PhD,RN,CNS,CPHQ,PresbyterianHos-pitalofPlano,Plano,TX.

Thecontributionsoftheadvancedpracticenurse(APN)toanin-stitutionareoftenanenigmatoadministratorsandothers.“What’sa CNS/APN do?” is a common question, and the inability to an-swerthisintermsofinstitutionalvalueleadstheAPNtobesaddledwith low-value tasks such as mandatory training. Dashboards areonetooltoaddressthisquestion.Anadministrativemetricusedtotrackfinancialandqualityperformance,dashboardscanbeadaptedtopresentthestrategiesandoutcomesachievedbytheAPN.ItisaninvaluabletooltodemonstratetheAPN’svaluetoaninstitution.

TheAPNroleincreasesinvaluewhentheirresponsibilitiescon-tributetodepartmentalandinstitutionalstrategicgoals.Articulatingthese contributions is easiest when tied to measurable outcomes.ThisabstractdemonstrateshowdashboardscanbeusedtoidentifymeasurableresultsandpresentthemtootherssothattheimpactofAPNpracticecanbedemonstrated.

TheAPNshouldfirstidentifythestrategicgoalsoftheinstitution,service, and department. APN tasks, projects, and processes areidentifiedandlinkedtothestrategicgoalstheysupport.Measurableoutcomescanbederivedfromthedesiredgoalsofspecificprocess-es.Forexample, thesuccessofaneducationprogramdesigned toreduce infection risk inneutropenicpatients ismeasured in termsofhospitaladmissionsforinfection.Wheneverpossible,dataisob-tainedfromexistingsources.Timeframesforreportingdatashouldberealisticandreflectthedatacollectionprocess.

Wehave found thatdashboardshavehelpedus to identifynurs-ing-sensitiveoutcomesimpactedbyAPNpractice.ThisinturnhashelpedustoarticulateexactlyhowourAPNrolessupportthestrate-gicgoalsoftheinstitution.Responsefromadministratorshasbeenvery positive. There is evidence that our dashboards have helpedsomeofustogainsupportforre-prioritizingtimeandresourcestosupportclinicalprojects.Accesstodatahasimprovedovertimeaswehavedemonstrateditsutilityinsupportingstrategicgoals.

DashboardsprovideameansforAPNstoorganizeandarticulatetheirpracticeandhowitlinkstonursing-sensitiveoutcomesandin-stitutionalgoals.Thisinturnhelpstogainandmaintainadministra-tivesupportforAPNsasvaluedmembersoftheinstitution.

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2426MAKING CHANGES: MEETING KNOWLEDGE AND COMPETENCYNEEDS OF PEDIATRIC NURSES. Ellen Carroll, BSN, RN, and MyraWoolery, MN, RN, CPON®, National Institutes of Health, Bethesda,MD.

Theintegrationofnurseswithavarietyofexpertisefromtwosepa-rateinpatientunitsintoacombined25bedpediatricunitposesmanychallengesandcanbeanxietyprovokingforsomestaff.Onepedi-atricunitspecializedinthecareofhematology/oncology/transplantpatientsaswellaspatientswithavarietyof immunedeficiencies;whilethesecondunitcaredmainlyforpatientswithchronicpedi-atricconditions/diseases(i.e.endocrine,neurological,andgenetic).Assessment of knowledge related to disease processes and treat-ment,criticalthinkingskills,andcompetenciesneedtobepartoftheinitialplanningphase.

Thepurposeof thisprojectwas todevelopaplan for the tran-sition to a new combined unit and an ongoing evaluation of theintegration.Acarefully constructed educationalprogram that in-cludesdidacticlearning,skillvalidationthroughreturndemonstra-tion, and clinical experiences, assists in building new skills andconfidence.

Aninitialeducationalprogramdevelopedbythenursemanager,CNS, and senior staff included: in-house educational programs(i.e.oncologyandendocrinecourses),in-serviceshighlightingdis-easeprocess/treatments;reviewofexistingandnewprotocols;andcrosstrainingwhichwasaccomplishedbypairingstafffrombothunits.

After initial training, staff demonstrated basic knowledge. Overtimecompetencyproficiencyhasincreased.Aframeworkforanan-nualvalidationprogramwasdevelopedwhichincludeddidacticas-sessment,skilldemonstration,andcriticalthinkingevaluationusingdisease-specific case scenarios. Ongoing annual assessments haverevealedincreasefamiliaritywiththediversepopulationandtreat-mentprotocols.Staffverbalizedlessanxietywhencaringforaprevi-ouslyunfamiliarpopulation.

During the integration phase, it is critical to ensure adequatestaffingbemaintainedtocontinueongoingtrainingnecessaryfora successful transition. Consideration of staffing patterns shouldincludeanassessmentofskillmixasstaffincreasetheircomfortlevelwith thediversepopulationandproficiencywithnewcom-petencies. Ongoing assessments provide a mechanism for deter-miningadditionaleducationalandclinicalexperiencesneeded tokeepstaffcurrentwiththeneedsofthevariouspopulations.Oneofthemanychallengesismaintainingcompetenciesinlowfrequencyandhighriskactivities.Theplandevelopedforthetransitionhasbeenincorporatedintoourorientationprogramandannualrevali-dationprogram.

2429EDUCATIONANDCOLLABORATION: IMPLEMENTATIONOFATHO-RACIC ONCOLOGY SPECIALTY MEETING. Denise O’Rourke, RN,OCN®,andKimMertens,RN,MSN,AOCNS,MSKCC,NewYork,NY.

Themanychangesinthetreatmentandcareofthethoraciconcol-ogy patient have presented an opportunity to provide staff educa-tiontokeepnursesuptodateonthelatesttrends.Thishascreatedthe need to explore methods in which to deliver new educationalinformation.Amonthlyspecialtymeetingwasdevelopedtoprovidenursing education while strengthening collaboration among treat-mentandofficepracticenursesintheoutpatientdepartmentatthisNCIdesignatedcancercenter.

The purpose of this presentation is to make oncology nursesawareofalternatewaystopromoteeducationandencouragestaff

collaborationandcamaraderiewhileenhancingprofessionaldevel-opment.

A need for a monthly specialty meeting was identified and hasbeenorganizedbyanoutpatientofficepracticenurse.Theresponsi-bilitiestoorganizethesemeetingsincludedreservingmeetingspaceandtime,topicselectionandidentificationofapresenter.Aneedsassessmentwasdistributedtothenursingstafftoelicitinformationsuchastopicsofinterestandbestavailabledatesandtimes.Exam-plesofsometopicspresentedinclude:“UnderstandingthePathol-ogyofLungCancer”,“Bevacizumab:ANewtreatmentOptionforNonSmallCellLungCancer”,CareofthePatientwhoUndergoaVideoAssistedThoracotomy”,and“MSKCCSurvivorshipProgramImplementation”.

ThemonthlyspecialtymeetingbeganinJanuary2005.Feedbackfromnursesrevealedpositiveresultsintermsofeducationalcontent.However,frequencyofamonthlymeetingischallengingfornursesduetoothercompetingmeetings.Basedonthisfeedback, thefre-quencyofthemeetingswillbedecreasedin2007.Inaddition,newmethodsofsharinginformationarebeingexplored.Someexamplesincludedistributingeducationalcontentviae-mailandintermittentlyusingfifteenminutesofstaffmeetings todeliver information.An-other option includes conducting a journal club several times peryeartocritiqueanddiscussrelevantinformationrelatedtothecareofthelungcancerpatient.

Thethoracicspecialtymeetingprovestobeavaluablesourceofnewinformationandeducationfornursingstaff.Thispresentationwill outline the process utilized in the development of a monthlyspecialtymeeting.Thismodelcanbeusedbyalloncologynursesworkinginclinicalpractice.

2431SHARINGTHEJOURNEYOFTHEBMTPATIENTWITHONCOLOGYNURSES.MelissaDufresne,RN,OCN®,KimAyrhart,RN,TaniaCabel-lero-Pravia,RN,BSN,JohnGannon,RN,BSN,GraceMarshall,RN,OCN®,andRitaDiBiase,MSN,APRN-BC,AOCNS,KarmanosCancerCenter,Detroit,MI.

Patientsundergoingbonemarrowtransplant(BMT)requirecom-plex and skillednursing care.BMTnursepreceptors are commit-ted to educating new nurses and can also bestow their wealth ofknowledgeupontheircolleaguesbyprovidingeducationalsessions.AcomprehensiveviewofthemanychallengesthataBMTpatientfaces can give oncology nurses an understanding of the physical,emotionalandpsychosocialneedsofpatientsandfamilies.

BMTnursepreceptorswereaskedtoprovideapresentationdetail-ingelementsofthetransplantprocess.Itwasidentifiedthatoncol-ogynursesweren’talwaysawareofthefullextentofpatient’sexpe-riencepriortoenteringtheirunitorarea.Inaddition,theinpatientandoutpatientarenasseemeddisconnected.BMTnursepreceptorsplanneda formalpresentationusing the conceptofvirtual patientscenarios.

BMT nurse preceptors from sister units and the BMT Clini-calNurseSpecialistcreatedaPowerPointpresentation titled“TheJourneyofaBMTPatient:SailinginUnchartedWaters”.EntryintothecancerhospitalwastheinitialfocuswithphotographsshowingmembersoftheBMTteam.Detailedtimelines,scheduledappoint-ments,tests,psychologicalandpsychosocialevaluationwerecom-municated.Topicsdiscussedwere:autologoustransplant;allogeneictransplant;matchedunrelateddonortransplant;pheresisproceduresforeachtypeofrecipient;storageofcells;chemotherapypreparativeregimens;roleoftheBMTnurse;complications;lengthofstay;dis-chargeprocedure;andclinicfollowup.BMTnursepreceptorsem-phasizedtheimpactonpatientsandfamilies/caregivers,alongwith

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clinicalcomponents,providingnurseswithacomprehensiveviewofwhatthispatientpopulationfaces.

In response to positive feedback from the oncology preceptors,educationalsessionswereprovidedforalloncologynurseswithinthehospital.TheBMTnursesreceivedhighscoresandpraisefromtheirpeersandothercancerhospitalpersonnel.

Oncologynursescangainawealthofknowledgefromoneother.Followingthejourneyofaspecificpatientpopulationprovidesare-alisticandhumanconceptof theexperience.Oncologynursesseewhattheircolleaguesexperienceeveryday.Preceptorsusetheiredu-catorrolesnotonlytoteachorientees,butalsotoexpandcolleagues’knowledge.

2432NURSINGOPPORTUNITIESFORIMPROVINGPREVENTIONOFCHE-MOTHERAPY-INDUCEDNAUSEAANDVOMITING(CINV)THROUGHEVIDENCE-BASEDPROPHYLAXIS:EVALUATIONOFPROVIDERPER-CEPTIONS AND PARTICIPANT OUTCOMES. Sandra Purl, RN, MS,AOCN®, Oncology Specialists, S.C., Park Ridge, IL; J.J. Stark, BS,CRC, andPetraKetterl,MD,CancerTreatmentCentersofAmerica,Tulsa,OK;andAmberClaussen,RN,OCN®,HematologyMedicalOn-cologyConsultants,Davenport,IA.

Despite effective treatmentoptions forCINVand thepublica-tion of evidence-based practice (EBP) antiemetic guidelines,CINVcontinuestonegativelyimpactthelivesofpatientsunder-going moderately emetogenic chemotherapy (MEC). ResearchindicatesthatpreventionofCINVinthefirstchemotherapycyclesignificantly reduces the risk of CINV in future cycles. Nurseshavetheopportunitytoimprovepatientoutcomesthroughbetterunderstanding and use of EBP options for prevention and treat-mentofCINV.

Purpose:toassessantiemeticpracticepatternsandidentifynurs-ingopportunitiesforimprovingantiemeticcareandoutcomes.Be-tweenOctober2005andJuly2006oncologistsandoncologynursescompletedsurveystodocumentantiemeticregimensprescribedwithcommon MEC treatments, and estimated incidence rates of acuteanddelayedCINV.Nursesrecordedemeticriskfactors,cancerdiag-nosis,chemotherapyandprescribedantiemeticsforeachparticipant.Participantscompleteddailydiariesforfivedayspost-treatmenttorecord episodes of nausea and/or vomiting, use of antiemetic res-cuemedication,functionalimpactandcallsorvisitstotheprovider/practiceduetoCINV.

Although almost 80% of participants received guideline-basedprophylaxis(5-HT

3+dexamethasone±other),therewassignificant

variabilityintheapproachtoantiemetictreatmentcombinations,in-cludingantiemeticcareinconsistentwithEBP.Theactualincidenceratesofnauseaandvomitingwerenotablyhigherthantherateses-timatedbybothoncologistsandnurses,particularlydelayednausea.Although 65% of participants experienced no emesis without us-ingrescueantiemetics,60%experiencednausea,and33%reportedfunctional interference due to nausea. Of the 16% of participantswhomissedworkorasocialcommitmentforpoorlycontrollednau-sea or vomiting, just one-fourth called or visited their practice toseekhelp.

UnderstandinganduseofEBPpriortochemotherapyandthrough-out thedelayedperiod, aswell as teachingpatients aboutoptionsto alleviate CINV, remain educational opportunities for oncologynurses.ThesmallnumberofpatientswhocalledorreturnedtotheirpracticeforpoorlycontrolledCINVcomparedtothenumberwhoexperiencedsignificantdelayednauseasuggestsapossibleneedforcreativeapproachesforpatientfollow-upbeyondtheacuteperiodtoimprovepatientoutcomesandqualityoflife.

2433PREVENTION OF HEMORRHAGIC CYSTITIS: THE EVIDENCE SAYSWHAT?!TerrySylvanus,MSN,APRN,BC,AOCN®,H.LeeMoffittCan-cerCenterandResearchInstitute,Tampa,FL.

Hemorrhagiccystitisisarecognizedtoxicityofhigh-dosecyclo-phosphamideadministration,whichhistoricallyoccurredin40-70%of patients who received it without prophylaxis during condition-ingforhematopoieticstemcelltransplant(HSCT).Threedisparatetherapiesarecurrentlyusedtoprotectagainstthissignificantcom-plication:hyperhydrationwith forceddiuresis, continuousbladderirrigation, and administration of mesna, depending on transplantcenterandphysicianpreferences.

This review was designed to determine what evidence exists tosupporttheuseofeachofthreetherapeuticinterventionsdesignedtopreventhemorrhagiccystitisinHCSTpatientsreceivinghigh-doseCyclophosphamide.Analgorithmwillbedesignedtoguidetheprac-titionerintheselectionofanappropriatepreventivestrategy,basedonpatientvariables,aswellastherapeuticbenefitsandrisks.

Anexpertoncologynursereviewedpublishedguidelines,reviewsandstudiesfrom1986-2006locatedthroughPubmedusingevidencebased practice filters, and through CINAHL using relevant searchterms.Selectioncriteria for inclusion in thereviewwas limited torandomized,prospective,controlledtrialsof theefficacyofhyper-hydration,CBIormesnain thepreventionofhemorrhagiccystitisinHSCTpatients.

Availablenationalnursingandmedicalguidelines,pertinentstud-iesandreviewsweresummarizedintoanevidencetableformat,anda clinical algorithm was developed.The importance of evaluationandconsiderationofpatientvariablesandpreferencesinthedevel-opmentofevidence-basedpracticeguidelineswashighlighted.

No studies reviewedprovided sufficient evidenceas to the clearsuperiorityofanyoneofthethreetherapeuticstrategiesinpreven-tion of hemorrhagic cystitis; rather, each intervention is appropri-ateindefinedclinicalcircumstances.Useofthedevelopedclinicalalgorithmwouldencouragestandardizationof transplantprotocolsregardlessofinstitutionalandpractitionerpreferences.Thereisalsoaveryrealneedforwell-designed,randomized,controlled,interdis-ciplinaryresearchtoaddressthisissueinthispopulation.

2437INCREASING HAND HYGIENE COMPLIANCE REQUIRES CULTURECHANGE.MichelleTreon,MSN,RN,OCN®,andKristenKelley,MPH,ClarianHealthPartners, Indianapolis, IN;PatriciaKneebone,BSN,RN,OCN®,IndianaUniversitySchoolofMedicine,Indianapolis,IN;andReginaMiles,BSN,RN,OCN®,ClarianHealthPartners, India-napolis,IN.

Anestimated90,000deathsoccuryearly fromhospital-acquiredinfections.Transmissionofpathogensoftenoccursviacontaminatedhands.Handhygieneisasimpleandeffectiveinterventiontoreducethe spread of infection. Despite this common knowledge, provid-ersdisregard this intervention.Compliancebyproviderswith rec-ommended hand hygiene procedures has remained unacceptable.Onetypeofhospital-acquiredinfectionisacentralvenouscatheter(CVC) infection. Reduction by 90% would save 225,000 patientsfromexperiencingthiscomplication,and$5.63billiondollarssavednationally.

Todesignaninnovativeeducationalinterventiontoincreaseaware-nessofinfectioncontrolpractices,andincreasehandhygienecom-pliance. Interventions targeted multidisciplinary providers on theadultHematology/Oncologyunit.TheprojectwasleadbytheClini-cal Nurse Specialist, Infection Control Practitioner, and OutcomeSpecialistwithparticipationfromtheunitstaffandUnitManager.

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ALikertsurveywascreatedforstafftodeterminedegreeofcom-pliancealigningwithknowledgeofinfectioncontrol.Surveyques-tionswerewrittentoelicithonestanswersandevokeaself-assess-ment. Second, an interactive hand culturing experiment occurred.Anonymousvolunteersperformedhandhygiene,touchedcommonunit surfaces, andplaced theirhandsonbloodagarplates.Photo-graphs of the cultures and organism identification were captured.Next,aGlow-germexperimentwascompletedtovisuallyevaluatethecleanlinessofprovider’shands.Commonlymissedareasinclud-edfingernails,aroundrings,andwrists.Finally,aposterwascreatedforthehospital’snurses’weekactivities.Thepostercontainedfacts,picturesofcorrectandincorrectinfectioncontrolpractices,picturesandresultsofthehandcultureexperiment,andinformationonorga-nizationinfectioncontrolpolicies.TheposterwasalsodisplayedontheHeme/Oncunitandwithaposterpost-test.

Handhygieneobservationauditscompletedbythehospital’sinfec-tioncontrolpractitioners revealedan increase incompliance,withratesstartingat35%andendingat95%.ConcurrentlynotedwasadecreasingincidenceofCVCinfections,andanoveralldescendingtrendsinceJanuary2004.

Althoughtheprojectoverlappedwithorganizationaleducation,therateofcomplianceonthisunitsignificantlyout-pacedotherclinicalareas.Beforeaculturechangecanoccur,creativityandinnovationarecrucialforreachingsuccess.

2438A PERFORMANCE REVIEW PROJECT COMPARING TWO TRANS-PARENTDRESSINGSINRELATIONTOCATHETERRELATEDBLOODSTREAMINFECTIONSINAHEMATOLOGICMALIGNANCYANDBONEMARROW TRANSPLANT IN AND OUTPATIENT PROGRAM. TracyDouglas,RN,MSN,OCN®,AmyHatfield,PharmD,AnitaReedy,MSN,RN,SachaSimmons,BSN,RN,andSaundraJohnson,MS,RN,Sid-neyKimmelComprehensiveCancerCenteratJohnsHopkins,Balti-more,MD.

Catheter-relatedbloodstreaminfection(CRBSI)iscommonlyas-sociatedwithseriouscomplicationsresulting inconsiderablemor-bidityandmortality.Moststudiesofcatheterrelatedinfectionshavetakenplace in intensivecareunits.ManyCRBSIcome fromcon-taminationofthecatheterfromthesurroundingskin.TheCenterforDiseaseControlrecommendscatheterexitsitesbekeptdryandcov-eredwithtransparentdressingsthatarechangedeverysevendaysorwhenwetorsoiled.In2002,theintensivecareunitsatourinstitutionexaminedanewtransparentdressingandthehospitalchangedtothisdressing.The oncology staff expressed concern about an increaseinCRBSI’s;however, itwasnotevident in the inpatient infectioncontrolsurveillancedatawhichtrackspatientswhohavebeenhospi-talizedforgreaterthan48hours.

WewantedtoevaluatetheamountandtypesofoncologyCRBSI’sinboththeinpatientandoutpatientsetting.Weexaminedinfectionratesinbothsettingswithtwodifferentdressingproducts.

Duringa two-monthperiod inpatientandoutpatienthematolog-ic malignancy and bone marrow transplant patients with tunneledcatheters usingSorbaview® dressingsweremonitored for bactere-mia.Thefollowing2monthswechangedthetransparentdressingtoTegaderm®1616.

Atotalof227central lineswereassessedoverafourmonthpe-riod.Therewere11.9bacteremiasper1000catheterdayswhenSor-baView®2000wasusedand7.6bacteremiasper1000catheterdayswhen theTegaderm®1616wasused,whichwasnotastatisticallysignificantchange(pvalue=0.64).Therewere36centrallineremov-alsforsignificantbacteremiasduringtheuseofSorbaView®2000and10during theuseofTegaderm®1616,whichwasstatistically

significant(pvalue=0.001).One-halfofbacteremiasoccurredintheoutpatientsetting,andresultedinhospitaladmission.

CRBSIs rates are gathered in our hospital on all ICU patientsand oncology inpatients who meet the surveillance definition andwhohavebeeninpatientforgreaterthan48hours.Manyoncologypatientshavecentralaccessacross thecontinuumofcare,are im-munocompromised,andcarefortheirowncatheters.Itisessentialtoreviewcentrallineinfectionratesincontextofthispopulation’sspecialneeds

2439A PILOT PROJECT TO EVALUATE THE ROLE OF A PATIENT FLOWCOORDINATOR TO FACILITATE TIMELY HOSPITAL DISCHARGES.BlancaVasquez-Clarfield,RN,MA,andMaryDowling,MA,MemorialSloan-KetteringCancerCenter,NewYork,NY.

Ensuring timely patient discharges from the hospital is a multi-faceted process requiring interdisciplinary collaboration. In orderto develop a sustainable, standardized approach to improving thedischargeprocess,patientcareneedsspecifictodischargemustbeaddressedearlyduringthehospitalstay.Dischargedecisionandno-tificationarealsokeyvariablesthatmayadverselyimpactjudiciousthroughput.A teamapproachallows thePatientFlowCoordinator(PFC)toworkcloselywithalldisciplinestoensureearlyidentifica-tionandresolutionofdischargeneeds.

Administrationidentifiedtheneedtoincreasebedavailabilityear-lierinthedaytoensureearlyadmissions,andincreasepatientsat-isfaction.Inordertofacilitatethisgoal,thisNCIdesignatedcancercenterdevelopedandimplementedaPatientFlowDischargeTeam.ThismultidisciplinaryteamconsistsofanursewhoactsasthePFCandamedicationreconciliationpharmacist.

Aunitbasedpilotprojectwasconductedtoproactivelyensurethecompletion of all discharge requirements on the day prior to dis-charge.ThePFC’sroleistoreviewalldischargeneedswithalldis-ciplinesandtoworkcloselywiththemedicalstaff.ThePFCistheprimarycontactforalladmitting,dischargeandtransferissues.Themedication reconciliation pharmacist reviews patients’ medicationprofilesforaccuracy,counselsthepatientregardingadministrationofdischargemedications,andexpeditesthefillingofprescriptions.Abudgetwasallottedtoprovidepatienttransportationtohomewhenotherarrangementswerenotpossible.

The occurrence of late discharges related to transportation wasreduced by 12%, and late discharges related to a delay in fillingprescriptionswerereducedby15%.Dischargesby11amwerein-creasedby28%bytheeighthweekofthepilot.

The Patient Flow Discharge Team was created to shepherd thepatientthroughthemultiplestagesofadmissionthroughdischarge.Dischargetohomecontinuestobeacomplicatedissue,notonlyforthemedicalandnursingstaff,butforthepatientandfamilyaswell.The PFC is able to focus on the coordination of the patient flowthroughtheentirehospitalization.

2442SURVEY AND CHART REVIEW EVALUATION OF THE PATIENT AS-SESSMENT,CARE&EDUCATIONALSYSTEM.GinaJohnson,MSN,RN,SupportiveOncologyServices, Inc.,Memphis, TN; TamiMark,PhD, Thomson Medstat, Washington, DC; and Barry Fortner, PhD,SupportiveOncologyServices,Inc.,Memphis,TN.

ThePatientAssessment,Care&Education(PACE)System™wasdesignedtoaddresstheunder-identificationandtreatmentofchemo-therapy-relatedsymptoms.Itusesapen-basede/Tabletoperatingoffawirelessnetwork.ItadministersthePatientCareMonitor™(PCM),a psychometrically validated, patient-reported symptom severity

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screeningscalethatgeneratesareal-time,point-of-carereport.CancerSupportNetwork™(CSN)provideseducationalmaterials.

Theaimwastoevaluatethesystem.Ninety-twoprovidersat16clinicsweresurveyedabouttheirex-

periences.Onehundredpatientsattwoclinicsweresurveyedabouttheirperceptions.Attwoclinics100patientchartswereabstractedintheyearspriortoandafterimplementationtodetermineassess-mentrates.

The majority of patients reported being satisfied with the PCM(55%). Slightly more than half indicated that it helped them re-member symptoms (53%) and 44% said it encouraged discussionofsymptoms.91%ofrespondentssaiditwaseasytouseandread(90%).79%ofpatientswouldrecommendittoothers.

Providersseemedtovaluethereport.Themajoritythoughtitin-creasedthefrequencyforsymptomidentificationandtreatment.Al-most60%indicatedthatthePCMhelpedalotwithallowingforag-gressivesymptomtreatment,andalmost50%reportedthatithelpedthemtoaggressivelytreatunder-reportedsymptoms.

The chart results show statistically significant increases in theassessmentratesfordepression,pain,andfatigueafterimplemen-tation.Priortoimplementationofthesystemonly9%ofpatientswereassessedfordepression,ascomparedto73%afterimplemen-tation.Fatigueassessmentincreasedby29percentagepoints,from63%ofpatientsto92%.Painassessmentincreasedby21percent-agepoints, from76%ofpatients to97%.Examining sites sepa-rately revealed thatSiteAsawan increase inscreeningrates forallthreesymptoms.SiteBscreeningratesfordepressionincreasedsubstantially,buttherewasaslightdeclineinscreeningratesforfatigueandpain.

Technology offers solutions for enhanced clinical care and effi-ciency.Nursesareinarolethatwillbeexpectedtoadopttechnologyforsuchpurposes.ThePACESystem™appearstobeapromisingapproachtoaddressingthewidespreadproblemofunder-identifica-tionandunder-treatmentofsymptoms.2443CNSsCOLLABORATETOOFFERCURRENTPERSPECTIVES INON-COLOGY NURSING. Tina Mason, ARNP, MSN, AOCN®, and LornaBaker,MSN,ARNP,CCRN,OCN®,H.LeeMoffittCancerCenter&Re-searchInstitute,Tampa,FL.

Clinical Nurses Specialists (CNSs) often focus on their area ofexpertise and at times can feel isolated. Consequently, CNSs atourcancercenterlookedforateam-buildingopportunity.Workingtogether to plan an annual regional oncology nursing conferenceservedtomeetthisneed.Secondarygainsincludedenhancementofinstitutionalrecognitionandreputation.

The purpose of this abstract is to outline the processes used indesigninganannualconference,CurrentPerspectivesinOncologyNursing,includingbarriersandsuccesses.

TheCNSsoffertheconferencewithfullsupportofNursingLead-ership.Eachprogramiscarefullyplannedtohighlighttimelytopics.Nursesappreciatetheopportunitytoattendaconferenceofthiscali-berintheir“ownyard”andexternalparticipantsenjoyseeingwhatourinstitutionhastooffer.Theconferencealsoprovidesachanceforournursestoberecognizedasexpertsamongtheirpeers.TheNurs-ingLeadershipGroupconsistentlysupportsandencouragesnursingstaffparticipation.

TasksaredividedamongtheCNSs.Carefulselectionofnationally-knownexperts alongwith experienced staff topresentyieldspro-gramsthatareextremelywellreceivedbyparticipants.Preparationbeginsayearpriortotheconferenceandextendsintothepost-evalu-ationphase.Whiletheprogramdesignwaslargelytheresultofthe

effortsofthecoregroupinconjunctionwithSeniorNursingLeader-ship,thesuccessofthisendeavorrequiredthecombinedeffortsofanumberofdepartments.Duetotimeconstraints,assistancefromtheConferencePlanningDepartmenthasbecomenecessary.

Ourupcomingseventhannualconferenceisextendedtoaday-and-a-half.Attendancehasmorethendoubledsinceinception.Modestprofitshaveresulted.Evaluationsareconsistentlypositive.Ninety-sevenpercentof attendeesof the last conference rated theoverallprogramasgoodor excellent.Wecontinue to strive for increasedattendance. Collaboration with the Conference Planning depart-menthassignificantlyreducedtimecommitmentoftheCNSs.Ourprogram is enhanced by financial support of vendors and internalgrants.

This endeavor has strengthened the CNS relationship while en-hancingourinstitution’sreputationandstatureregionally.Benefitsarerealizedforbothindividualsandtheinstitution.Lessonslearnedcanbeincorporatedforsimilarprogramsinthefuture.

2444ROLE OF INPATIENT NURSES IN CLINICAL TRIALS: EMBRACINGTHECHALLENGE.AliceBoyington,RN,PhD,H.LeeMoffittCancerCenter&ResearchInstitute,Tampa,FL.

One scientific endeavor undertaken at our NCI-ComprehensiveCancerCenter is translationofbasicsciencediscoveries intoanti-cancerdrugs, furtherstudied inphaseIandIIclinical trials (CT).The Oncology Nursing Society supports that every cancer patienthastherighttoparticipateinsuchtrialsifmedicallyindicatedandthat nurses caring for thesepatients possess special knowledge inresearchandCTs.Historically,CTpatientshavereceivedtreatmentinourresearchdepartment.Arecenttrendtoadmitthemtoourin-patientunitshasnecessitatedincorporationofresearchpracticeintotheclinicalpracticeofinpatientnurses.

The purpose of this project is to design a system to ensure ef-fective communication across inpatient and research departmentsanddeliveryofhighqualitycancercareforCTpatients.ASWOT(Strengths,Weaknesses,Opportunities,andThreats)frameworkwasusedtoidentifyandanalyzefactorsinternalandexternaltothede-partments.

A team representing inpatient and research staff clarified theprojectpurposeandconductedtheSWOTanalysis.Scenarioswereused to stimulate discussion about contrasting patient situationsthat affect the quality of care. Ultimately, the categories of fac-torsthatresultedfromtheanalysisanddiscussionwerestructure,education, communication/documentation, patient identification,resourcesandother.Astaffnursefocusgroupidentifiedanddis-cussed issuessurroundingCTinpatients.Themesfromthesekeystakeholders mirrored and enhanced those previously identified.Staffenthusiasmfortheprojecthasresultedintheircontinuedpar-ticipation.Teammembershaveassumedresponsibilityforfollow-upactions;theteammeetsmonthlytoreportonprogressandplannextsteps.

The evaluation process includes (a) number of outputs, i.e. newpolicies,integrationofcancerresearchandCTcontentintoeduca-tionalofferings,andrevisedclinicalladderelements;(b)outcomessuchascompletenessofdatarecordedonresourcedocuments,main-tenanceofprotocolintegrity,andincreasedknowledgeofresearchpractice.

NursesareeducatedasclinicalpractitionersandmaynotbeawareofthechallengesassociatedwithCTpatients.Buildingsystemsthatfocusesonfactorsthatintegrateclinicalandresearchcareisanop-portunitytoenhanceprofessionaldevelopmentofoncologynursesandtoimprovethequalityofcareforCTpatients.

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2446ADAPTATION THEORY AND SYMPTOMS OF POST-TRAUMATICSTRESS DISORDER IN CANCER PAIN PATIENTS. Linda Huebert,RN,BSN,OCN®,RoswellParkCancerInstitute,Buffalo,NY;StephenSchwabish,PhD,FieldingGraduateUniversity,SantaBarbara,CA;andMichaelZevon,PhD,andOscardeLeon-Casasola,MD,RoswellParkCancerInstitute,Buffalo,NY.

Previous studies examining oncology patients experiencing painhavereportedanincreaseinpost-traumaticstressdisorder;howeverthemethodologyandlevelofreportedpost-traumaticstressdisorder(PTSD)hasbeenvariable.TheextenttowhichPTSDexistsinthecancerpainpopulationalsoremainsunclear.Inaddition,thepoten-tialmoderatingimpactofcognitiveadaptationbeliefsontheseverityofPTSDwarrantsexploration.

Toempiricallyexplorerelationshipsbetweencomponentsofcog-nitiveadaptation theoryand thedevelopmentofPTSD inpatientsreceivingtreatmentforcancer-relatedpain.

Cognitiveadaptation theoryhasbeenshown inprior research toberelated tostressmanagement ina rangeofpatientpopulations.ThehypothesisisthatPTSDsymptomswillbeminimizedinpainpatientswhoemploy theoptimism,mastery, and self-esteemcog-nitiveadaptationresponses.Conversely,lessuseofthesecognitiveresponses is hypothesized to be related to higher levels of PTSDseverity.

Anempiricalevaluationoftherelationshipofcognitiveadaptationtheorycomponents–optimism,mastery,andself-esteemcognitions–toPTSDsymptomsincancerpainpatientswasconducted.

A self report questionnaire based methodology was used. Cor-relational analyses will examine the strength and direction of therelationshipsbetweenoptimism,masteryandself-esteemandPTSDseverity.Thepilot sampleexaminedhereinconsistsof25patients(18+years)currentlyreceivingtreatmentinthePainClinic.Patientswereevaluatedwithwellvalidatedconstructmeasures.MeasuresofcognitiveadaptationtheoryincludeLifeOrientationTest,theRosen-bergSelf-EsteemScale,andtheMasteryScale.ThisstudywillusethePTSDChecklist–Civilian,awidelyused,welldevelopedmea-sureofpost-traumaticstress.Descriptivestatisticswillbecomputedforthedependentvariablesandsubjectdemographics.

Support for thehypothesized impact of cognitive adaptationbe-liefswillprovidevaluableinformationrelevanttothedevelopmentofinterventionswiththiscriticalpopulation.Theseinterventionscanbeintegratedintoongoingnursingcareforthischallengingpopula-tion.

2448QUALITYOFLIFEINPATIENTSWITHPROSTATECANCER:ACLINI-CIANDRIVENSTUDY.MelissaKratz,RN,MSN,AOCN®,AndreaGe-shan,RN,MSW,andSharonKimmel,PhD,LehighValleyHospitalandHealthNetwork,Allentown,PA.

Mendiagnosedwithprostatecancer(PC)faceauniquechallengein choosing a curative therapy that may significantly affect posttreatment quality of life (PT-QOL).There are limited studies thatexaminePT-QOLcomparedbyPCtherapy:radicalprostatectomy,externalbeamradiationtherapy(EBRT)andbrachytherapy.Ascli-nicianswhocoordinatemultidisciplinarysecond-opinionconsulta-tions,weguidepatientsintheirdecision-makingprocess.

Studypurposeistoidentifyandbetterunderstandthepatients’PT-QOLexperienceacrossvariouscurativetherapies.Studyisdonein2 phases: phase 1 investigates prevalence and PT-QOL indicatorsof patients presenting with localized PC to this institution. Phase2includesafunctionalassessmentofthepatient’sexperiencedPT-QOLissues.

The patient participation in decision making model was uti-lized.

AfunctionalassessmentofcancertherapyandPT-QOLquestion-nairewillbedistributedinPhaseII.Purposeofthequestionnaireisto better understand thepatients’ experiences.Questionnaireswillbeemployedandmaybemodifiedbasedonissuesidentifiedfromafocusgroupofprostatecancersurvivors.

PhaseI:552menweretreatedduring2004-2005.Meanage68±9years,92%white,84%married.84%(462)werediagnosedStage2,8%(43)Stage3,7%(41)Stage4and1%(6)stageunknown.Total-follow-upmonths7916(mean14.6±8.8).95%(524)aliveat lastcontact. Treatment breakdown: 49% (270/552) underwent radia-tiontreatment(RT);70%(189/270)EBRT,28%(75/270)Brachy-therapy.42%(232/552)underwentsurgery.RTpatientswereolder(70.5±8years)thanSurgical(65±9).(p<0.001)Therewasnosta-tisticallysignificantdifferenceinGleasonscoringbetweenthetwogroups.

Itisanticipatedtheoutcomeofthisstudywillbeusedtodevelopinterventionsdesignedtoguidepatientsintheircurative-therapyde-cisionmaking-processandbetterpreparepatientstoanticipateandmanagerealandperceivedPT-QOLissues.

2457TAKING RADIATION ONCOLOGY PATIENT EDUCATION TO THENEXTLEVEL:THEUSEOFTHECULTURALCAREMODEL.MaryannDzibela,RNC,MSN,OCN®,CCRP,MedImmuneOncology,Gaithers-burg,MD.

Patients and families manage and cope best when they have agood support system and good relationships with their caregiv-ers.Theprimaryroleoftheradiationoncologynurseistoprovideeducationinanoutpatientsetting.Thiseducationalprojectenabledthe staff to use an innovative approach to cancer education.TheSunriseModel,usedtodepictthetheoryofculturecare,diversity,anduniversality,empoweredthenurseswithauniqueframeworkandrichperspectivetodeliveranalternatesupportsystemforin-dividualizedcare.

Thepurposeof thisposter is to illustrate, asanexemplar (a)anoutlineofDr.MadelineLeininger’sSunriseModel(b)applicationofthemodelforit’suseinoncologyeducationand(c)theintegrationofaculturecareeducationprogramfortheoncologyteam.

Severalkeystrategieswereimplementedbyusingthetheoreticalframework of nursing by Dr. Madeleine Leininger: “The TheoryofCultureCare,DiversityandUniversality.”Radiationnursesandtherapistswereeducatedweeklyfor6weeks.Examplesofculturalgroups,values,patternsandhealthbeliefswerepresentedandwerefollowedbyopendiscussions.ATransculturalManualwaspresent-ed and on hand in the department to assist in delivering effectivenursingcare.

Improvementineducatingpatientsintheradiationdepartmentisnecessary for successful delivery of care to the culturally diversepopulation.Thegoalofthisprojectwasmetbyelevatingthelevelofdeliveryofculturallysensitiveclientcarebyusing“TheTheoryofCultureCare,DiversityandUniversality.”Thestafflearnedtoiden-tify,describe,andexaminethistheoryandusethisnewknowledgeto better understand health care practices within various culturalgroups.

Thenewmodelofcarepresented to theeducators ina radiationoncologypracticenot only increased awareness; it helpednurtureapositive,supportiveandcaringrelationshipbetweenthestaffandtheirpatients,families,andcommunity.Futurestudiesareimpera-tiveusingthismodelofcare.Culturecareknowledgeisessentialinguidingthenurseeducator.

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2458IMPLEMENTING EVIDENCE-BASED PRACTICE WITH LEADERSHIPDEVELOPMENT INSTITUTE PROJECT PLAN. Cynthia Idell, RN, BA,MSN,AOCN®,andMarciaGrant,RN,DNSC,FAAN,CityofHopeNa-tionalMedicalCenter,Duarte,CA.

Althoughevidence-basedpractice(EBP)isafocusoftheOncologyNursingSociety(ONS),staffadaptationofEBPremainschalleng-ing.Arecentstaffnursesurveyindicated29%havenoexperiencewithEBPwhile47%areconsidered“beginners”.Knowledgegapsoccur despite multi-year efforts aimed at translating research intopracticeusingcasestudies/EBPreview.Barriersincludetimecon-straints, knowledgedeficits, and resource access.EBP is essentialfor organizational strategicgoals, e.g. sharedgovernance councilsandidentificationofnurse-sensitivepatientoutcomes.Anorganiza-tionalapproachtopromotestaffutilizationofEBPisdesirable.

ThroughparticipationintheONSLeadershipDevelopmentInsti-tute,anadvancedpracticenursedesignedaprojectplancontaininga tiered strategy to institutionalize EBP practice.The first tier pi-lotedanEBPcurriculumtotrainstaffRNstoidentifynurse-sensitivepatientoutcomes, toreviewclinicalpracticeguidelines,and to in-corporateguidelineconceptsintodailypracticethroughbycreatingspecificactionplans.ThetargetaudiencewasnurseswhowishedtobecomeconsciousconsumersofEBP.Inthesecondtier,EBPcham-pions moved on to populate shared governance clinical practice,quality,andresearchcouncils.

A project team created EBP curriculum to build staff skill-sets.Internalandexternalassessmentswereperformed,includingdriving/ restraining forces.Thecoursecontainedaction-oriented, interac-tiveactivitytopromoteclinicianuseofEBP.Approachesincluded:expertEBPfaculty lectures,smallgroupwork,computer training,casestudiesandclinicalpracticeguidelineapplication.Projectplansweregenerated;follow-upoccurredat3and6monthintervals.Ad-ditionalfundingforEBPchampiontrainingwasrealizedthroughanUni-Healthgrant.

Projectgoalswereevaluatedvia:1)Pre-posttestEBPknowledgesurveys;2)Councilparticipation;3)Evaluationofprojectplanout-comesbyfaculty;and4)Performanceimprovementtrendsofnurse-sensitiveoutcomes,e.g.pain/fatiguemanagement.

Evidence-basedpracticeisagrowingfield,yetnursesfacebarriersinadaptationofbestpractices.Forexample,symptommanagementfallswithintheRNscopeofpracticeandoutcomesarenursingsen-sitive.AninteractiveEBPcurriculumdesignedtominimizebarriersandtoincreasestaffawareness,whencombinedwithlong-termfol-low-upof individualprojectplans,maybeused to institutionalizeEBP.2459ADDRESSINGTHEINVISIBILITYOFNURSING:IMPLICATIONSFROMANANALYSISOFNCI-DESIGNATEDCOMPREHENSIVECANCERCEN-TER WEBSITES. Deborah Boyle, RN, MSN, AOCN®, FAAN, BannerGoodSamaritanMedicalCenter,Phoenix,AZ.

Conventionalwisdomupholdsthat‘thereasonfortheexistenceofthemodernhospitalistoprovidenursingcare’andthat‘physiciansareanepisodicpresenceinthelivesofpatientswhilenursescontroltheenvironmentofhealing.’Yetinpublicandprofessionalcommu-nicationvenues,detailsconcerningmedicalexpertisepredominatewhile corollaries of nursing competency remain inabsentia. Is thespecialtyofcancernursinginvisible?

Thisproject’sgoalwastoevaluatethedegreeofnursingpresenceinthe39ComprehensiveCancerCenter(CCC)websites.

EachwebsitewasaccessedfromNCIhomepagelinkages.Intheabsenceofnursing recognitionon theCCChomepage, at least5

linkswerebroachedtopursuecitationsaboutnursingpractice.The‘Search’optionwasalsoutilizedwiththeterm‘Nursing’.Eachsitewasevaluatedforthepresenceofthefollowingdata:citationoftheCNOinleadershipdirectories,listingofnursingpersonnelandre-sourceswithinphonelistings,mentionofnurseswithin interdisci-plinaryteams,integrationofnurseinvestigatorsinresearchrosters,inventoriesofnursingeducationprograms,andintegrationofnurse-specificinnovationsinannualreportsandmediaselections.

Resultsrevealedapaucityofinformationdescribingthescope,na-tureandcompetenciesofcancernursinginthe39CCCs.NoCCClistednursingonitshomepageandonlytwoidentifiedtheCNOintheirleadershipdirectory.Fourteenofthe39siteshadnolistingofnursing anywhere in itswebsite.Despite the fact that cancer carecouldnotexistwithoutexperienced,knowledgeable,empathicandproficientoncologynurses,theircontributionswereonlymarginallyrecognizedinthetargetedformalcommunicationvenueofanalysis.

A proposal for changing this current reality will be delineated.Theserecommendationshaveimplicationsforthe39CCCs,the20NCI-designated Cancer Centers, and community cancer programsnationwide.For thosewhopractice inaclinical researchenviron-ment,oncologynursingskillsaremanifestedinoversightofnoveltherapies, intensive and ongoing supportive care of patients andfamilies, effective interdisciplinary communication, and continuedhigh-levelcriticalthinking.Aconcertedefforttomarketcancernurs-ingisrequiredtochangethiscurrentparadigmthatfostersnursinginvisibility.2461“DID SOMEONE TELL YOU ABOUT MEDICATION SIDE EFFECTS TOWATCHFORWHENYOUWENTHOME?”ValsammaVarghese,RN,andHyacinthGordon,RN,MSN,OCN®,CRRN,MDACC,Houston,TX.

AstudybyClarke,etal revealed thatup to50%ofhospitalizedpatientsperceivedthattheyhadnotreceivedinformationaboutthesideeffectsoftheirmedications.Teachingpatientsabouttheirmedi-cations is one of the primary education responsibilities of nurses.Tomakeinformeddecisionsaboutmedications,patientsneedtobeeducatedaboutpotentialsideeffects.Additionally,knowledgeaboutmedicationsideeffectsallowspatients to report tocaregivers inatimelymannersodecisionscanbemadeabouteffectiveness.

Althoughpatientinstructionsforhomemedicationsareprovidedpriortodischarge,inarecentsurveyconductedbytheNRC+PickerInstituteatalargecomprehensivecancercenter,50%ofpatientsonasurgicaloncologyurologyandorthopedicunitreportedtheywerenottoldaboutmedicationsideeffectstowatchforwhentheyweredischarged.

A quality improvement project was implemented to ensure thatnurses provided information to patients about side effects of theirmedications.Agoalwasestablishedtolowersurveyscoresto0%ontheNRC+Pickersurvey(lowerscorereflectsbestpractice).Strategiesincludedparticipationbytheentireteamofnursesandpartnershipswithnursesandpatients/familytoensurethepatientisprovidedwithandcanrecallthemedicationinstructionsprovided.“AskYourNurse”postersweredesignedandplacedinpatients’roomsasaremindertoseekinformationaboutthesideeffectsofmedicationsreceived.

NRC+ Picker and unit follow-up survey scores one month afterimplementationofstrategiesrevealedthat100%ofpatientsreportedthattheyweretoldaboutthesideeffectsmedications.Anincreaseinthenursingdocumentationaboutpatients’reportsofsideeffectswasnoted.

Patientsshouldbeeducatedaboutthesideeffectsofmedicationssothattheycanreporttocaregiversinatimelymannerandappropri-atetreatmentoptionscanbeexplored.Nursesareinauniqueposi-

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tiontocommunicatemedicationsideeffectinformationtopatients.Implementation of a quality improvement project to promote theeducationofpatientsaboutthesideeffectsoftheirmedicationscanimprovepatientcareoutcomes.

2464DEVELOPMENTOFAPLANFORTHEEARLYDETECTIONANDINTER-VENTIONFORDELIRIUMINPATIENTSWITHCANCER.KimSlusser,RN,BSN,CHPN,LesleyTokarzVancura,RN,MS,CNP,andBarbaraHolmes Gobel, RN, MS, AOCN®, Northwestern Memorial Hospital,Chicago,IL.

Duringafallsqualityimprovementproject,itwasnotedthat35%ofpatientsadmitted to theoncologyunitswhofellhaddevelopedmentalstatuschangesduringtheiradmission.Deliriumwasalsore-portedinpatientsanecdotallybynurses.

An Evidence Based Practice (EBP) journal club was formed todevelopaplanforearlydetectionofdeliriumandidentificationofevidencebasednursinginterventionstopreventorminimizetheex-perienceandnegativeoutcomesofdelirium.

Thejournalclubconsistingofoncologynursesmeteverythreeweeks to review the literature. The initial screening tool deter-minedtobeusefulintheassessmentoftheoncologypatientwastheportableminimentalstatusexam.Itwasdecidedthiswouldbeanexcellentscreeningtoolforadmissiontodetermineifthepatienthas any underlying cognitive disorders such as dementia. Then,multipledeliriumassessmentscaleswerereviewedanddiscussedforreliability,validity,andapplicabilityfortheoncologypopula-tion. The instrument also had to be short and easy for the staffnurse to utilize, ensuring compliance and accurate findings.TheConfusionAssessment (CAM) instrumentwaschosen. Itmet allthecriteriaandhadestablishedusewithoncologypatients.Reviewoftheliteratureonnursinginterventionsfordeliriumyieldedverylittleresearchdata.Expertopinionandpublishedpracticeguide-lineswereusedasthebasisfordevelopingguidelinesfordeliriuminterventions.

Oncology nurses were educated on the importance of assessingformentalstatuschangesandappropriateinterventionsfortheon-cologypatientexperiencingdelirium.Deliriumassessmentandin-terventionswereadded to theannualRNcompetency training foroncology.

As a result of the journal club findings and recommendations,changeinpracticeisbeingpursuedwhichincludestheportableminimentalstatusexamonadmission,CAMassessmentsevery12hours,andtheimplementationofdeliriuminterventionsbasedontheCAMresults.Thismodelisinitsfinalstagesofapprovalwiththeantici-patedimplementationtooccurbywinterof2007.Onceapproved,theuseoftheassessmenttoolsandimplementationofinterventionswillbeauditedforcomplianceandfor impactonpatient’smentalstatus.

2469CREATIVEMETHODTOSUPPORTMULTIDISCIPLINARYEVIDENCE-BASED PRACTICE IN ONCOLOGY. Anne Delengowski, RN, MSN,AOCN®,ThomasJeffersonUniversityHospital,Philadelphia,PA.

Evidence-basedpractice is thecoreofclinicalpractice inoncol-ogytoday.Developingandcoordinatingthesepracticesacrossdis-ciplinesinanylargeorganizationisasignificanttask.Theneedtoassurethecontinuityofthesepracticestothecareoftheoncologypatient is critical. In an attempt to drive evidence based practiceacrosstheoncologyservices,includingBMTinalargeurbanhos-pital,theoncologynursesinitiatedandcoordinatedthedevelopmentofamultidisciplinarygroupofprofessionalswiththeongoingtask

ofidentifying,developingandimplementingstandardsofcarebasedoninterdisciplinaryevidence.

The group began by identifying the most critical standard thatcrossed units and disciplines. It identified neutropenic fever as astandard.Thegroupconsistedofalldisciplinesinvolvedinthecareofthecomplicatedpopulation,includingnursesfrominpatientandoutpatientareas,physiciansfromhematology/oncology,EDandin-fections disease. Pharmacist, nutritionist and representatives fromthefacultyoftheschoolofnursingwereincluded.

Inordertoaccomplishthepurposeofdevelopinginterdisciplin-ary evidence-based standards, the group needed to question as-sumptionsaboutpresentpracticesacrossalldisciplines.Thegroupwaschallengedtopullliteraturefromallthedifferentspecialties.Allgroupmembers’opinionswerevaluedwhensupportedbybestevidence.Uponcompletionandagreementbythecommitteeofthestandard, itwas then sent to thevarioushospital committees forfinalapproval.

Thegrouphascontinuedtodevelopstandardsthatarehighrisk/high volume issues that cross disciplines. Tumor Lysis syndromeandhypercalcemiawerethenextprojectsaddressedbythegroup.

Inadditiontotheclinicalvalueofthemultidisciplinaryevidencebasedpractice,theunifyingexperiencewithinthegrouphasbuiltmutualrespectforthemembers,includingthevalueoftheopinionofeachdiscipline.Atthebeginningoftheprocess,eachmemberbrought certain beliefs and ingrained practices, acknowledgingsubstantiation must be required to prove evidence based theory.Thegroupismovingforwardwithacommittedeffortanddedica-tiontoseekmorestandardizationinkeyareasofcare.Thefutureofclinicalcarerestsonthestrongfoundationoftheevidencewebuildtoday.2470YOUNG WOMEN’S EXPERIENCES WITH BREAST CANCER: AN IM-PERATIVEFORTAILOREDSERVICES.MargaretFitch,RN,PhD,To-rontoSunnybrookRegionalCancerCentre,Toronto,Canada.

Adiagnosisofbreastcancer isdifficult forawoman, regardlessofherage.Seventeenpercentofwomenarediagnosedwithbreastcancerundertheageof50andbreastcanceristheleadingcauseofdeathinwomenbetween35and50yearsinCanada.Thiscohortofwomenhasuniqueperspectivesabouttheirliferolesandresponsi-bilitiesthatcouldinfluencetheirexperiencesandneedsduringthediagnosisandtreatmentofbreastcancer.

The ultimate aim of this qualitative investigation was to betterunderstandhowtotailorinformationandsupportinterventionsforyoungwomendiagnosedwithbreast cancer.The specificpurposewastoexploretheperspectivesandexperiencesofwomen45yearsorlessatthetimeoftheirbreastcancerdiagnosis.

Thesupportivecareframeworkguidedthiswork.Twenty-eightwomenunderwentin-depthinterviewsregardingthe

eventssurroundingtheirdiagnosisandtreatmentforbreastcancer,theirresponsestothoseevents,thechallengestheyexperienced,andhowtheymanagedwiththosechallenges.Analysiswasguidedbyaphenomenologicframing.

The interviews were profound and full of passion. Repeatedly,these young women described an intense desire to live and to beabletofulfillroles,responsibilities,andcommitmentsthatwereofimportancetothem.Threeoverarchingthemeswererevealed:every-thingdependsonactingnow;everythingis“outofsync”;and,can-cerinvadedmywholelife.Manyofthesewomencouldnotfindap-propriateservicesorinformationfortheiragegroup.Theinterviewsprovided rich data about the views of young women coping withthecancerexperienceandcreateanimperativefor tailoringfuture

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services more appropriately. Particularly, those designing servicesandprogramsneedtothinkaboutchildcare,thetimeofdaywhenprogramsareoffered,anduseof technologyfor thisagegroupofbreastcancersurvivors.Specificinformationneedstobeavailableaboutfertility,bodyimage,andsexuality.

2473PATIENT-INITIATED STRATEGIES FOR LIVING WITH COGNITIVECHANGES:IMPLICATIONSFORCANCERNURSES.MargaretFitch,RN,PhD,TorontoSunnybrookRegionalCancerCentre,Toronto,Canada.

Cancerpatientshavereportedexperiencingcognitivechangesdur-ing,andfollowing,theircancertreatment.Althoughefforthasbeenmade tomeasurecognitivechangesand identify thosewhomightbenefitfromintervention,relativelylittleefforthasbeenfocusedonpatient solutions for copingwith the cognitive changes.For thosewhoexperiencewhatsurvivorsrefertoas“chemobrain”or“chemofog”, the impact can be profound.A better understanding of howindividuals experience the impact and the strategies they use tocope with the changes could be used to inform patient educationprograms.

Thisqualitativeinvestigationwasundertakento increaseourun-derstandingabouttheinterventionspatientsusetocombatcognitivechangesassociatedwithcancertreatment.

In-depthinterviewsexploreddescriptionsof1)cognitivechangesexperiencedbypatients,2) the impactof thechangeson the indi-viduals,3)thestrategiespatientsinitiatedtodealwiththechanges,and4)whichstrategiestheyfoundhelpful.Apurposivesampleof34 patients (various cancer sites) and 15 family members partici-pated.Aphenomenologicframingwasusedtoanalyzetheinterviewtranscripts.

Patientparticipantsexperiencedvariouscognitivechangesinclud-ingtheinabilitytoconcentrate,rememberdetailsorperformsimplecalculations. Many perceived that the changes as temporary andwereexpectingtoreturntopretreatmentstatus.Dependingontheirworkdemands,or leisureactivities, theactual impactandconcernaboutanychangesvaried.Someparticipantsclearlyfounditwasadailychallengetomanage.Strategiespatientsusedmostfrequentlyincludedwritingnotes,makinglists,usingspecialreminders,andus-inggamestostimulatetheirmentalfunction.Manyenlistedhelpoffamilymembersandmadeuseofhumor.Allparticipantsdiscussedtheimportanceofbeingtoldprior totreatmentabout thepotentialtoexperiencecognitivechangesandhowtoassesswhethertheyarehappening. They also wanted to learn strategies for dealing with

themfromcancernursesandothersurvivors,notbelefttodiscoverstrategiesthemselvesonatrialanderrorbasis.Forthosewhoexperi-encecognitivechanges,theimpactcanbeprofound.2474USINGRESEARCHKNOWLEDGEEMBEDDED INPOLICYREPORTSTO CREATE QUALITY WORKPLACES FOR CANCER NURSES: LES-SONSINKNOWLEDGEEXCHANGE.MargaretFitch,RN,PhD,TorontoSunnybrookRegionalCancerCentre,Toronto,Canada.

Improving the working lives of cancer nurses is a key factor inaddressingtheshortageofcancernurses.SignificantefforthasbeendevotedinCanadatosummarizingcurrentresearchknowledgeabouthowtocreatequalityworkenvironmentsfornursesandproducingpolicyreportsfordisseminationofthatknowledge.Itisanticipatedthesereportswillpromoteknowledgeuptakeandutilizationinprac-ticearenas.

Thisstudywasundertakentodeterminetheawarenessanduseofpolicyreportsincancersettings.Additionally,theinvestigationwasdesignedtoidentifyqualityworkplaceinitiativesthathadbeenun-dertakenandfactorsthatinfluencedtheirsuccess.

TheworkwasguidedbyLomas’sconceptualframeworkonknowl-edgetransfer.

In-depth interviewswereconductedwithseniordecisionmakers(n=124) incancerorganizationsacross thecountry, changecham-pions(n=19),middlemanagers(n=14)andstaffnurses(n=5)aboutexperienceswithqualityworkplace initiatives.The initialfindingswerepresentedtoabroadrangeofstakeholders(4sessions,120par-ticipants)andfocusgroups(7sessions,33participants)fordebateandfurtherpolicyandresearchrecommendationdevelopment.

The awareness of the policy reports was lower than expected(14%-60%)anduseof the report informationwasprimarily sym-bolic.However,manyqualityworkplacechangeinitiativeshadbeenundertakenbythecancerorganizations.Theinitiativesoftenfocusedon the topicareas in thepolicy reports,but few individuals couldidentifyaspecificreportasthebasisfortheirownqualityworkplaceinitiative.The findings raise serious concerns about how researchfindings about quality work environments are disseminated effec-tively.Theadviceofferedbytheparticipantsregardingfuturework-place initiatives revolvedaround theneed formeaningful involve-mentofstaffmembers,thevalueofrelationshipsandcollaboration,accountability for knowledge utilization, being committed to thechange,capacity tosustain thechange,andclarityaboutexpectedoutcomesforthechangeinitiative.

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