Volume 21, Issue 2, Spring 2011

Oncology nurses’ perceptions of their relations with family members in an ambulatory cancer care setting: A mixed methods study

CONJ, 21(2), 64-71.
by Michelle Lobchuk, RN, PhD, and Sonia Udod, RN, MN, PhD(c)

Abstract: Trends signal an increasing prevalence of people living through and beyond a cancer diagnosis with an enhanced reliance on ambulatory cancer care services and family caregiving. Despite this trend, there has been limited focus on nurses’ experiences with providing support to families who care for patients in the community. For oncology nurses in ambulatory care settings, job satisfaction has decreased significantly as they are concerned with their ability to consistently provide safe and quality care to patients and their family. Although other studies indicated that the lack of time and limited resources are regrettably accepted aspects of nurses’ work environments, our mixed methods small-scale study addressed how work environments still can meet the growing need for enhanced support and relations among nurses, patients, and families in ambulatory cancer care.

About the authors: Michelle Lobchuk, RN, PhD, Associate Professor, Faculty of Nursing, University of Manitoba, Faculty of Nursing; Sonia Udod, RN, MN, PhD(c), University of Saskatchewan, College of Nursing.

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Courage, collaboration, complexity and chemotherapy safety: The view from the sharp end

CONJ, 21(2), 81-85.
by Esther Green, BScN, MSc(T), Rachel White, MA, Karen Janes, BScN, MScN, Anthony Fields, MA, MD, LMCC, RCPSC, and Anthony Easty, PhD, PEng, CCE

Abstract: The Canadian oncology community was devastated by the news in August 2006 that a patient had died from an overdose of fluorouracil. Where we once thought our checks and balances ensured patient safety, we now knew they were not enough. Practice immediately began to change around the country. However, the incident report highlighted that there was much we still didn’t know about safety issues in intravenous ambulatory chemotherapy safety in Canada. In response, an inter-disciplinary, pan-Canadian team launched an 18-month exploratory study, resulting in a report identifying several safety issues and associated recommendations. This paper summarizes the key insights we have gathered for Canadian oncology nurses in being part of this study: that we need courage to come forward and disclose safety concerns; we should collaborate to come up with safety improvements that work for everyone; and we should strive to simplify our work at the sharp end by reducing complexity upstream and throughout the system.

About the authors: Esther Green, BScN, MSc(T), Provincial Head Nursing and Psychosocial Oncology, Cancer Care Ontario; Rachel White, MA, Health Technology Safety Research Team, University Health Network, Toronto, ON; Karen Janes, BScN, MScN, Nursing Practice Leader at the BC Cancer Agency; Anthony Fields, MA, MD, LMCC, RCPSC, Vice President, Cancer Corridor, Alberta Health Services and Professor of Oncology at the University of Alberta; Anthony Easty, PhD, PEng, CCE, Health Technology Safety Research Team, University Health Network, Institute of Biomaterials and Biomedical Engineering, University of Toronto.

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An exploration of the experience of compassion fatigue in clinical oncology nurses

CONJ, 21(2), 91-97.
by Beth Perry, RN, PhD, Greg Toffner, BSc, MRT(R), RTR, MHS (candidate), Trish Merrick, RN, BScN, and Janice Dalton, RD, MHS

Abstract: Compassion fatigue (CF) is “debilitating weariness brought about by repetitive, empathic responses to the pain and suffering of others” (LaRowe, 2005, p. 21). The work performed by oncology nurses, and the experiences of the people they care for, place oncology nurses at high risk for CF (Pierce et al., 2007; Ferrell & Coyle, 2008). Thus oncology nurses were chosen as the study focus. This paper details a descriptive exploratory qualitative research study that investigated the experience of CF in Canadian clinical oncology registered nurses (RNs). A conceptual stress process model by Aneshensel, Pearlin, Mullan, Zarit, and Whitlatch (1995) that considers caregivers’ stress in four domains provided the study framework (see Figure 1). Nineteen study participants were recruited through an advertisement in the Canadian Oncology Nursing Journal (CONJ). The advertisement directed potential participants to a university-based online website developed for this study. Participants completed a questionnaire and wrote a narrative describing an experience with CF and submitted these through the secure research website. Data were analyzed thematically. Five themes include: defining CF, causes of CF, factors that worsen CF, factors that lessen CF, and outcomes of CF. Participants had limited knowledge about CF, about lack of external support, and that insufficient time to provide high quality, care may precipitate CF. The gap between quality of care nurses wanted to provide and what they were able to do, compounded by coexisting physical and emotional stress, worsened CF. CF was lessened by colleague support, work-life balance, connecting with others, acknowledgement, and maturity and experience. Outcomes of CF included profound fatigue of mind and body, negative effects on personal relationships, and considering leaving the specialty. Recommendations that may enhance oncology nurse well-being are provided.

About the authors: Beth Perry, RN, PhD, Associate Professor, Centre for Nursing and Health Studies, Athabasca University.

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Gaining a better understanding of the support function of oncology nurse navigators from their own perspective and that of people living with cancer: Part 2

CONJ, 21(2), 114-121.
by Johanne Hébert and Lise Fillion

Abstract: Individuals living with cancer have a wide range of needs throughout the disease trajectory. To better meet them, the PQLC [French acronym of the Quebec Cancer Control Program] implemented the oncology nurse navigator (ONN) role. A first article presented the nature of the needs of individuals living with cancer and of the support provided by ONNs. This second article aims at gaining a better understanding of the ONN support function from the ONNs’ own perspective and to complete an exploratory description of their support interventions for individuals living with cancer and their loved ones throughout the care trajectory. The sample includes ten ONNs.
They reported doing support interventions for all the various types of needs, especially in the informational (44%) and practical areas such as coordinating appointments for exams, practitioners and various services (35%). The results also suggest that a needs assessment is a prerequisite to intervention. Lastly, all participants underscored the importance of the helping relation and trusting relationship to clarify their support function. These results are consistent with the findings of several recent articles on the psychosocial role of oncology nurses.

About the authors: Johanne Hébert, RN, MSc, PhD-in-Nursing Student, Université Laval, Coordinator, URSI [Nursing Research Unit], CHUQ [Quebec City University Hospital Centre], Quebec City, QC;
Lise Fillion, RN, PhD (Psychology), Professor, Nursing Science Faculty, Université Laval, CRC [Cancer Research Centre], Université Laval, Hôtel-Dieu de Québec [Quebec City Hotel-Dieu].

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